What is uterine fibroids What is its effect on pregnancy and sexual intercourse

Uterine fibroids are more common in women aged 40-50 years. Most women with fibroids do not experience any symptoms and often discover them by chance during a medical check-up for another reason. However, for those who do have symptoms, living with fibroids can be challenging.In this Dalili Medical article, we will discuss uterine fibroids, their symptoms, causes, and treatment options.

How to Cleanse the Uterus from Fibroids?

Uterine fibroids can be removed through surgical procedures such as laparoscopic myomectomy or with medications that help shrink the fibroids. Additionally, maintaining a healthy diet and lifestyle can help reduce inflammation and speed up recovery.

How to Get Rid of Uterine Fibroids?

Getting rid of uterine fibroids depends on their size, location, and whether the patient wants to preserve fertility. The most common treatment options include hormonal medications, uterine artery embolization, or surgery, which is often the most effective solution depending on the case.

Can Uterine Fibroids Be Treated with Medication?

Yes, in some cases, uterine fibroids can be treated with medication, but the results depend on the size, location, and symptoms of the fibroids. Hormonal medications such as GnRH agonists (like Decapeptyl) and birth control pills can help reduce fibroid size and control bleeding. These medications lower hormone levels that support fibroid growth, thereby significantly alleviating symptoms.

Can Uterine Fibroids Disappear on Their Own?

Uterine fibroids usually do not go away on their own, especially if they are large or causing bothersome symptoms. However, after menopause, fibroids tend to shrink due to decreased hormone levels. Medications can help shrink fibroids and reduce symptoms, but in some cases, medical interventions like embolization or surgery may be necessary.

What Is Mild Uterine Fibrosis?

Mild uterine fibrosis is a common condition among women, characterized by benign fibroid growths made of muscular and fibrous tissue within the uterine wall. The size and location of fibroids vary from one woman to another. In some cases, fibroids do not cause symptoms, while in others, they may lead to health issues and discomfort, especially in women of reproductive age.

Types of Uterine Fibroids

Uterine fibroids (also known as uterine myomas or leiomyomas) are abnormal growths of fibrous tissue within the uterine wall. They are usually benign (non-cancerous) tumors. There are several types of uterine fibroids, and each type differs in location and impact on the uterus and the body. Let’s explore them in detail:

Intramural Fibroids: This is the most common type, forming within the muscular wall of the uterus. If the fibroid grows large, it can cause an expansion in the size of the uterus.
Subserosal Fibroids: These develop beneath the outer layer covering the uterus. If they grow large, they can make the uterus appear larger on one side.
Submucosal Fibroids: These fibroids develop inside the uterine cavity, specifically within the muscle layer beneath the inner uterine lining. This type is less common than others but tends to cause more severe symptoms.
Pedunculated Fibroids: These are a special type of fibroid, either subserosal or submucosal, that attach to the uterus via a thin stalk or stem, resembling a mushroom.
Cervical Fibroids: This rare type develops in the cervix, the lower part of the uterus that connects to the vagina.

How Can Fibroids Affect Pregnancy?

The impact of fibroids on pregnancy depends on their size and location. There are several possible scenarios:

If the fibroid is small and located in the uterine wall:

It usually does not affect pregnancy.
It may cause mild cramps or discomfort.
Regular monitoring by a doctor is sufficient.

If the fibroid is large or inside the uterine cavity:

It may cause bleeding during pregnancy.
It can increase the risk of miscarriage or preterm labor.
It might lead to an abnormal fetal position in the uterus.

If the fibroid is in the cervix:

It can make natural childbirth more difficult.
A cesarean section may be necessary if the fibroid obstructs the baby’s passage.

Symptoms of Uterine Fibroids During Pregnancy

Some women may not experience any symptoms, but if fibroids are present, the following symptoms may appear:

Abdominal or back pain and cramps.
A feeling of pressure on the bladder or difficulty urinating.
Light bleeding in some cases.
Rapid fibroid growth due to increased hormone levels.

Do Fibroids Grow During Pregnancy?

