Fibroids Definition, Classification, Causes, Symptoms, Diagnosis and Treatments

OVERVIEW

What are Fibroids?

What is FibroidsFibroids are benign tumors (non-cancerous) that grow from muscle layers of the uterus. They can grow on the outside, inside or within the smooth muscle of the uterine wall. A single fibroid is called a uterine fibroma. However, the term fibroid is more common as most cases involve six to seven fibromas on average. The fibroid mass is primarily composed of smooth muscle and fibrous tissue, including extracellular matrix (i.e., collagen, fibronectin, proteoglycan). Fibroids often cause an enlargement of the uterus itself, due to the fibromas stretching the walls of the uterus to be as large as that of a pregnant female. A fibroma can vary in size from that of a small bean to as large as a melon. Other names include fibromyomas, fibromas, myofibromas or myomas.

Classification


There are 5 different classifications of fibroids intramural, subserosal, submucosal, intracavity and cervix fibroids

  • Intramural fibroids: These fibroids are located in the thick wall of the uterus (myometrium) and are the most common type of fibroids, but also the easiest to remove.
  • Subserosal fibroids: Located in the outer wall of the uterus, this type of fibroma can often grow to be the largest. One of two types of fibroids that can form a “stalk” on which the mass is attached termed pedunculated fibroids.
  • Submucosal fibroids: Fibroids located in the muscle beneath the lining of the uterine wall (endometrium). They also can form pedunculated fibroids.
  • Intracavity fibroids: This form of fibroids is located in the cavity of the uterus itself.
  • Cervical fibroids: These fibroids form in the cervix, the neck of the uterus.

Intramural fibroids ubserosal fibroids

Causes

There is no universal consensus on what precisely causes fibroids, but there are several theories. Most recently, it has been observed that women who develop fibroids often have high estrogen and progesterone levels, which occurs primarily during pregnancy. Moreover, when estrogen levels are low such as during menopause, fibroids tend to shrink whereas when estrogen levels are high, fibroids have been seen to swell. This theory is prime reasoning as to why it is common to see overweight women develop fibroids. A higher state of body fat means there is an excess conversion of the body’s sex steroids to the estrogen equivalent, estrone. Increased levels of estrogen and estrone are believed to play a key role in fibroid development and growth. The production of estrone is common in overweight patients because fat cells contain the key enzyme aromatase, which is responsible for this conversion. Other growth factors, such as insulin-like growth factor (IGF) have also been thought to play a role in fibroid development. Meanwhile, many others believe there is a significant genetic component to fibroids because it can be inherited from a mother or family member who has had the disease in the past.

Risk Factors

  • Fibroids affect at least 20% (1 in 5) women at some point during their life.

  • Fibroids happen to 1 in 100 premenopausal women, versus 1 in 1,000 women after menopause.

  • Fibroids are 9 times more likely in black females than white (although racial differences in socioeconomic status and access to healthcare is a probable contribution to this discrepancy).

  • Women between the ages of 30 to 50 years old are more likely to develop fibroids.

  • Being obese or overweight can increase a women's risk of developing fibroids

  • Genetics/Heredity have been shown to play a role in a woman's risk of developing fibroids.

Fibroids and Pregnancy

For the most part, fibroids do not usually affect pregnancy. Nevertheless, there are some instances in which fibroids can make conception difficult and can even lead to miscarriages. When fibroids physically distort the uterine cavity, several complications can arise, including infertility, recurrent miscarriages, premature labor or complications of labor. Thus in cases with large symptomatic fibroids, women may often choose to undergo imaging review of the uterus via hysteroscopy or hysterosalpingography.

Fibroids may also press against and block the entrance to the fallopian tubes preventing the egg from reaching the uterus. When fibroids block the birth canal, they can also interfere with labor and delivery, causing the need for a Caesarean section. Finally, fibroids can play a role in post-delivery recovery as they can increase heavy bleeding and the time it takes for a woman's womb to return to its normal shape and size.

