# Uterine Fibroids: From Symptoms to Treatment
Most women have never heard of them – until they show up on an ultrasound. Uterine fibroids are among the most common benign tumors of the female reproductive system, yet they are discussed surprisingly little in everyday conversation. Perhaps it's because many women experience no symptoms at all, or because the topic of women's health is still surrounded by unnecessary embarrassment. Either way, it's worth knowing what exactly fibroids are, how they manifest, and in what situations it's important to take action.
Uterine fibroids, medically known as leiomyomas, are benign growths composed of smooth muscle and connective tissue that develop in or on the uterine wall. According to the American College of Obstetricians and Gynecologists (ACOG), up to 70–80% of women will develop them during their lifetime, with the highest incidence occurring between the ages of thirty and fifty. Interestingly, a large proportion of these women are completely unaware of their fibroids because they cause no symptoms whatsoever. For others, however, fibroids can present with a wide range of unpleasant symptoms that can significantly affect the quality of daily life.
To understand why fibroids develop, we need to look at the hormonal landscape of the female body. Estrogen and progesterone – two key hormones that regulate the menstrual cycle – play a crucial role in fibroid growth. Fibroids contain more estrogen and progesterone receptors than the surrounding uterine tissue, which is why they respond to these hormones more intensely. This explains why fibroids most commonly grow during the reproductive years, when levels of both hormones are at their highest, and why they often shrink or stop growing after menopause. In addition to hormonal factors, genetic predisposition also contributes to the development of fibroids. If a mother or sister had fibroids, the risk increases two- to threefold. Ethnic background also plays a role – studies published in the American Journal of Obstetrics and Gynecology have repeatedly confirmed that women of African descent develop fibroids more frequently, at a younger age, and with more pronounced symptoms.
There are also other factors that can influence the development and growth of fibroids. These include overweight and obesity, as adipose tissue produces estrogen, as well as vitamin D deficiency, a diet rich in red meat and alcohol, or conversely, low intake of fruits and vegetables. Some research suggests that chronic stress and lack of physical activity may also contribute to fibroid development, although the exact mechanisms are not yet fully understood. This is precisely why taking care of overall health and maintaining a balanced lifestyle is one of the pillars of prevention, even though it obviously cannot guarantee that fibroids will never appear.
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How to Recognize Fibroids and What Problems They Can Cause
The symptoms of fibroids depend on their size, number, and location within the uterus. Doctors distinguish three basic types: submucosal fibroids, which grow toward the uterine cavity, intramural fibroids located directly within the muscular wall of the uterus, and subserosal fibroids, which protrude toward the abdominal cavity. Submucosal fibroids, even though they tend to be smaller, often cause the most noticeable symptoms because they directly affect the uterine lining.
The most common symptom is heavy and prolonged menstrual bleeding. Women describe having to change pads or tampons every hour, bleeding lasting longer than seven days, or the appearance of large blood clots in menstrual blood. Such intense bleeding can eventually lead to iron-deficiency anemia, which manifests as fatigue, pallor, shortness of breath, and an overall decline in performance. And paradoxically, it is often chronic fatigue that ultimately brings a woman to the doctor – not the bleeding itself, which she has gradually "gotten used to."
Another common manifestation is pressure or pain in the lower abdomen and pelvis. Larger fibroids can press on surrounding organs – on the bladder, leading to frequent urination, or on the bowel, which can cause constipation. Some women experience pain during sexual intercourse, while others notice their waist circumference increasing without gaining weight. It is not uncommon for a woman with a large fibroid to look as though she is several months pregnant.
Consider, for example, Jana, a forty-year-old teacher who suffered from painful and heavy periods for years. She told herself it was simply her normal. But when constant fatigue began to plague her and colleagues noticed her pallor, she had herself examined. An ultrasound revealed several fibroids, the largest of which was six centimeters in diameter. Only then did she realize that what she had considered "her normal" was actually not normal at all. Stories like Jana's are incredibly common and show how important it is to listen to your body and not dismiss symptoms that gradually become part of your daily routine.
