Uterine fibroids are a common diagnosis for women and are almost always benign (non-cancerous). As women grow older, they are more apt to develop a fibroid with many sources suggesting that up to 50% of all women will develop a fibroid by the age of 50. Women in their 40's and early 50's are more likely to be diagnosed with fibroids than women in their 20's and 30's. Fibroids account for about one third of all hysterectomies performed each in year in the United States. Not all fibroids cause symptoms but when symptoms occur they can negatively impact a woman’s quality of life. Women may have one fibroid or multiple fibroids.
The medical term for fibroid is leiomyoma, a type of myoma tumor. They are tumors of the smooth muscle of the uterus and contain muscle tissue. Fibroids are classified according to their location in the uterus.
- Submucosal–this type of fibroid grows into the cavity of the uterus and distorts it.
- Intramural or Myometrial–these fibroids grow in the wall of the uterus but do not distort the cavity of the uterus.
- Subserosal–this fibroid grows on the surface of the uterus.
- Pedunculated–these fibroid grow from a stalk either inside or outside the uterus.
Fibroids Causes and Risk Factors
The cause of fibroids is unknown though there may be a genetic connection and hormones affect them. Fibroids rely on both progesterone and estrogen for growth causing them to grow rapidly during pregnancy and shrink during menopause.
Besides a family history, risk factors include obesity, never having given birth, hypertension, beginning menstruation before age 10, and being of African heritage.
Women with fibroids may experience several different symptoms. Menstrual bleeding can become heavy and last seven days or longer. Pain may occur during intercourse. Leg pains and lower backache may occur. There can be a feeling of pressure or heaviness in the lower pelvic region as well as bloating and swelling in this area. Some women experience bladder concerns including frequent urination and trouble emptying the bladder. There can also be issues with fertility and pregnancy.
There are several ways to diagnosis fibroids. During a routine pelvic exam, your surgeon may notice abnormalities in the shape of your uterus. An ultrasound can then be used to confirm the diagnosis. At times, a CT scan or MRI may be needed to confirm diagnosis or make determinations for surgery.
To evaluate the extent of a submucosal fibroid, your doctor may order a hysteroscopy or sonohysterography. During a hysteroscopy, your doctor can look inside your uterus using a hysteroscope (lighted telescope). Saline will be used to expand your uterus to allow the doctor to see more clearly. During a sonohysterography, saline is used to expand the uterus for ultrasound images.
Another test that may be recommended is a hysterosalpingogrpahy. For this test, dye is used to highlight the uterus and fallopian tubes for an x-ray.
A laparoscopy may be suggested if a fibroid is suspected on the outside the uterus. During this surgery, a laparoscope (thin scope with a light and camera) is inserted into a small incision often in the belly button. This allows the doctor to look around the outside of the uterus and take pictures.
There are many treatment options available for fibroids from doing nothing to having a hysterectomy. Treatment can depend on the type of fibroid, number of fibroids, your age, fertility concerns, and any symptoms you may be having.
Several medications may be used to treat fibroid symptoms. If the primary issue is heavy bleeding, hormonal options such as birth control pills can be a good choice. GnRH agonists such as Lupron can be used to stop heavy bleeding as well as attempt to shrink the fibroid. With an IUD, pain and bleeding issues could be addressed.
There are also outpatient procedures that may be an option. During an ablation, the endometrium and any fibroids within the uterus can be removed. This eliminates heavy bleeding as well as the fibroid(s). During either a Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE), particles are inserted in the blood vessels suppling the fibroid in order to stop the blood supply to the fibroid. As a result, the fibroid shrinks. Myolysis involves inserting a needle into the fibroid and destroying it with either heat or cold. MRI-guided focused ultrasound surgery (MRgFUS) uses MRI guided ultrasound to heat the fibroid and cause its cells to die.
More invasive surgical options include a myomectomy or hysterectomy. During a myomectomy, the fibroid is cut from the uterus and the uterus is then stitched closed. A hysterectomy involves the removal of the uterus with the fibroids. Though this procedure is the only definite way to cure fibroids, it comes with several risks, involves the removal of an organ, and ends the ability to every conceive and carry a child.
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