Uterine fibroids are non-cancerous tumors that grow on the inside or outside surface of the uterus. Some fibroids are entirely contained within the muscular walls of the uterus, and others protrude out from the uterine wall. Another type of fibroid, called a pedunculated fibroid, grows on a stalk-like structure attached to the surface of the uterus.
Fibroids are thought to develop as the result of dysfunction in a gene that regulates the growth of uterine cells. When the gene is dysfunctional, cells begin to divide more quickly, resulting in the formation of a benign tumor. Certain risk factors are believed to increase the likelihood that a woman will develop one or more fibroids. These risk factors include the use of contraceptive medication in the early teens and a high consumption of red meat. Women of African descent also have an increased risk of fibroids.
Most fibroids are small and asymptomatic. For some women, however, fibroids can cause significant pain and discomfort. Possible symptoms of fibroids include abnormal menstrual bleeding, severe uterine cramping and digestive problems. Some women have fertility problems, and women who are pregnant have an increased risk of complications such as abruptio placentae, in which the placenta separates from the wall of the uterus. A pedunculated fibroid has similar risk factors and can cause greater pain than fibroids of other types. This is because extreme pain can result if the stalk of a pedunculated fibroid becomes twisted.
Because most fibroid tumors are asymptomatic, fibroids generally are diagnosed during routine gynecological examinations. When fibroids are asymptomatic, treatment often is unnecessary, but the woman’s doctor might monitor the tumor at regular intervals. Because of the structure of the tumor, a pedunculated fibroid is more likely to produce symptoms, and diagnosis is therefore often made on the basis of symptoms, followed by an ultrasound to determine the location and size of the tumor.
Pedunculated fibroid treatment can be accomplished in one of three ways. Symptomatic treatment includes medications to control pain and heavy menstrual bleeding. For example, oral contraceptives might be recommended for women with uterine fibroids, because they can reduce the heaviness of menstrual bleeding. Some medications can temporarily shrink fibroids and reduce pain.
Because medication can provide only temporary symptomatic relief, women with painful pedunculated fibroids can opt for surgical fibroid removal or shrinkage. Fibroids can be permanently and completely removed only via surgery, but some women opt for a less-invasive procedure called uterine artery embolization. In this procedure, shrinkage of the fibroid is achieved by reducing its blood supply; the tumor is not completely removed, but shrinkage generally leads to improvement in symptoms. Neither surgery nor uterine artery embolization can prevent new fibroids from growing.