Fibroids (leiomyomata uteri) are the most common
benign tumors of the uterus. They usually come in a variety of shapes and
sizes, as well as numbers, in the uterus. Very rarely do they turn to cancer –
the exact incidence being less than 1% in a patient’s lifetime. Women who are
at risk usually have a family history, are Black or Hispanic, and may have an
elevated Body Mass Index (BMI). As a matter of fact, because we are seeing more
women with an increase in BMI, Caucasian women are presenting with fibroids
more frequently as well. While there is still a lot to understand about the
development of fibroids, they grow for two reasons: hormones, in particular
estrogen, and blood supply.
Fibroids can be located in different parts of
the uterus. There are some fibroids that are located underneath the surface of the uterus,
which are called subserosal; these generally do not cause bleeding but can
cause pressure. There are those that are embedded in the muscle of the uterus,
which are called intramural. Finally, there are those fibroids that affect the
lining of the uterus, which are called submucosal, and these are the ones that
usually present with excessive bleeding.
Symptoms and Tests
The most common symptoms of fibroids are heavy bleeding,
pressure, increased frequency in urination and pelvic pain. Although most
fibroids do not usually cause pain, if they outgrow their blood supply, it can
cause pain due to degeneration (which means tissue breakdown). Fibroids are
usually diagnosed with a pelvic exam and a pelvic sonogram. Transvaginal
sonography is very good at detailing whether a fibroid is affecting the uterine
lining or not.
While the leading cause of hysterectomies is
fibroids, there are many more conservative treatments that are available now.
Birth control pills are one of these treatments; not only can they suppress
bleeding, but they can also suppress the hormones that can control the growth
of the fibroid. Decreasing weight also decreases the amount of exogenous
estrogens that can control the growth as well. Uterine artery embolization can
cut off the blood supply to the uterus, thus controlling growth and bleeding.
In the case of submucosal fibroids, they can be resected hysteroscopically by
going into the uterus and removing the fibroid through the vagina. Another
procedure called a myomectomy just removes the fibroids, thus conserving the
uterus. Lastly, you can also just watch them: If they don’t bother you, don’t
bother them. Specific treatment modalities should be discussed with your
physician to see what works best for you.
All uterine fibroids are made of abnormal
uterine muscle cells growing in a tight bundle or mass.
Uterine fibroids are sometimes classified by
where they grow in the uterus:
- Myometrial (intramural) fibroids are in the
muscular wall of the uterus.
- Submucosal fibroids grow just under the
interior surface of the uterus, and may protrude into the uterus.
- Subserosal fibroids grow on the outside wall
of the uterus.
- Pedunculated fibroids usually grow outside of
the uterus, attached to the uterus by a base or stalk.
Uterine fibroids can range in size, from microscopic to
several inches across and weighing tens of pounds.
of Uterine Fibroids
Most often, uterine fibroids cause no
symptoms at all -- so most women don’t realize they have them. When women do
experience symptoms from uterine fibroids, they can include:
menstrual periods (7 days or longer)
bleeding during periods
or fullness in the belly or pelvis
in the lower belly or pelvis
Some experts believe that some uterine fibroids can
occasionally interfere with fertility and pregnancy. Although it's rare, a
uterine fibroid projecting into the uterus might either block an embryo from
implanting there, or cause problems with the pregnancy later.
Effects on Pregnancy
One of the most common concerns that I am
asked about in my clinical practice is whether the patient can become pregnant
with a fibroid. Again, location is key. Depending on where it is, whether it
affects the cavity where the baby grows or blocks the fallopian tube for
fertilization, treatment will be dictated by these factors. If those issues are
not present, women can become pregnant and have a normal pregnancy. All these
issues should be discussed with your physician prior to pregnancy to determine
your specific needs. Fibroids will grow during pregnancy, often experiencing
the greatest growth during the first trimester.
Although intimidating at first, fibroids are
not as scary as they sound. Not everyone must have them removed, and a solid
relationship with your physician will help guide you as to the best treatment.
If you are ever in doubt, seek a second opinion. If your
physician does not perform minimally invasive procedures, there are many
specialists that do.
Source: DoctorOz, WebMD