FIBROIDS

Noncancerous growths that develop in or just outside a woman’s uterus (womb). It is also known as leiomyomata, they develop from normal uterus muscle cells that start growing abnormally forming a benign tumor.

Causes

Although extremely common, the exact cause is not known but seems to be linked to the hormone estrogen.

Other factors may influence development of uterine fibroids:

  • Pregnancy: tendency to develop uterine fibroids increases the more children one has.
  • Early menstruation: First period occurred before age 10 are more likely to have uterine fibroids.
  • Women taking birth control pills are less likely to develop significant uterine fibroids.
  • Family history: Women whose mothers and sisters have uterine fibroids are more likely to have them.

Types of Uterine Fibroids

All uterine fibroids are similar in their makeup, abnormal uterine muscle cells growing in a tight bundle or mass.

Classified by location of growth:

  • Myometrial (intramural) fibroids – muscular wall of the uterus.
  • Submucosal fibroids – under the interior surface of the uterus, and may protrude into the uterus
  • Subserosal fibroids – outside wall of the uterus.
  • Pedunculated fibroids – outside of the uterus, attached to the uterus by a base or stalk.

It may range in size, from microscopic to several inches across and weighing tens of pounds.

Symptoms of Uterine Fibroids

Most often, there are no symptoms at all so most women don’t realize they have them.

When women do experience symptoms from uterine fibroids, they can include:

  • Prolonged menstrual periods (7 days or longer)
  • Heavy bleeding during periods
  • Bloating or fullness in the belly or pelvis
  • Pain in the lower belly or pelvis
  • Constipation
  • Pain with intercourse

DIAGNOSIS

Physician may do/request:

  • History & Physical Exam
    • Manual pelvic examination
  • Ultrasound
    • An ultrasound probe is inserted into the vagina or over the pelvis on the abdomen, and high-frequency sound waves reflect off the uterus and pelvic structures aiding the visualization of the structures
  • Magnetic resonance imaging (pelvic MRI)
    • An MRI scanner uses a high-powered magnet and a computer to create highly detailed images of the uterus and other pelvic structures and can confirm the presence of uterine fibroids, if the diagnosis is unclear.
  • Uterine biopsy
    • A small piece of tissue (biopsy) taken from the uterus can usually tell a fibroid from cancer. May be done through the vagina, or may require surgery.
  • Hysterosalpingogram
    • Dye is injected into the uterus through the vagina and cervix, and X-ray films show an outline of the uterus and fallopian tubes
  • Sonohysterogram
    • A water solution is injected into the uterus through the vagina and cervix, and an ultrasound is then done. This may show uterine fibroids or other growths not visible on a traditional ultrasound.
  • Hysteroscopy
    • A tube with a lighted viewer on its tip (endoscope) is advanced into the uterus, and a video screen shows the uterus interior. Hysteroscopy can detect uterine fibroids projecting into the uterus, but cannot visualize any part of a fibroid in the uterus wall or outside the uterus.

In most women, a pelvic exam and ultrasound are sufficient to make the diagnosis of uterine fibroids.

 

RECOMMENDED MEDICATIONS

Goals of treatment:

  • Relieve severe pain or other symptoms caused by fibroids.
  • Correct anemia caused by heavy bleeding.
  • Shrink fibroids before fibroid removal (myomectomy) or uterus removal (hysterectomy).
  • Avoid hysterectomy.
  • When treatment is stopped, symptoms usually return.

Medicine

To relieve heavy menstrual bleeding, anemia, or painful periods:

  • Nonsteroidal anti-inflammatory drug (NSAID)
  • Birth control hormones (pill, patch, or ring)
  • An intrauterine device (IUD) that releases small amounts of a certain hormone (levonorgestrel) into the uterus
  • A progestin shot (Depo-Provera)
  • Iron supplements are an important part of correcting anemia caused by fibroid blood loss.

To shrink fibroids before surgery and to temporarily relieve symptoms:

  • Gonadotropin-releasing hormone analogue (GnRH-a) therapy puts the body in a state like menopause but should be used for only a few months, because it can weaken the bones and may also cause unpleasant menopausal symptoms. Fibroids grow back after GnRH-a therapy is stopped
  • Ulipristal (Fibristal) is used to treat moderate to severe symptoms of fibroids in women who are planning to have surgery. This medicine should not be used for more than 3 months.

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