UTERINE FIBROIDS

  • Noncancerous growths that develop in or just outside a woman’s uterus (womb).
  • 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 occured 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.
  • 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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