It is also important to note that pregnancy itself can cause fibroids to develop, due to the elevated levels of progesterone and estrogen that occur when a woman is pregnant. However, there is little evidence to support this theory. Pregnancy has also been noted to cause “red degeneration.” This condition cuts off the fibroids’ blood supply causing the fibromas to turn red and die triggering intense abdominal pain and contractions of the womb that can lead to miscarriages.

This is an image of the uterine wall experiencing red degeneration.
This is an image of the uterine wall experiencing red degeneration.
The “reddening” fibromas can be easily seen here using Dr. Seckin’s patented Aqua Blue contrast.

Congruent Disorders

  • Benign fibromas (leiomyomas) can transform into leiomyosarcomas, malignant smooth muscle tumors of the uterus, in about 0.1% of fibroids cases. A pathological exam is the only way to observe this rare transformation.

  • Patients with fibroids often present with anemia.

Fibroids vs. Adenomyosis

There are many cases in which fibroids are misdiagnosed as adenomyosis, as well as the reverse. However, the main difference is that fibroids are more of a focal condition in which benign singular fibromas arise in several areas of the uterus, whereas adenomyosis is usually, for the most part, more diffuse. Even in cases of focal adenomyosis and adenomyoma adenomyosis, the diseased areas are more spread out and contain small pools of blood as opposed to the single, focal mass that is a fibroma. Adenomyosis is ultimately much more challenging and “messier” to remove than fibroids when it comes to excision surgery.

Adenomyoma and Fibroids

SYMPTOMS

  • Heavy and prolonged menstrual bleeding (menorrhagia), which can include clots

  • Feeling of pressure in the pelvis, which can cause abdominal pain, back pain and bladder and/or bowel dysfunction

    • Frequent urination

    • Urinary urgency

    • Urinary incontinence or leakage

    • Difficulty emptying bladder

    • Constipation

    • Hemorrhoids

  • Abdominal bloating

  • Infertility

  • Deficiency of blood cells (anemia)

  • Fatigue

  • Dyspareunia (pain during intercourse). This is common in cervical fibroids

  • Deep thigh aches with varicose veins

  • No symptoms at all, which is reported in 75% of women diagnosed. Differences in symptoms may be due to varying size and location of the fibromas themselves

DIAGNOSIS

Indirect Visualization:

  • Ultrasound: Just like adenomyosis, an ultrasound (sonogram) is the most commonly used imaging technique used to diagnose fibroids. However, while adenomyosis will often appear as diffuse thickening of the uterine wall, fibroids will be seen as round areas with a discrete border. There are two forms of ultrasound used to diagnose adenomyosis: abdominal and vaginal ultrasound. While an abdominal pelvic ultrasound is used to find large fibroids, a transvaginal ultrasound is a bit more invasive in order to detect small, more nuanced fibroids.

  • MRI: While ultrasound may be the most common technique, magnetic resonance imaging (MRI) is the most powerful diagnostic tool used for imaging purposes. In the case of fibroids, MRI can distinguish leiomyomas from other intramural lesions. However, when it comes to endometriosis most physicians choose to conduct an ultrasound before an MRI because it can be done in an office setting and is far less expensive.

An US showing a fibroma, which is clearly seen as a dark mass upon imaging
An ultrasound image that is clearly showing a fibroma as a dark mass.

Direct visualization: These techniques are more invasive and expensive than an ultrasound or MRI. Thus they are usually performed along with surgeries or instances of highly concerning symptoms. Nevertheless, they provide clear and direct imaging of the uterus and in turn fibroids

  • Hysteroscopy: During this diagnostic procedure, a small telescope is inserted into the vagina to examine the inside of the womb, allowing the surgeon to easily visualize the fibromas

  • Laparoscopy: This slightly more invasive procedure allows direct visualization of the outside of the uterus and the surrounding pelvic structures, by using a small camera on the end of a tube (laparoscope) that is inserted into small incisions made in the abdominal and pelvic cavities.

TREATMENT

Non-surgical:

Drugs: While there are no medications that will permanently shrink fibroids, there are drugs that can help control fibroid symptoms and can even reduce the size of fibroids. These medications do this by lowering estrogen and progesterone levels, while simultaneously reducing blood flow to the fibroids themselves. However every case is different, and what may work for one patient may not work for another.

