What are fibroids?

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UTG Medical Students’ Association

Women have an organ in their reproductive system called the uterus or womb, where the unborn baby is kept until delivery. Fibroids (also known as uterine fibromyomas, leiomyomas or myomas) are non-cancerous firm, compact tumors that can be found in the uterus. The size of the tumors can be as small as a pea or as large as a grapefruit, and they usually occur in women of reproductive age, growing at varying rates and sizes until the onset of menopause.

Types of Fibroids
· Intramural Fibroids: They are the most common type. They grow in the wall of the uterus.
· Subserosal Fibroids: They grow on the outside of the uterus. As they grow larger, they can cause pain due to their size or pressure put on nearby organs.
· Submucosal Fibroids: They bulge into the uterine cavity.
· Pedunculated Fibroids: These fibroids grow on small stalks inside or outside the uterus.
It is possible to have more than one type of fibroid.

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Symptoms
Majority of women with fibroids do not know they have fibroids because there are no symptoms present. Presence or absence of the symptoms depends on the size, number, and location of the fibroids and include:
· Having heavy or prolonged menstrual periods
· Abnormal bleeding between menstrual periods
· Period pain
· Iron deficiency anemia (as a result of the heavy or abnormal bleeding between menstrual periods)
· Frequent urination
· Pressure sensation on the bladder, bowel or back
· Lower back pain
· A lump or swelling in the abdomen
· Painful sex

Factors that increase or decrease the risk of fibroids

Women in their reproductive ages (ages 12 to 49) are at an increased risk for these tumors. Before the age of fifty, an estimated twenty to eighty percent of women will be affected. Those women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Estrogen is the primary female sex hormone responsible for the development and regulation of the female reproductive system and secondary sexual characteristics.

Other risk factors include:
Family history: Uterine fibroids have a higher prevalence in black women. If a mother has fibroids, her daughter is about three times more likely to have them herself.
Early onset of Periods: It is believed that girls who have their periods before the age of ten are more likely to be affected later in life.

Bad eating habits: a poor diet can lead to an increased risk of developing fibroids. Overweight or obese women are twice as likely to be affected. Eating green vegetables may help protect from these tumors.
High blood pressure: Studies have shown an association between high blood pressures and increased incidence of fibroids.

Research has also shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children (children born alive) have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children. The National Institute of Child Health and Human Development is conducting further research on this topic and other factors that may affect the diagnosis and treatment of fibroids.

Surprisingly enough, smoking has a possible decreased effect on fibroid development and growth. However, it is not a reasonable option as it is associated with higher risks of lung, bladder, and cervical cancer.

 

Treatment
Fibroids are most often found during a routine pelvic and/or abdominal examination which may indicate the presence of a firm, irregular pelvic mass to the physician.
Since most fibroids usually decrease in size and may slowly disappear as a woman approaches menopause, treatment will not be required unless they are causing problems such as:

· impairing fertility
· period pain
· heavy bleeding
· pressure symptoms

Nonetheless, it is important to carefully monitor the fibroids as well as the symptoms experienced to ensure that there are no significant changes or developments, and that the tumors are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. The type of treatment used will depend on:
· the symptoms caused by the fibroids
· their position
· their size
· whether the symptoms interfere with daily living
· the woman’s overall health and medical history
· Her tolerance for specific medications, procedures, or therapies
· Her opinion or preference
· Her desire for pregnancy

In general, treatment for fibroids may include:
· Hysterectomy: involves the surgical removal of the entire uterus.
· Conservative surgical therapy: uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy.

· Gonadotropin-releasing hormone agonists (GnRH agonists): This approach lowers levels of estrogen and triggers a “medical menopause.” Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.

· Anti-hormonal agents: Certain drugs oppose estrogen, and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used. Progesterone is a hormone that helps the female body for conception and pregnancy, and regulates the monthly menstrual cycle.

· Uterine artery embolization: Also called uterine fibroid embolization, is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Health care providers continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.

· Anti-inflammatory painkillers: This type of drug is often effective for women who experience occasional pelvic pain or discomfort.
· Intrauterine device (IUD): This is a device that is placed in the uterus. It can reduce heavy periods.
· Endometrial resection: A hysteroscope (a device used to inspect the uterine cavity) is used under general anesthesia to cut out a fibroid that is partially or completely inside the cavity of the uterus, and partially in the wall of the uterus. These are called ‘sub mucosal’ fibroids and they usually cause heavy periods.

· MRI–directed ultrasound technique: Guided by an MRI (Magnetic Resonance Imaging), high intensity focused ultrasound waves cause a confined increase in temperature to destroy the fibroid.
Fibroids and Pregnancy
Some women with fibroids have trouble getting pregnant while many other women are able to naturally get pregnant with their fibroids.

The tumor might cause pregnancy and post pregnancy complications such as:
· Miscarriage
· Premature labor and delivery
· Bad positioning of the baby in the womb
· Cesarean section (delivery of a baby through surgical operation) because the fibroid obstructs the baby moving down into the birth canal
· Reduced placental flow because the fibroids put pressure on the placenta
· Severe bleeding after childbirth.

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