Uterine Fibroids
What are fibroids?
Fibroids are the most frequently seen tumors of the female reproductive
system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas,
are firm, compact tumors that are made of smooth muscle cells and fibrous
connective tissue that develop in the uterus. It is estimated that between
20 to 30 percent of women of reproductive age have fibroids, although
not all are diagnosed. Some estimates state that up to 75 percent of women
will develop fibroids sometime during their childbearing years, although
only about one-third of these fibroids are large enough to be detected
by a physician during a physical examination.
In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous).
These tumors are not associated with cancer and do not increase a woman's
risk for uterine cancer. They may range in size, from the size of a pea
to the size of a softball or small grapefruit.
What causes fibroid tumors?
While it is not clearly known what causes fibroids, it is believed that
each tumor develops from an aberrant muscle cell in the uterus, which
multiplies rapidly because of the influence of estrogen.
Who is at risk for fibroid tumors?
Women who are approaching menopause are at the greatest risk for fibroids
because of their long exposure to high levels of estrogen. Women who are
obese and of African-American heritage also seem to be at an increased
risk, although the reasons for this are not clearly understood.
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 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.
What are the symptoms of fibroids?
Some women who have fibroids have no symptoms, or have only mild symptoms,
while other women have more severe, disruptive symptoms. The following
are the most common symptoms for uterine fibroids, however, each individual
may experience symptoms differently. Symptoms of uterine fibroids may
include:
- heavy or prolonged menstrual periods
- abnormal bleeding between menstrual periods
- pelvic pain (caused as the tumor presses on pelvic organs)
- a firm mass, often located near the middle of the pelvis, which can
be felt by the physician
In some cases, the heavy or prolonged menstrual periods, or the abnormal
bleeding between periods, can lead to iron-deficiency anemia, which also
requires treatment.
How are fibroids diagnosed?
Fibroids are most often found during a routine pelvic examination. This,
along with an abdominal examination, may indicate a firm, irregular pelvic
mass to the physician. In addition to a complete medical history and physical
and pelvic and/or abdominal examination, diagnostic procedures for uterine
fibroids may include:
- x-ray - electromagnetic energy used to produce images of bones
and internal organs onto film.
- transvaginal ultrasound (Also called ultrasonography.) - an
ultrasound test using a small instrument, called a transducer, that
is placed in the vagina.
- magnetic resonance imaging (MRI) - a non-invasive procedure
that produces a two-dimensional view of an internal organ or structure.
- hysterosalpingography - x-ray examination of the uterus and
fallopian tubes that uses dye and is often performed to rule out tubal
obstruction.
- hysteroscopy - visual examination of the canal of the cervix
and the interior of the uterus using a viewing instrument (hysteroscope)
inserted through the vagina.
- endometrial biopsy - a procedure in which a sample of tissue
is obtained through a tube which is inserted into the uterus.
- blood test (to check for iron-deficiency anemia if heavy bleeding
is caused by the tumor).
Treatment for fibroids:
Since most fibroids stop growing or may even shrink as a woman approaches
menopause, the physician may simply suggest "watchful waiting." With this
approach, the physician monitors the woman's symptoms carefully to ensure
that there are no significant changes or developments and that the fibroids
are not growing.
In women whose fibroids are large or are causing significant symptoms,
treatment will be determined by your physician(s) based on:
- your overall health and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
- your desire for pregnancy
In general, treatment for fibroids may include:
- hysterectomy
Hysterectomies involve the surgical removal of the entire uterus. Fibroids
remain the number one reason for hysterectomies in the United States.
- conservative surgical therapy
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 (such as progestin and Danazol), and appear
effective in treating fibroids. Anti-progestins, which block the action
of progesterone, are also sometimes used.
- fibroid emobolization
Fibroid embolization is a new, experimental technique which involves
identifying which arteries are supplying blood to the fibroids and then
blocking off these arteries, which cuts off the fibroids blood supply
and causes them to shrink. Physicians are still evaluating the long-term
implications of this procedure on fertility and regrowth of the fibroid.
- anti-inflammatory painkillers
This type of drug is often effective for women who experience occasional
pelvic pain or discomfort.
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