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What are fibroids?
Uterine fibroids are
non-cancerous [usually] tumors that develop within or attach to the wall of the
uterus, a female reproductive organ also called the "womb" which is designed to
hold a pregnancy.
What causes a fibroid?
Uterine fibroids are the most
common pelvic tumor.
The cause of uterine fibroid tumors is unknown. Oral contraceptives and
pregnancy lower the risk of developing new fibroid tumors.
Fibroids may be present in 15 - 20% of women in their reproductive years -- the
time after starting menstruation for the first time and before menopause.
Fibroids may affect 30 - 40% of women over age 30. The growth of a fibroid seems
to depend on the hormone estrogen. As long as a woman with fibroids is
menstruating, the fibroids will probably continue to grow, usually slowly.
Fibroids rarely affect females younger than 20 or who are postmenopausal [those
who have reached an age where their periods have stopped]
Fibroids begin as small seedlings that spread throughout the muscular walls of
the uterus. They can be so tiny that you need a microscope to see them. However,
they can also grow very big. They may fill the entire uterus, and may weigh
several kilograms. Although it is possible for just one fibroid to develop,
usually there is more than one.
Locations of fibroids:
Sometimes, a fibroid hangs from a long stalk, which is attached to the outside
of the uterus. Such a fibroid is called a pedunculated fibroid.
What complaints could you
have because of fibroids?
* Sensation of fullness or
pressure in lower abdomen
* Pelvic cramping or pain with periods
* Abdominal fullness, gas
* Increase in urinary frequency
* Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood
clots
* Sudden, severe pain due to a pedunculated fibroid which may have got twisted
Sometimes a patient may have
large fibroids without any symptoms or complaints and this may only be
picked up during a routine gynaecological check up.
How are fibroids diagnosed?
A pelvic examination may reveal
an irregularly shaped, lumpy, or enlarged uterus. Frequently, this diagnosis is
reliable. In some cases, diagnosis of fibroids is difficult, especially in obese
women. Fibroid tumors have been mistaken for ovarian tumors, inflammation of the
fallopian tubes, and pregnancy.
A transvaginal ultrasound or pelvic ultrasound may be performed to confirm the
findings.
A D and C or a pelvic laparoscopy may be necessary to rule out potentially
cancerous conditions.
How are fibroids treated?
Treatment depends on the
severity of symptoms, the patient's age, whether or not she is pregnant, the
desire for future pregnancies, her general health, and characteristics of the
fibroids. Some women may just require monitoring of the fibroid. This requires
pelvic exams or ultrasounds every once in a while.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn may
be recommended for women who have cramps or pain with menstruation. Birth
control pills (oral contraceptives) may be used to help control heavy periods
and to stop the fibroid from growing. Iron supplements may be given to prevent
anemia in women with heavy periods.
In some cases, hormonal therapy involving drugs such as injectable Depo
Leuprolide is prescribed to shrink the fibroids. This medicine reduces the
production of the hormones estrogen and progesterone. The hormones create a
situation in the body that is very similar to menopause. Side effects can be
severe and may include hot flashes, vaginal dryness, and loss of bone density.
Hormone treatment may last several months. Fibroids will begin to grown as soon
as treatment stops. In some cases, hormone therapy is used for a short period of
time before surgery or when the woman is expected to reach menopause soon.
Some sort of surgery is the
only definitive treatment for fibroids.
Hysteroscopic resection of fibroids may be
needed for women with fibroids growing inside the uterine cavity. In this
procedure, a small camera and instruments are inserted through the cervix into
the uterus to remove the fibroid tumors.
A myomectomy is a surgical procedure to remove just the fibroids. It is
frequently the chosen treatment for premenopausal women who want to have
children, because it usually can preserve fertility. Another advantage of a
myomectomy is that it controls pain or excessive bleeding that some women with
uterine fibroids have. The disadvantage of a myomectomy is that there are often
"seedling" fibroids which are so small that they cannot be seen and removed, and
these may grow again after 5-10 years and the patient may require another
surgery at that time. Still it could give the patient her time to have a baby
and that is the reason myomectomies are carried out even at the risk that the
patient may need a another surgery after some time. If you have had a myomectomy
and later get pregnant you will usually be advised to undergo a
caesarian section for your delivery
as the contractions of a normal delivery may cause the stitches in your uterus
to come apart.
A myomectomy may be carried out
via an open surgical technique, laparoscopic
technique or a hysteroscopic technique depending
on the number, size and location of the fibroids.
If a patient has finished her
child bearing and is of an age where she does not want any more children then a
hysterectomy is usually the best option as then
there is absolutely no chance of recurrence of the problem.
Complications of fibroids
-
possible infertility
-
anaemia which may be quite
severe
-
emergency situations such as a
twisted pedunculated fibroid
-
very rarely cancerous changes
[usually after menopause]
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