  • Birth control: Often prescribed to reduce heavy bleeding

  • Short-term GnRHa (3-6 month use): Gonadotropin-releasing hormone agonists (GnRHa) are used to shrink fibroids and are usually the most frequently used medication when it comes to fibroids. They also stop menstrual flow

  • Long-term GnRHa w/steroid hormones (after 3-6 month use): Long-term use of GnRHa can lead to bone loss density due to the reduced levels of estrogen. Thus long-term use of GnRHa is supplemented with steroid hormones of estrogen and progesterone, which are safely employed to extend the maximum use of GnRHa without sacrificing efficacy

Innovative medical treatments: There are several innovations that are under investigation for the future treatment of uterine leiomyomas

  • Medicated IUD: Putting a medicated intrauterine device (IUD) into the uterus can decrease a woman’s blood flow and thus reduce the size of her fibroids. However, this is not advised in a uterus greater than 12-weeks in size

  • Progesterone antagonist: Just as Gonadotropin-releasing hormone has an agonist used for the treatment of fibroids, so does progesterone. In some studies, this agonist has been shown to induce uterine shrinking and can even stop menstrual cycles as a whole for women with fibroids. However, this method is not available in the U.S.

  • Antifibrotic drug: Used to control prolonged and/or profuse blood flow in women with leiomyomas by diminishing the endometrium.

  • Androgenic agents: Often referred to as male hormones, synthetic androgens can help slow or stop the growth of fibroids and relieve symptoms such as anemia and menstruation altogether.

  • Mifepristone: French abortion pill that decreases the size of fibromas and reduces abdominal uterine bleeding.

Surgical:

  • Myomectomy: This is the surgical removal of myomas via cutting into the uterus, followed by uterine suture repair. There are three types of myomectomies: laparotomic, laparoscopic and hysteroscopic myomectomies

  • Laparotomic myomectomy: This open abdominal surgery gives the surgeon full visualization to remove the fibroids.

  • Laparoscopic myomectomy: Minimally invasive abdominal surgery that is the preferred method for removing fewer than 4 small fibroids. This is a much more precise, difficult and longer surgery, but is also extremely effective

  • Hysteroscopic myomectomy: Minimally invasive vaginal surgery used only for small, pedunculated submucosal fibroids. This procedure does not require an incision into the abdomen

  • Hysterectomy- The surgical removal of the uterus. This surgery should only be used as a last resort for treating fibroids. If the fibroids are large, diffuse and cannot be treated by any other protocol than a hysterectomy is considered. Very rarely is this form of surgery needed for fibroids, and yet it accounts for ⅓ of hysterectomies in the U.S.

OUR APPROACH

Deep Excision laparoscopic myomectomy: Unlike many other reproductive surgeons, we believe that after decades of learning and operating, Dr. Seckin (Fibroid Dr) is highly skilled in treating most cases of fibroids via laparoscopic myomectomy and uterine repair. We also believe that excision surgery is the best method for removing myomas as this is the only way that a fibroma can be removed at its root. In cases of laser ablation, there are often small bits of myoma left underneath the tissue itself. In the case of fibroids very rarely do we see the need for open, invasive myomectomy, let alone a hysterectomy.

It is important to find a surgeon who will perform a myomectomy ensuring complete removal of each underlying fibroma. Through laparoscopic myomectomy, we are able to ensure thorough removal of the patient’s fibroids, all with minimal invasion. We pride ourselves on handling each myomectomy with an extreme sense of precision and attention to detail.

Our office is located on 5th Ave and 68th NY, NY.
You may call us at 212-988-1444 or have your case reviewed by clicking here.

PATIENT STORY

Marilyn M. was diagnosed with fibroids in her early 30’s, after experiencing severe pelvic pain. A few years later Marilyn was told that she also had endometriosis. After several GYN appointments and multiple operations, Marilyn’s half a decade battle led her to be treated by Dr. Seckin, one of the best fibroid surgeon and fibroid dr. See how Marilyn’s treatment, comprehensive laparoscopic surgery combined with hormonal supplementation medication, has changed her life.