Yes, fibroids can grow during pregnancy due to increased estrogen levels. This growth may cause sudden pain when the fibroid doesn’t receive enough blood, a condition known as degeneration. The pain can be severe, but in most cases, it improves with rest and painkillers prescribed by the doctor.

Fibroids and Childbirth: Can They Cause Problems?

Natural Birth:

If the fibroid is small and not obstructing the baby’s passage, natural birth can proceed normally.

Cesarean Section:

If the fibroid is large or in a position that blocks delivery, the doctor may opt for a cesarean section.
In some cases, if the fibroid is very large, the doctor might remove it during the C-section, but this decision depends on the mother’s overall health.

Can Uterine Fibroids Turn into Cancer?

Uterine fibroids rarely turn into cancer. Fibroids are benign (non-cancerous) tumors, and most women with fibroids live normal lives without serious complications.
However, in very rare cases (less than 1%), a rare type of cancer called uterine sarcoma may develop. This does not mean that the fibroid itself has turned into cancer; rather, the cancer is a separate tumor that forms in the uterus.

How to Differentiate Between a Normal Fibroid and Cancer?

Growth Speed: Fibroids grow slowly, while cancerous tumors grow very rapidly.
Unusual Symptoms: Such as extremely heavy bleeding and persistent, severe pain.
Advanced Imaging: MRI scans or advanced ultrasound techniques help determine the nature of the tumor.

How Can Fibroids Cause Infertility?

The impact of fibroids on pregnancy depends on their type and location in the uterus:

Submucosal Fibroids (Inside the Uterine Cavity):

This is the most likely type to affect fertility as it grows within the uterine lining.
It may prevent embryo implantation after fertilization.
It can cause heavy bleeding, which may weaken the uterine lining.
In some cases, it may lead to recurrent miscarriages.

Intramural Fibroids (Within the Uterine Wall):

If large, they can press against the uterine cavity, reducing the chances of embryo implantation.
They may cause menstrual irregularities, which can affect ovulation.

Subserosal Fibroids (Outside the Uterus):

This type usually does not affect fertility as it is located away from the uterine cavity.
However, if very large, it may put pressure on the fallopian tubes or ovaries, potentially affecting ovulation.

Cervical Fibroids (In the Cervix):

They may make it difficult for sperm to reach the egg, affecting fertilization.

Can Pregnancy Occur with Uterine Fibroids?

Yes, pregnancy can occur naturally if the fibroid is small and does not affect the uterine cavity or ovaries.
Some women conceive after treatment, whether through surgery or medication.
In some cases, fibroids shrink after pregnancy and childbirth due to hormonal changes.

Uterine Fibroid Surgery

Uterine fibroid surgery is a procedure to remove fibroids from the uterus. It can be performed in three different ways:

Abdominal Surgery: The surgeon makes an incision in the lower abdomen to remove the fibroid.
Laparoscopic Surgery: A minimally invasive procedure with faster recovery compared to traditional surgery.
Hysteroscopic Surgery: The fibroid is removed through the vagina and cervix without external incisions.

Stages of Uterine Fibroids

The stages of fibroids depend on their size, location, and impact on the uterus and surrounding organs. They are classified as follows:

Stage 1: Small (Early) Fibroid

Very small in size (less than 2 cm).
No noticeable symptoms, often detected incidentally during an ultrasound.
Does not cause issues with menstruation or pregnancy.
No treatment is required at this stage, but regular monitoring is recommended if it starts growing.

Stage 2: Moderate Fibroid

Grows between 2 to 5 cm in size.
May cause heavy menstrual bleeding and mild pain.
Sometimes presses on the bladder or intestines, leading to frequent urination or constipation.
Treatment depends on symptoms and may include medication to reduce its size or embolization therapy.

Stage 3: Large Fibroid

Grows larger than 5 cm, sometimes reaching the size of an orange or bigger.
Symptoms become more pronounced:
- Heavy menstrual bleeding.
- Pelvic and lower back pain.
- Pressure on the bladder and intestines, causing frequent urination or constipation.
Treatment is necessary at this stage, either through embolization or surgery, depending on the case.