Fibroids can also complicate family planning. Submucosal fibroids can prevent embryo implantation or increase the risk of miscarriage. Larger fibroids can deform the uterine cavity, making pregnancy more difficult. However, this does not mean that a woman with fibroids cannot become pregnant – it depends on the specific situation, and consultation with a gynecologist or reproductive specialist is always advisable.
Diagnosing fibroids is fortunately fairly straightforward. The basic examination is a transvaginal ultrasound, which can reliably visualize fibroids and determine their size and position. In some cases, a doctor may recommend magnetic resonance imaging (MRI), which provides a more detailed picture, especially before a planned surgical procedure. It is important to know that the mere presence of fibroids does not necessarily mean that immediate intervention is required.
When and How to Treat Fibroids
The decision about treatment depends on several factors: the severity of symptoms, the size and growth of fibroids, the woman's age, and her reproductive plans. As the well-known rule of gynecological practice states: "We treat symptoms, not ultrasound findings." If a fibroid is not causing any problems and is not growing, regular monitoring is sufficient – usually through ultrasound check-ups once or twice a year.
However, when symptoms begin to affect quality of life, several treatment options come into play. Medication-based treatment includes hormonal preparations that can shrink fibroids or reduce bleeding. These include gonadotropin-releasing hormone analogs (GnRH agonists), which temporarily induce a menopause-like state, thereby lowering estrogen and progesterone levels. Newer treatments include selective progesterone receptor modulators, such as ulipristal acetate, which can shrink fibroids without the side effects typical of GnRH agonists. A hormonal intrauterine device with levonorgestrel effectively reduces menstrual bleeding, although it does not directly shrink fibroids.
For women who wish to preserve their uterus and are planning a pregnancy, a myomectomy may be appropriate – surgical removal of the fibroids themselves while preserving the uterus. Depending on the size and location of the fibroids, the procedure can be performed laparoscopically, hysteroscopically, or through a traditional open surgery. Myomectomy has very good outcomes, but it is important to be aware that fibroids can return – according to some studies, this happens in up to 30% of patients within five years.
Among modern minimally invasive methods is uterine artery embolization, in which an interventional radiologist blocks the blood vessels supplying the fibroids, causing them to shrink. This method is suitable for women who do not want to undergo surgery, but it is not recommended for women planning pregnancy, as its impact on fertility is not entirely clear. Another option is magnetic resonance-guided focused ultrasound (MRgFUS), which destroys fibroid tissue with heat without any incision.
In cases where fibroids are very large, numerous, or cause severe symptoms and the woman is no longer planning a pregnancy, the doctor may recommend a hysterectomy – removal of the entire uterus. While this is a definitive solution that eliminates any risk of fibroid recurrence, it is of course a major step that deserves careful consideration and an open conversation with the doctor about all alternatives.
As Professor Jacques Donnez, one of the world's leading experts on uterine fibroids, noted: "The treatment of fibroids should always be individualized – there is no universal solution that suits every woman." And it is precisely this individualization that is key. Every woman has different symptoms, different life circumstances, and different priorities, which is why the treatment plan should always be based on an open dialogue between the patient and her doctor.
In addition to conventional treatment, an increasing number of women are interested in how they can influence their condition through lifestyle changes. Research suggests that regular exercise, maintaining a healthy weight, adequate vitamin D intake, and a diet rich in fruits, vegetables, and whole grains may help slow fibroid growth. Conversely, excessive consumption of red meat, alcohol, and processed foods may promote fibroid growth. This is not a miracle cure, but a sensible complement that can contribute to overall well-being and better symptom management.
Mental well-being also plays an important role. Chronic pain, heavy bleeding, and fatigue can lead to anxiety, depression, and feelings of isolation. Women should not hesitate to seek psychological support or join support groups where they can share their experiences with other women in a similar situation. Open communication with a partner, family, and friends also helps reduce the emotional burden associated with this condition.
In conclusion, one essential point must be emphasized: regular gynecological check-ups are the best prevention of complications associated with fibroids. Early detection allows monitoring of their development and intervention at the right moment – before fibroids cause serious problems. No woman should consider heavy bleeding, chronic fatigue, or pressure in the lower abdomen as something she simply has to live with. Modern medicine offers a wide range of effective solutions – all it takes is knowing about them and not being afraid to ask.