You can read more stories of patients with fibroids, of varying stages, in our testimonial section.

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  • Megan Rafael Moreno

    I was in pain for 2 years. I was getting no answers, and because dr Goldstein and dr seckins were willing to see and treat me I'm finally feeling almost back to normal. They were very down to earth and helpful in my time of need. Dr Goldstein was easy to talk to and caring, she took care of me…

  • Nancy Costa

    Dr. Seckin is one of the best endometriosis surgeon. Every time I go to the office, he really listens to me and is always concerned about my issues. Dr Seckin's office staff are a delight and they always work with me. I feel I can leave everything to them and they will take care of it. Thank you to the…

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    Fast forward 5 years to find out incidentally I had a failing kidney. My left kidney was only functioning at 18%. During this time, I was preparing all my documents to send to Dr. Seckin to review. However, with this new information I put everything on hold and went to a urologist. After a few months, no one could figure…

  • Monique Roberts

    I'll never stop praising Dr. Seckin and his team. He literally gave me back my life.

  • Erin Brehm

    I had a wonderful experience working with Dr. Seckin and his team before, during and after my surgery. I came to Dr. Seckin having already had laparoscopic surgery for endometriosis 5 years prior, with a different surgeon. My symptoms and pain had returned, making my life truly challenging and my menstrual cycle unbearable. Dr. Seckin was quick to validate my…

  • Anita Schillhorn

    I came to Dr. Seckin after years of dealing with endometriosis and doctors who didn't fully understand the disease. He quickly ascertained what needed to be done, laid out the options along with his recommendation and gave me the time to make the right decision for me. My surgery went without a hitch and I'm healing very well. He and…

  • Nicholette Sadé

    Dr. Seckin brought me back to life! I am now 3 weeks into my recovery after my laparoscopy surgery, and I feel like a new and improved woman! Being diagnosed with Endometriosis, then 25yrs old in 2015, and discovering the severity of my case being stage 4, made me devastated. Dr. Seckin's vast knowledge of the disease, sincere empathy, and…

  • Jason Curry

    My wife had her laparoscopic excision surgery to remove endometriosis with Dr. Seckin on Jan 30, 2014. She doesn't write online reviews so I'm writing this on her behalf. I accompanied her with each office visit she had. The staff--Lucy and Kim, are very friendly, warm and professional. Dr. Seckin was excellent in every capacity. He spent a lot of…

  • Liz Filippelli

    He is an awesome doctor who saved my daughters life from debilitating endometriosis..she knew instantly upon awaking from surgery that she was better..that wad May and no complaints only praises for Dr. Wonderful Seckin!!

  • Karen N

    I was diagnosed with Endometriosis at 19. I saw several Endometriosis "Specialists" since then, had a few laproscopic surgeries to "remove" the endometriosis and continued to be in pain. I had a hysterectomy in 2012 and was told this would stop the pain once and for all. No such luck! Tired of spending days in bed with a heating pad,…

  • Lauren Rodriguez

    I researched and found Dr. Seckin after dealing with years of doctors who couldn't help me or refused to go the extra mile for their patients. I have to say I am truly blessed to have found such a compassionate and talented doctor. He is exquisite with everything he does, and both his team at the office and surgical team…

  • Kellya Vespa

    Dr. Seckin is a very skilled surgeon. There are not many doctors like him that truly understand the effects of endometriosis. I am lucky to have found him. The staff is wonderful too.

  • Meg Connolly

    Dr. Seckin truly LOVES what he does and cares about his patients from the bottom of his heart. My life has already changed in 3 weeks and I couldn’t be more grateful. Should I ever need another operation for endometriosis, Dr. Seckin will be the one to do it. I recommend him to anyone I come across with similar problems…

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    Dr. Seckin is an amazing Doctor he is very compassionate, caring and he will be honest with you. He's been my doctor for 19yrs and I am so grateful to have someone taking care of me that knows what he is doing and knows the best way to treat each and every situation. I would definitely recommend him and his…