Uterine fibroids are noncancerous growths of the uterus(womb) that often appear during childbearing years. Also called  myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.

Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

SYMPTOMS

In women who have symptoms, the most common symptoms of uterine fibroids include:

●Heavy menstrual bleeding

●Prolonged menstrual periods — seven days or more of menstrual bleeding

●Pelvic pressure or pain

●Frequent urination

●Difficulty emptying your bladder

●Constipation

*Backache or leg pains.

FIBROID LOCATION AND THE ASSOCIATED CLINICAL SYMPTOMS

●Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are more likely to cause prolonged, heavy menstrual bleeding and are sometimes a problem for women attempting pregnancy.

●Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing a pressure sensation, or on your spinal nerves, causing backache.

●Intramural fibroids. Some fibroids grow within the muscular uterine wall (intramural fibroids). If large enough, they can distort the shape of the uterus and cause prolonged, heavy periods, as well as pain and pressure.

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

CAUSES

The main causes of uterine fibroids are unknown, however research and clinical experience point to these factors:

*Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells. There’s also some evidence that fibroids run in families and that identical twins are more likely to both have fibroids than nonidentical twins.

*Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

*Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

RISK FACTORS

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include:

*Heredity. A mother or sister withou’re at i fibroids, increases the risk of developing fibroids in the next generation.

*Race. Black women are more likely to have fibroids than women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids.

*Other factors. Onset of menstruation at an early age, having a diet higher in red meat and lower in green vegetables and fruit, and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

COMPLICATIONS

Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss.

*Pregnancy and fibroids

Fibroids usually don’t interfere with conception and pregnancy. However, it’s possible that fibroids could cause infertility or pregnancy loss. Submucosal fibroids may prevent implantation and growth of an embryo. In such cases, doctors often recommend removing these fibroids before attempting pregnancy or if you’ve had multiple miscarriages. Rarely, fibroids can distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes.

*Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

*Uterine artery embolization*. Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.

*Myolysis.* In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. Myolysis is not used often. Another version of this procedure, radiofrequency ablation, is being studied.

*Laparoscopic or robotic myomectomy. In a myomectomy,  fibroids are removed, leaving the uterus in place. If the fibroids are small and few in number, the doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in the abdomen to remove the fibroids from the uterus.

*Hysteroscopic myomectomy.This procedure may be an option if the fibroids are contained inside the uterus (submucosal).  A surgeon accesses and removes fibroids using instruments inserted through the vagina and cervix into the uterus.

*Endometrial ablation and resection of submucosal fibroids. This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Typically, *endometrial ablation* is effective in stopping abnormal bleeding. Submucosal fibroids can be removed at the time of hysteroscopy for endometrial ablation, but this doesn’t affect fibroids outside the interior lining of the uterus.

OPTIONS FOR TRADITIONAL SURGERY PROCEDURES INCLUDE

*Abdominal myomectomy: multiple fibroids, very large fibroids or very deep fibroids are removed using an open abdominal surgical procedure to remove the fibroids. Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead.

*Hysterectomy: is the removal of the uterus.It remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends the ability to bear children.Women can also choose to get their ovaries removed; this brings on menopause.  Most women with uterine fibroids can choose to keep their ovaries.

RISK OF DEVELOPING NEW FIBROIDS

For all procedures, except hysterectomy, tiny tumors (seedlings) that your doctor doesn’t detect during surgery could eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. New fibroids, which may or may not require treatment, also can develop.

ALTERNATIVE MEDICINE

Some websites and consumer health books promote alternative treatments, such as specific dietary recommendations, enzymes, hormone creams or homeopathy. So far, there’s no scientific evidence to support the effectiveness of these techniques.

PREVENTION

Although researchers continue to study the causes of fibroid tumors, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible, but only a small percentage of these tumors require treatment.

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