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Uterine Fibroids

Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. Uterine fibroids are usually round. Uterine fibroids are often described based upon their location within the uterus. Fibroids are located along the lining of the uterus.

Early pregnancy decreases the likelihood that fibroids will develop. Fibroids have not been observed in girls who have not reached puberty, but adolescent girls may rarely develop fibroids. An increased risk of developing fibroids include having the first menstrual period (menarche) prior to age 10, consumption of alcohol, uterine infections and elevated blood pressure. 

 

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Most women with fibroids have no symptoms. However, abnormal uterine bleeding is the most common symptom of fibroids. If the tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause heavy periods, painful periods, prolonged periods or spotting between menses. Women with excessive bleeding due to fibroids may develop iron deficiency anemia. Uterine fibroids that are degenerating can sometimes cause severe, localized pain.
 
Fibroids can also cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. Large fibroids can cause:
  • Pressure in the pelvic region.
  • Pelvic pain.
  • Pressure on the bladder with frequent or obstructed urination.
  • Pressure on the rectum with painful and obstructed defecation.

Uterine fibroids are diagnosed by pelvic exam and even more commonly by ultrasound. Often, a pelvic mass cannot be determined to be a fibroid on pelvic exam alone, and ultrasound is very helpful in differentiating it from other conditions such as ovarian tumors. MRI and CT scans can also play a role in diagnosing fibroids, but ultrasound is the simplest, cheapest, and best technique for imaging the pelvis. Occasionally, when trying to determine if a fibroid is present in the uterine cavity (endometrial cavity), a hysterosonogram (HSG) is done. In this procedure, an ultrasound exam is done while contrast fluid is injected into the uterus through the cervix. 

 

There are several options for the treatment of uterine fibroids that include:
  • Surgery (hysterectomy, myomectomy, cryosurgery). 
  • MRI-guided high-intensity focused ultrasound.
  • Uterine artery embolization.
  • Uterine artery occlusion (UAO), which involves clamping the involved uterine arteries as opposed to injecting the polyvinyl alcohol beads.

Non-surgical techniques are usually hormonal in nature and include the use of drugs that turn off the production of estrogen from the ovaries. These medications are given for three to six months. When successful, they can shrink the fibroids by as much as 50%.

Side effects of these drugs are similar to the symptoms of menopause and can include hot flashes, sleep disturbance, vaginal dryness, and mood changes. Bone loss leading to osteoporosis after long-term (6 to 12+ months) use is one complication.

 

  • Check for recurrence of fibroids.
  • Follow up tests are must.
  • Post procedure pelvic examinations are must .
  • Maintaining hygiene during periods is must.

 

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Uterine Fibroids

Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. Uterine fibroids are usually round. Uterine fibroids are often described based upon their location within the uterus. Fibroids are located along the lining of the uterus.

Early pregnancy decreases the likelihood that fibroids will develop. Fibroids have not been observed in girls who have not reached puberty, but adolescent girls may rarely develop fibroids. An increased risk of developing fibroids include having the first menstrual period (menarche) prior to age 10, consumption of alcohol, uterine infections and elevated blood pressure. 

 

Symptoms

Most women with fibroids have no symptoms. However, abnormal uterine bleeding is the most common symptom of fibroids. If the tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause heavy periods, painful periods, prolonged periods or spotting between menses. Women with excessive bleeding due to fibroids may develop iron deficiency anemia. Uterine fibroids that are degenerating can sometimes cause severe, localized pain.
 
Fibroids can also cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. Large fibroids can cause:
  • Pressure in the pelvic region.
  • Pelvic pain.
  • Pressure on the bladder with frequent or obstructed urination.
  • Pressure on the rectum with painful and obstructed defecation.

Diagnosis

Uterine fibroids are diagnosed by pelvic exam and even more commonly by ultrasound. Often, a pelvic mass cannot be determined to be a fibroid on pelvic exam alone, and ultrasound is very helpful in differentiating it from other conditions such as ovarian tumors. MRI and CT scans can also play a role in diagnosing fibroids, but ultrasound is the simplest, cheapest, and best technique for imaging the pelvis. Occasionally, when trying to determine if a fibroid is present in the uterine cavity (endometrial cavity), a hysterosonogram (HSG) is done. In this procedure, an ultrasound exam is done while contrast fluid is injected into the uterus through the cervix. 

 

Treatment

There are several options for the treatment of uterine fibroids that include:
  • Surgery (hysterectomy, myomectomy, cryosurgery). 
  • MRI-guided high-intensity focused ultrasound.
  • Uterine artery embolization.
  • Uterine artery occlusion (UAO), which involves clamping the involved uterine arteries as opposed to injecting the polyvinyl alcohol beads.

Non-surgical techniques are usually hormonal in nature and include the use of drugs that turn off the production of estrogen from the ovaries. These medications are given for three to six months. When successful, they can shrink the fibroids by as much as 50%.