Stage 4: Multiple or Massive Fibroids

Multiple fibroids or an extremely large fibroid (sometimes as big as a football).
Can cause severe complications such as:
- Continuous bleeding leading to anemia.
- Uterine enlargement, making the abdomen appear as if pregnant.
- Pregnancy complications or recurrent miscarriages.
Surgical intervention is often required, ranging from fibroid removal to, in extreme cases, hysterectomy (removal of the uterus).

How is Uterine Fibrosis Diagnosed?

Routine Medical Examination

The doctor performs a pelvic exam, and if they detect an enlarged uterus, they may suspect fibroids and request further tests for confirmation.

Ultrasound (Sonography)

Transvaginal Ultrasound: The most accurate method to determine the size and location of fibroids, performed by inserting a small probe into the vagina.
Abdominal Ultrasound: Conducted by moving the ultrasound device over the abdomen, useful for detecting larger fibroids.

Magnetic Resonance Imaging (MRI)

Performed when ultrasound results are unclear. It provides precise details about the size, number, and location of fibroids and helps differentiate them from other uterine conditions.

Hysterosalpingography (HSG - X-ray with Dye)

Useful in cases of fertility issues, as the dye highlights the uterus and fallopian tubes in X-ray images.

Hysteroscopy

A minimally invasive procedure using a small camera inserted through the vagina into the uterus to accurately visualize fibroids inside the uterine cavity.

Laparoscopy

A diagnostic procedure where a small camera is inserted through a tiny incision in the abdomen to examine the uterus and detect fibroids externally.

Types of Uterine Fibroid Treatments

Laparoscopy (Diagnostic and Surgical)

If the doctor suspects fibroids outside the uterus, they may use laparoscopy, a procedure performed through a small incision in the abdomen to examine and remove fibroids.

Fibroid Removal Surgery (Myomectomy) – Removing Only the Fibroid

The best option for women who want to preserve their uterus and maintain fertility.
The fibroid is removed while keeping the uterus intact.
There are three different surgical approaches:

Hysteroscopic Myomectomy: If the fibroid is inside the uterine cavity, a hysteroscope is inserted through the vagina to remove it.
Laparoscopic Myomectomy: If the fibroid is of moderate size, small incisions are made in the abdomen to remove it.
Open Abdominal Myomectomy: If the fibroid is very large, an abdominal incision is made for complete removal.

Recovery Time:

Hysteroscopic Myomectomy: 1-2 weeks
Laparoscopic Myomectomy: 2-3 weeks
Open Surgery: 4-6 weeks

Hysterectomy – Complete Removal of the Uterus

Suitable for women who do not plan to have children in the future.
The final solution for very large fibroids causing severe symptoms.
It can be:
- Partial Hysterectomy: Removal of the uterus while preserving the ovaries.
- Total Hysterectomy: Removal of both the uterus and ovaries.

Recovery Time: 6-8 weeks

Uterine Fibroid Embolization (UFE)

A non-surgical procedure using interventional radiology.
A thin catheter is inserted into the artery supplying the fibroid, and a special substance is injected to block blood flow, causing the fibroid to shrink and die.
Suitable for women who prefer to avoid surgery, but it is not always the best option for those planning pregnancy in the future.

Recovery Time: 1-2 weeks

Can Fibroids Return After Surgery?

After Myomectomy (Fibroid Removal Only): New fibroids may develop over time, especially if there is a genetic predisposition.
After Hysterectomy (Complete Uterus Removal): Fibroids cannot return as the uterus is completely removed.
After Uterine Fibroid Embolization (UFE): The success rate is high, but some fibroids may shrink instead of disappearing completely.

Symptoms of Uterine Fibroids

Many women may have fibroids without any noticeable symptoms, often discovering them incidentally during a medical checkup. However, if fibroids grow larger or are in a sensitive location, they can cause significant symptoms.

Types of Fibroids Based on Location in the Uterus:

Intramural Fibroids: Grow within the muscular wall of the uterus.
Submucosal Fibroids: Develop towards the inner uterine cavity.
Subserosal Fibroids: Grow on the outer surface of the uterus, sometimes pressing on nearby organs.

