Uterine fibroids affect on average one in three women, according to Health Insurance. If this non-cancerous tumor goes unnoticed in most cases, its symptoms can be very disabling or even lead to hysterectomy.
What is a uterine fibroid?
A uterine fibroid is a so-called benign (therefore non-cancerous) tumor that appears in the muscle of the uterus. We also speak of fibromyoma or myoma of the uterus. It can grow on the wall of the uterus, grow outward or inward. Its size varies from less than a millimeter to the entire size of the uterus and it can weigh several hundred grams. A woman can have several fibroids at the same time or successively.
What causes uterine fibroids?
The exact reasons for the appearance of a fibroid are still unknown. Nevertheless, we know that they are hormone-dependent: their development is influenced by sex hormonesparticularly estrogens, female hormones,” explains Prof. Jean-Luc Brun, gynecologist at the Bordeaux University Hospital and vice-president of the French Society of Gynecopathology.
Who is affected by fibroids?
It is estimated that one in three women on average is affected by a fibroid. “It mainly concerns women between the ages of 30 and 50”, underlines Professor Brun. Some women are at higher risk of developing uterine fibroids. For genetic reasons, among women of Afro-Caribbean origin, one person in two is affected, and at a younger age than in the rest of the population, sometimes as early as adolescence. “In women of European descent, the fibroid is more frequently symptomatic after 40 years”, specifies the gynecologist.
Other factors, such as not blocking the cycle with a pill or not having had children, also play a role in the possible appearance of a fibroid. “Both of these situations are associated with relative hyperestrogenism. But both of these causes are minor compared to genetics,” he adds.
Uterine fibroids are the leading cause of hysterectomy (removal of the uterus) in France: “more than 65,000 cases per year according to the High Health Authority”, reports Angèle Mbarga, president of the association Fibroma Info France, who fights so that the uterine fibroid ” be recognized as a public health issue ».
What are the symptoms of a fibroid?
A fibroid may cause no symptoms and go unnoticed. This is also the case “for 80% of them”, specifies Prof. Brun. Many fibroids are only discovered when a woman has fertility problems, during exploratory examinations. However, when the symptoms are present, they can affect the quality of life of women, or even be very disabling.
The most common are:
- Very heavy periods (menorrhagia) and/or bleeding between periods (metrorrhagia). ” Bleeding is one of the most debilitating symptoms, explains Angèle Mbarga. For some women, these can last for weeks. And when we talk about heavy periods, it can be losses that require changing protection every thirty minutes, for example”.
- Intense pain in the lower abdomen
- A feeling of heaviness in the lower abdomen
- Urinary and digestive problems, in case of compression of the bladder or intestines by a fibroid
- constipation
- Pain during sex.
Ultrasound diagnosis
In the presence of one or more of these symptoms, it is recommended to consult a doctor. In addition to the symptoms, the diagnosis of the fibroid will be made with additional examinations such as an ultrasound. The president of Fibroma Info France regrets that the symptoms of fibroids are still too often considered trivial by doctors. “On average, among the women we follow, medical wandering before diagnosis is two years “, testifies Angèle Mbarga, who herself experienced this situation.
If left untreated, these symptoms can lead to complications:
- Severe anemia (iron deficiency), phlebitis, venous thrombosis or pulmonary embolism due to bleeding
- A risk of miscarriage or premature delivery when the fibroid is located inside the uterine cavity or deforms it
- Fertility problems. “Infertility is not caused by the fibroid itself but by the deformations of the fallopian tubes and the uterus that its growth causes”, specifies Professor Brun.
- Sudden and intense pain in the pelvic region during the necrosis of certain fibroids.
What are the treatments for fibroids?
There is no treatment to permanently remove fibroids.. Medication is used to reduce the most troublesome symptoms. If the woman does not experience any symptoms that affect her quality of life, the fibroid is not treated.
- Against heavy bleeding : progestogens by mouth or by the installation of a hormonal intrauterine device (nicknamed “IUD”) and drugs which act on blood coagulation.
- For pelvic pain: analgesics. If the symptoms of the fibroid are too severe, surgery can be considered.
- La myomectomie aims to remove the fibroid(s), while preserving the uterus. However, fibroids reappear in 20% of cases.
- Hysterectomy (removal of the uterus). “It must be considered in consultation with the patient, in women who have no or no longer plans to become pregnant, and who do not wish to keep their uterus”, underlines Professor Brun.
- Uterine artery embolization is an alternative to surgery, “still too little known to patients”, regrets Angèle Mbara. It is performed by an interventional radiologist, who injects microbeads into the vessels irrigating the fibroid. This decreases in volume gradually.
Where is the research on fibroids?
The research focuses more about fibroid treatments than its causes. “Today, we no longer have any medicine to reduce their size,” explains Professor Brun. Many have been withdrawn from the market due to their heavy side effects”. A new drug should be on the market within the next two years. It is an antagonist of GnRH (a hormone secreted by the brain which controls the production of estrogen). “Studies show that this treatment, administered orally, blocks the development of the fibroid, and can also reduce its volume”, underlines the gynecologist.
Professor Brun also mentions advances to intervene on fibroids without surgery, such as myolysis. “It is a destruction of the fibroid by diffuse ultrasound or by radiofrequency”. These techniques can melt minimally invasive fibroids. High-intensity ultrasound myolysis is notably offered at the Bordeaux University Hospital. But this act is not supported by Health Insurance, the High Authority for Health has still not validated it.
- Photo credit: Getty images
