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What are Uterine Fibroids?

The female uterus is a complex reproductive organ with a unique anatomy. The basic structure is made up of layers: the outer-most layer is called the peritoneum and surrounds the thin, fluid-secreting perimetrium layer. Next is the myometrium, which consists of smooth muscle. The inner-most layer and lining of the uterine cavity is called the endometrium. The entire uterus is surrounded by an intricate system of blood vessels. The outer lining of cells of the endometrium sloughs off periodically if the female does not become pregnant; this shedding is responsible for menstrual bleeding.


Uterine fibroids (also called leiomyomas) grow from the smooth muscle and can be found on the peritoneum, within the myometrium and on the endometrium. These fibroids are non-cancerous growths which often develop during childbearing years, after a woman has gone through puberty. Although the exact cause is unknown, it appears that the hormone estrogen, which helps regulate the menstrual cycle, plays a key role in their growth.


Uterine fibroids are extremely common, affecting many women at some point in their lives. Most of the time, uterine fibroids can be so small they do not cause any physiological problems and go unnoticed. Fibroids can also grow very large, possibly filling up the uterine cavity and weighing several pounds. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow. When estrogen levels fall after menopause, fibroids can shrink.


Inflammation is involved in reproductive events such as ovulation, menstruation and implantation. Regulation and resolution of inflammatory pathways is necessary for proper reproductive function, and the onset of reproductive disorders may be the result of malfunctioned or persistent inflammation.1 The commonality of fibroids and the universality of menstruation has led to an increasing belief that injury related to menses may cause an improper inflammatory response leading to the formation of uterine fibroids.2,3

Uterine fibroids develop from the smooth muscle of the myometrium. A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass. Medical research is working to identify the cause of fibroids, but some contributing factors are evident:

  •  Genetic alterations are found in replicating uterine muscle cells
  •  Hormones estrogen and progesterone influence the growth of fibroids; fibroids have an increased number of estrogen receptors compared to normal uterine tissue 
  •  Other chemicals such as growth factors and cytokines interact with tissue and promote the growth of fibroids4 

Risk of developing uterine fibroids also increases with other factors:

  • Family history of fibroids 
  • Obesity
  •  African-American women have a higher risk to get fibroids larger in size and at an earlier age than other women 
  • Oral contraceptives, pregnancy and childbirth have been shown to have protective effects against uterine fibroids.2

Uterine fibroid symptoms can emerge slowly over years or rapidly in several months. Most women with uterine fibroids show mild or no symptoms and do not require treatment. Symptoms can pose a problem for some, and the location of the fibroid usually influences the types of symptoms present. The most common symptoms include:

  •  Heavy menstrual bleeding
  •  Menstrual periods lasting longer than normal (7+ days)
  •  Pelvic pain or pressure
  •  Frequent urination
  •  Constipation
  •  Lower back or leg pain

Uterine fibroids can cause multiple complications with pregnancy but it is not common. Sometimes, fibroids can make it difficult to become pregnant, creating infertility. During pregnancy, existing fibroids may grow due to the increased blood flow and estrogen levels. Large fibroids in the uterine cavity can cause abnormal fetal positions and placenta problems. If fibroids block the birth canal then a cesarean section delivery may be necessary. Uterine fibroids increase the risk for miscarriage, and premature labor and delivery. Pain and excessive bleeding after childbirth are also seen.

Other complications of fibroids include:

  •  Severe pain and excessive bleeding, which may require surgery
  •  Anemia resulting from heavy bleeding
  •  Urinary tract infections resulting from blockage of the urinary tract if a fibroid presses on it
  •  Infection or breakdown of uterine fibroid tissue

There is no single, best approach to uterine fibroid treatment. Medical treatment is usually only sought when symptoms are too severe and pose health risks. If you have uterine fibroids with little or no symptoms or are nearing menopause, it is typically recommended to have regular pelvic exams to monitor the fibroid growth and symptoms; this is often referred to as watchful waiting.

Several medications are used to relieve symptoms, but they do not shrink fibroids. These include:

  •  Non-steroidal anti-inflammatory drug (NSAID) therapy is used for pain and heavy bleeding
  •  Birth control pills and intrauterine devices which release hormones that may lighten menstrual bleeding
  •  Iron supplements for anemia

Many surgical procedures are used to remove fibroids from the uterus. The type of operation is dependent upon the location and size of the fibroids, as well as the severity of symptoms. Procedures include:

  •  Hysterectomy: removal of the uterus
  •  Myomectomy: removal of the fibroids
  •  Myolysis:  destruction of fibroids by laser
  •  Endometrial ablation: destruction of lining of uterus with heat
  • Uterine artery embolization: block blood vessels to fibroid
1. Jabbour HN, Sales KJ, Catalano RD, et al. Inflammatory pathways in female reproductive health and disease. Reproduction. 2009; 138:903-919.
2. Flake GP, Andersen J, Dixon D. Etiology and Pathogenesis of Uterine Leiomyomas: A Review. Env Health Persp. 2003; 111(8):1037-1054.
4. Maybin JA, Critchley HO, Jabbour HN. Inflammatory pathways in endometrial disorders. Mol Cell Endocrinol. 2010; [Epub ahead of print].
5. Sozen I, Arici A. Interactions of cytokines, growth factors, and the extracellular matrix in the cellular biology of uterine leiomyomata. Fertil Steril. 2002; 78(1):1-12.
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