Risks

Side effects of these drugs are similar to the symptoms of menopause and can include hot flashes, sleep disturbance, vaginal dryness, and mood changes. Bone loss leading to osteoporosis after long-term (6 to 12+ months) use is one complication.

 

After Procedure

  • Check for recurrence of fibroids.
  • Follow up tests are must.
  • Post procedure pelvic examinations are must .
  • Maintaining hygiene during periods is must.

 

FAQ Section

1) What are uterine fibroids?

Uterine fibroids, also known as uterine leiomyomas, are non cancerous growth that occurs in the female reproductive system during the childbearing years. They usually go unnoticed as they do not show any significant symptoms for quite some time. They are benign, compact tumours made of smooth muscle cells and fibrous connective tissues. They vary in their sizes from being extremely small to being so large of being capable of enlarging the uterus.

2) Can fibroids turn Into cancer?

Most of the uterine fibroids that occur are non-cancerous. However, it is observed in extremely unusual cases, that these fibroids can become cancerous. This possibility occurs with a probability of one in every thousand. This condition is called leiomyosarcoma. 

3) What happens If you become pregnant and have fibroids?

Having fibroids during pregnancy is a common case and is not considered to be harmful. In fact, women having either one or more fibroids usually experience no pregnancy complications. Only a fraction, i.e. about ten to thirty percentage of the women experience complications like abdominal pain accompanied by light vaginal bleeding. The surgical removal of these fibroids is usually delayed until the delivery is over.

4) Who is most likely to have fibroids ?

Women who are in the reproductive age, and women aged between thirty to forty years are more susceptible to suffering from uterine fibroids. Heredity also plays a crucial role in the developing of uterine fibroids in women.

5) What are the symptoms of fibroids?

Some of the commonly observed symptoms associated with Uterine Fibroids are as follows :

  • Menstrual periods lasting for more than a week
  • Pelvic pressure or pain
  • Constipation
  • Frequent urge to urinate
  • Difficulty in emptying of the bladder
  • Backache or leg pains
  • Heavy menstrual bleeding

6) What factors can increase a woman's risk of developing fibroids?

Some of the factors that influence the risk of developing uterine are :

  • Women in the reproductive age more often tend to develop uterine fibroids.
  • Heredity – If any of your close relatives have fibroids, then you will have a higher tendency of developing them.
  • The racial background may also increase the risk.
  • The risk of uterine fibroids increases with obesity.
  • Diet can also play a role in developing uterine fibroids.

7) What complications can occur with fibroids?

Some of the complications that can arise due to fibroids are menstrual periods lasting for more than a week, pelvic pressure or pain, constipation, frequent urge to urinate, difficulty in emptying of the bladder, backache or leg pains and heavy menstrual bleeding. In some rare cases, pregnancy complications have also been observed.

8) How are fibroids diagnosed?

Diagnosis of fibroids is done through various tests and procedures recommended by your gynaecologist such as :

  • Ultrasound: Uses sound waves for the mapping and measuring of the fibroids.
  • Lab Tests: Prescribed in cases of any unusual cases such as Complete Blood Count test for abnormal bleeding.
  • Magnetic Resonance Imaging (MRI) : Shows the size and location of the fibroids and identifies different types of tumor.
  • Hysterosonography: uses sterile saline to expand the uterine cavity, making it easier to get images of submucosal fibroids and the endometrium.

 

9) Can fibroids come back after treatment?

Yes, fibroids can return after treatment and is not a very rare phenomenon. If the fibroids return without any symptoms, then no further treatment is required. If the fibroids return without any symptoms, then there is no need to worry.

10) When is treatment necessary for fibroids?

Treatment for fibroids is necessary when the symptoms start interfering with your daily life or they start causing any sort of inconvenience.

 

11) Can medication be used to treat fibroids?

Medications that target hormones which regulate your menstrual cycle are prescribed such as :

  • Gonadotropin-releasing hormone (Gn-RH) agonists like Lupron block the production of estrogen and progesterone.
  • Gonadotropin-releasing hormone (Gn-RH) agonists to relieve heavy bleeding caused by fibroids.
  • Tranexamic acid (Lysteda) to ease heavy menstrual periods.

12) What types of surgery can treat fibroids?

Some of the surgical treatment methods for uterine fibroids are :

  • Abdominal Myomectomy : It is a surgical procedure for the removal of very large, deep or multiple fibroids.
  • Hysterectomy : This surgical procedure involves the removal of the uterus.
  • Uterine artery embolization : Small particles (embolic agents) are injected into the arteries supplying the uterus resulting in the cutting off blood flow to fibroids leading to shrinkage and death of the fibroid.
  • Myolosis : The blood vessels that feed the fibroids is shrunk with the help of a laser or electric current.