Menstrual Cycle Irregularities

Extremely heavy menstrual bleeding.
Prolonged periods lasting more than 7 days.
Large blood clots during menstruation.
Severe cramps and pelvic pain during menstruation.

Pain and Pressure in the Abdomen and Pelvis

Constant lower abdominal or lower back pain.
Noticeable bloating (some women may mistakenly think they are pregnant).
Severe cramps even outside of menstrual periods.

Urination and Bowel Problems

Frequent urination due to fibroid pressure on the bladder.
Difficulty urinating or a feeling of incomplete bladder emptying.
Constipation or difficulty passing stool if the fibroid presses on the intestines.

Fertility and Pregnancy Issues

Delayed conception due to implantation difficulties.
Recurrent miscarriages in some cases.
Preterm labor or abnormal fetal positioning.

Pain During Intercourse

Some women experience discomfort or pain during sex, especially if the fibroid is near the cervix.

Ways to Prevent Uterine Fibroids

There is no guaranteed way to completely prevent fibroids, but certain lifestyle choices may reduce the risk or slow their growth if they are small.

Maintaining a Healthy Weight

Excess weight increases estrogen levels, which can stimulate fibroid growth.
Following a balanced diet and reducing excess fat intake can help.

Healthy and Nutritious Eating

Recommended Foods:

Leafy greens (spinach, kale): Help reduce inflammation.
Fresh fruits (oranges, berries): Rich in antioxidants that protect the uterus.
Whole grains (oats, brown rice): Help balance hormones.
Omega-3-rich foods (fish, nuts): Reduce inflammation.

Foods to Avoid:

High-fat processed foods (fast food, fried foods).
Excessive sugar and carbonated drinks.
Processed meats (salami, pastrami).

Regular Exercise

Exercise reduces excess estrogen levels, which can fuel fibroid growth.
Even a 30-minute daily walk helps balance hormones.

Reducing Stress and Anxiety

Chronic stress can cause hormonal imbalances.
Try relaxation techniques like yoga, meditation, walking, or reading.

Avoiding Harmful Chemicals

Some chemicals, such as pesticides and recycled plastics, contain estrogen-like compounds that affect uterine health.
Use glass containers instead of plastic whenever possible, and avoid storing hot food in plastic containers.

Regular Check-Ups with a Gynecologist

Even without symptoms, getting an ultrasound every year is recommended to monitor uterine health.
If you have a family history of fibroids, consult your doctor for necessary tests.

Difference Between Uterine Fibroid Embolization (UFE) and Traditional Surgery

Factor	UFE (Embolization)	Traditional Surgery
Type of Procedure	Non-surgical	Surgical
Recovery Time	Short (a few days)	Long (weeks)
Surgical Incisions	Very small or none	Large, depending on surgery type
Preservation of Uterus	Yes	Depends on surgery type
Complications	Very few	May have more risks
Anesthesia	Local	General or regional
Effectiveness	Shrinks fibroids gradually	Removes fibroids immediately
Pregnancy Possibility	Possible after recovery	Possible, depending on surgery type

Herbal Remedies for Uterine Fibroids

Using herbs to treat uterine fibroids may help relieve symptoms and reduce fibroid size, but it is not a substitute for medical treatment. Always consult a doctor before using any herbal remedies.

1. Green Tea

Rich in antioxidants that slow fibroid growth.
Helps reduce inflammation and improve blood circulation.
Can be consumed twice daily.

2. Turmeric

Contains curcumin, which reduces inflammation and may shrink fibroids.
Can be mixed with honey or added to food.

3. Cinnamon

Improves blood flow to the uterus and helps reduce fibroid pain.
Can be added to tea or milk and consumed daily.

4. Flaxseeds

High in omega-3, which reduces excess estrogen that fuels fibroid growth.
Can be sprinkled on yogurt or added to smoothies.

5. Chaste Tree (Vitex)

Regulates hormones and lowers excess estrogen levels.
Helps reduce heavy bleeding caused by fibroids.

6. Ginger

Boosts blood circulation and reduces inflammation.
Useful for relieving pain and regulating menstrual cycles.

7. Dandelion Root

Supports liver function to eliminate excess hormones.
Aids digestion and reduces inflammation.
Can be consumed as a tea 2-3 times a day.

