UTERINE FIBROIDS...Understand Your Body.

  A uterine fibroid (fibromyoma,leiomyoma) is a benign tumor that forms from the smooth muscle tissue of the uterus (myometrium).A single cell divides repeatedly, eventually creating a firm, rubbery mass dif different from the adjacent tissue. Growth patterns vary,some grow slowly some rapidly and other 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.

• Uterine fibroids are most common among women of reproductive-aged
• Large fibroids can cause severe symptoms like secondary infertility
• Uterine fibroids usually remain benign and have a low risk of becoming malignant

Illustrated picture of multiple uterine fibroids.

 

Cause of Uterine Fibroids

Doctors do not know the cause of uterine fibroids, but research and clinical experience point to these factors as the major cause of uterine fibroids:

• Genetic changes – are oftenly hereditary with a distinct familial predisposition confirmed by genetic testing which reveals hereditary mutations in some of the genes.
• Hormonal changes - Lining of the uterus is very sensitive to hormonal changes. Histological analysis of fibroids indicates a large amount of oestrogen and progesterone receptors than in a healthy myometrium (mid layer of the uterus).

 

Symptoms of Uterine Fibroids

 Initial developmental stages of fibroids are usually asymptomatic( have no clinical signs) and are discovered incidentally during a pelvic exam or prenatal ultrasound of the uterus. These are some of the most common symptoms of a uterine fibroids:

• 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
• Severe iron-deficiency anemia - as a result of the heavy bleeding
• Large fibroids may cause infertility by obstructing the connection of the fallopian tubes to the uterus or by interfering with the fetus implantation in the uterus
• Miscarriages may be caused by fibroids

Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and, rarely, fever. A fibroid that hangs by a stalk inside or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk and cutting off its blood supply.
Fibroid location, size and number influence signs and 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.

 

 Uterine Fibroids Diagnosis

Specialists use the following methods for diagnosing uterine fibroids:

• Abdominal or transvaginal ultrasound of the uterus
• X-ray methods - hysterosalpingography with contrast and a CT scan of the pelvic organs
• MRI of the pelvis organs
• Hysteroscopy - endoscopic visualization of the uterus
• Laboratory tests: Hormones and coagulation factors
• Biopsy of the fibroid to ensure it’s benign. The procedure is performed during the hysteroscopy

 

Treatment of Uterine Fibroids

 There are a variety of treatment options for fibroids, ranging from medical management of symptoms to definitive surgical management.Fibroids cannot be eliminated by medications but symptoms can be managed with certain medications.In some cases, hormonal treatment is enough to block the effect of progesterone and estrogen on the fibroid’s receptors. Hormonal intrauterine devices are also an option and have proven to effectively shrink existing fibroids:

• Combined oral contraceptive pills The birth control pill contains both estrogen and progesterone hormones, which can help decrease bleeding symptoms. Some studies show that they can slow the growth of fibroids, but cannot decrease the size of the fibroid
• Progesterone Releasing IUD (intrauterine device) This device is inserted into the uterus and contains a small amount of progesterone hormone. This can decrease bleeding symptoms. It has no effect on the fibroid itself.
• Progestin pills These pills contain progesterone hormone, which will decrease bleeding side effects. These pills have no effect on the fibroid itself.
• Gonadotropin Releasing Hormone (GnRH) agonists These medications (Lupron, Zoladex, Synarel, etc.) suppress the release of natural estrogen and progesterone production, which then causes shrinkage of fibroids and decrease in bleeding symptoms. These medications cause a temporary menopausal state and are often associated with hot flashes. Typically, your doctor will put you on this medication to correct anemia from heavy bleeding and shrink the size of the fibroid prior to surgical management. GnRH agonists are not a long-term management option.
• NSAIDs (nonsteroidal anti-inflammatory drugs) These are non narcotic pain relieving drugs that may help with the painful symptoms of fibroids but will not effect the fibroid or any bleeding symptoms.

 

 Minimally Invasive Treatment of Uterine Fibroids 

The main goal of minimally invasive treatment methods is to preserve the uterus and its reproductive function, which is essential to young women. Reproductive Health specialists use the following methods:

• Embolization of the uterine arteries and their branches in order to cut off the blood supply to the fibroid. The fibroid then stops growing and eventually its cells die.
•  Myolysis - the fibroid is destroyed by a medical laser, cryotherapy or high-frequency ablation laparascopically.
• Hysteroscopic myomectomy – a minimally invasive endoscopic procedure that allows the removal of fibroid mass from the submucosal layer of the uterus.
• Endometrial ablation and submucosal resection – fruitfully reduces the clinical symptoms of submucosal fibroids, which include heavy bleeding during the menstrual cycle.

 

Surgical treatment of Uterine Fibroids 

In cases where the above mentioned methods are undesired for the patient, either of the following surgical treatment options can be used:

• Hysterectomy – complete removal of the uterus. The procedure can be performed through both laparoscopic and open surgery. It is operative in cases of multiple fibroids which are accompanied by severe clinical symptoms. In most cases uterine fibroids do not require removal of the ovaries or postoperative hormonal treatment.
• Myomectomy – organ-sparing method, which involves only the removal of the fibroids and without affecting the patient’s fertility. This surgery is suitable in cases of several fibroids.

The vast majority of gynecological surgeries are performed laparascopically. This method does not require a large abdominal incision, thereby significantly reducing both the risk of complications and the hospitalization period.

 Preparing for an appointment

Your first appointment will likely be with either your primary care provider or a gynecologist. Because appointments can be brief, it's a good idea to prepare in advance for your appointment.

 

What you can do

• Make a list of any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
• List any medications, herbs and vitamin supplements you take. Include doses and how often you take them.
• Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
• Take a notebook or electronic device with you. Use it to note important information during your visit.
• Prepare a list of questions to ask your doctor. List your most important questions first, in case time runs out.

For uterine fibroids, some basic questions to ask include:

• How many fibroids do I have? How big are they?
• Are the fibroids located on the inside or outside of my uterus?
• What kinds of tests might I need?
• What medications are available to treat uterine fibroids or my symptoms?
• What side effects can I expect from medication use?
• Under what circumstances do you recommend surgery?
• Will I need a medication before or after surgery?
• Will my uterine fibroids affect my ability to become pregnant?
• Can treatment of uterine fibroids improve my fertility?
• What other alternative treatments might I try?

Make sure that you understand everything your doctor tells you. Don't hesitate to ask your doctor to repeat information or to ask follow-up questions.

 

 

What to expect from your doctor

Some questions your doctor might ask include:

• How often do you experience these symptoms?
• How long have you been experiencing symptoms?
• How severe are your symptoms?
• Do your symptoms seem to be related to your menstrual cycle?
• Does anything improve your symptoms?
• Does anything make your symptoms worse?
• Do you have a family history of uterine fibroids?

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.


 Facebook