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UTERINE FIBROIDS

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UTERINE FIBROIDS

Uterine fibroids are benign growths of the uterus that often appear during the reproductive years.

  • Also called uterine leiomyoma, uterine fibroids depend on estrogen and progesterone to grow and therefore only relevant during the childbearing or reproductive year.
  • Uterine fibroids decrease in size or calcify after menopause due to a decrease in hormone production.
  • A woman can have one uterine fibroid or multiple fibroids.
  • Fibroids are common and account for 3% of reasons why it may be hard for a woman to get pregnant. Occasionally, they cause recurrent miscarriages
  • A larger percentage of women with fibroids may have pregnancy outcomes.
  • It was estimated in 2013 that about 171 million women were affected by uterine
  • Large fibroids may push onto the bladder causing a frequent need to urinate.
  • Many women develop uterine fibroids sometime in their life but may not be aware as it usually causes no symptoms.
  • Uterine fibroids are commonly described based on their location in the uterus.
  • Intramural fibroids grow within the muscular wall of the uterus. They are the most common.
  • Submucosal fibroids bulge into the uterine cavity beneath the inner lining of the uterus. This position is responsible for the minute cases of infertility associated with urine fibroids. It is reasoned that this location may disrupt the function of the lining and the ability of the embryo to implant.
  • Subserosal fibroids grow beneath the serosa and project to the outside of the uterus.
  • Cervical fibroids are located in the wall of the cervix.
  • Uterine fibroids almost never develop into cancer and are not associated with an increased risk of uterine cancer.

CAUSES

The reason why women develop fibroids is unknown, but research points to the following factors,

  • Genetic changes
  • Estrogen and progesterone hormones appear to promote the growth of fibroids. These two hormones enhance the development of the uterine lining during each menstrual cycle in preparation for pregnancy.
  • Abnormalities in the blood vessel system.

Known risk factors that can have an impact on the development of fibroids are:

  • Family history
  • Black women or women of African descent are 3 times more likely to develop fibroid
  • Obesity, polycystic ovary syndrome, diabetes, hypertension, alcoholism, a vitamin D deficiency and eating red meat

SYMPTOMS

Many women with fibroid don’t develop symptoms, however, if symptoms exist they may include:

  • Heavy menstrual bleeding
  • Frequent urination
  • Pelvic pain, including pain during sex
  • A backache or leg pains
  • Difficulty emptying the bladder
  • Constipation

DIAGNOSIS AND TREATMENT

DIAGNOSIS

If you have symptoms of fibroids, your doctor may carry out the following test and imaging techniques:

An ultrasound. This gives your doctor the picture of your uterus and enables your doctor to confirm the presence of fibroids. The doctor may then map and measure the fibroids.

If you have heavy menstrual bleeding, your doctor may order a lab test to investigate potential causes. This may include a complete blood count to see if you have anemia and other blood test to rule out the possibility of bleeding disorder or thyroid problems

MRI can show the location and size of your fibroids

Hysterosonography. For this, the uterine cavity can be expanded by using sterile saline making it easier to get a picture of submucosal fibroids

Hysterosalpingography, this may be recommended if infertility is of concern.

Hysteroscopy, to expand the uterine cavity allowing your doctor to examine the walls of the uterus and the openings of the fallopian tubes.

TREATMENT

Many options and approaches exist for treatment.

The non-surgical procedure involves the use of medications and focuses on regulating the menstrual cycle hormones and treating symptoms such as pelvic pain and heavy menstrual bleeding. They don’t remove the fibroids but can shrink them. Medication may include:

Nonsteroidal anti-inflammatory drugs for pain

Progestin-releasing intrauterine device to help with heavy bleeding

Tranexamic acid (Lysteda) taken only on heavy menstrual period to help relieve bleeding

Gonadotropin-releasing hormone agonists that put you in a temporary postmenopausal stage. As a result, menopause stops and fibroids shrink.

A low dose of oral contraceptives

The surgical procedure may include hysterectomy, myomectomy, MRI-guided focused ultrasound surgery (FUS) and urine artery embolization.

Urine artery embolization, small particles are injected into the arteries supplying the uterus, cutting off blood flow to the fibroids, causing them to shrink and die.

Myomectomy is the removal of the fibroids.

Hysterectomy is the removal of the uterus and it provides the only proven permanent solution to uterine fibroids. Hysterectomy may end your chances of giving birth.

Endometrial ablation, for this, a specialized instrument = is inserted into your uterus to destroy the lining of your uterus. This procedure either ends your menstruation or reduces your menstrual flow and is effective in stopping excess bleeding.

Discuss your treatment options with your doctor as all treatments have risk and benefits.