8. Red Raspberry Leaf

Strengthens uterine muscles and reduces excessive bleeding.
Rich in antioxidants that support uterine health.
Can be prepared as tea.

9. Sage

Balances hormones and lowers excess estrogen.
Helps reduce cramps and bloating.
Can be consumed once a day.

10. Fenugreek

Improves blood flow to the uterus and reduces inflammation.
Naturally regulates hormones.
Can be consumed as tea or soaked in water overnight.

11. Calendula (Marigold)

Supports uterine health and reduces heavy bleeding.
Anti-inflammatory and promotes reproductive health.
Can be consumed as an herbal tea or added to food.

12. Thyme

A powerful anti-inflammatory that enhances uterine blood circulation.
Can be consumed as tea or used in cooking.

13. Chia Seeds

Rich in omega-3, which reduces inflammation and maintains hormone balance.
Helps shrink fibroids and supports uterine health.
Can be added to smoothies or yogurt.

14. Licorice Root

Balances hormones and reduces excess estrogen.
Natural anti-inflammatory and detoxifies the liver.
Can be consumed as tea (caution for high blood pressure patients).

15. Nettle (Stinging Nettle)

High in iron, replenishing lost blood due to heavy bleeding.
Boosts blood circulation and reduces uterine inflammation.
Can be consumed as tea daily.

16. Marjoram

Naturally regulates hormones and reduces fibroid growth.
Helps relieve menstrual cramps.
Can be consumed twice daily.

17. Garden Cress (Lepidium Sativum)

Cleanses the uterus and naturally reduces fibroids.
Rich in antioxidants that support reproductive health.
Can be consumed with milk or warm water.

18. Ginseng

Boosts blood circulation to the uterus and reduces inflammation.
Helps manage stress, preventing hormonal imbalances.
Can be taken as a supplement or tea.

19. Chamomile

Soothes the uterus and reduces fibroid-related pain.
Anti-inflammatory and hormone-balancing properties.
Best consumed as tea before bedtime.

20. Black Seed (Nigella Sativa)

Strengthens the immune system and reduces fibroid-related inflammation.
Helps regulate hormonal balance.
Can be taken with honey or added to meals.

21. Valerian Root

Known for its calming effects on the uterus and reducing fibroid cramps.
Helps relieve stress, which affects hormone balance.
Best consumed as a warm tea before bed.

22. Red Clover

Contains natural compounds that help balance hormones.
Enhances blood circulation to the uterus and reduces fibroid growth.
Can be taken as an herbal tea or supplement.

23. Amla (Indian Gooseberry)

A powerful antioxidant that reduces inflammation.
Supports liver function to eliminate excess estrogen.
Can be consumed as juice or a supplement.

24. Sunflower Seeds

Rich in magnesium, which reduces uterine inflammation.
Contains vitamin E for healthy tissues.
Can be eaten as a snack or added to salads.

25. Evening Primrose Oil

Helps relieve fibroid pain and menstrual cramps.
Rich in fatty acids that support uterine health.
Can be taken as a supplement.

26. Horsetail Herb

Known for its detoxifying properties and inflammation reduction.
Strengthens connective tissues in the uterus.
Can be consumed as herbal tea.

27. Hyssop

Anti-inflammatory and supports uterine health.
Helps regulate menstrual cycles.
Can be consumed as a warm herbal drink.

28. Celery

Improves uterine blood circulation and reduces fibroid growth.
Rich in antioxidants that protect against inflammation.
Can be eaten fresh or added to juices.

29. Saffron

Enhances blood circulation and improves uterine health.
Helps reduce inflammation and pain.
Can be added to milk or tea.

30. Olive Leaves

Reduces inflammation and strengthens immunity against abnormal uterine growths.
Can be consumed as tea or taken as a supplement.

The appropriate specialty for treating uterine fibroids is a Gynecologist & Obstetrician.

If the condition requires more specialized intervention, it may involve:

Interventional Radiologist → If uterine fibroid embolization (UFE) is needed for treatment.
Gynecologic Surgeon → If the condition requires surgical removal of fibroids or hysterectomy.