Fibroids are benign growths in the wall of the uterus, the reproductive organ where a fetus develops. The tumors often grow into the uterine cavity. In rare cases, fibroids may protrude from the uterus toward nearby organs. Fibroids vary in size from very small to eight or more inches in diameter. Usually more than one fibroid is present. About 20-30% of women of childbearing age, and as many as half of all women, have fibroids. Many do not realize it. Most do not develop symptoms until their late 30s or 40s.
Causes
The cause of fibroids is unknown. Genes and abnormalities in substances that regulate blood vessel development may make some women prone to fibroids. Female reproductive hormones stimulate fibroid growth. Fibroids increase in size during pregnancy then decrease after childbirth. Fibroids become less of a problem after menopause. However, symptoms may return with hormone replacement therapy.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Symptoms
Symptoms range from none at all to mild or severe, depending on the size and location of the growths.
Symptoms include:
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Pelvic pain
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Feeling of pelvic pressure
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Heavy menstrual bleeding
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Clots in menstrual flow
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Long periods
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Bleeding between periods
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Increased cramping during periods
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Pain during sex
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Frequent need to urinate
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Constipation
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Bloating
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Enlarged uterus, giving the appearance of pregnancy
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Low back or leg pain
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Infertility by blocking the fallopian tubes
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Miscarriage
Iron-deficiency anemia may develop if bleeding is heavy. Symptoms include:
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Weakness
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Fatigue
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Pale skin
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Light-headedness
Diagnosis
Doctors find most fibroids during routine pelvic exams. An abdominal ultrasound confirms the diagnosis. A transvaginal ultrasound may be done to obtain clearer images. A CT scan or magnetic resonance imaging (MRI) may be ordered in complex cases. Hysteroscopy allows the doctor to see inside the uterus using a thin, lighted tool inserted in the vagina and passed through the cervix. During the procedure, the doctor may be able to remove small fibroids or reduce the size of larger growths.
Treatment
Most women with fibroids have no symptoms and do not need treatment. The doctor may recommend "watchful waiting," monitoring the size and growth of the fibroids at regular intervals using ultrasound.
Treatments include:
Pain Medication
Over-the-counter pain pills ease mild symptoms. Prescription pain relievers may be needed. Nonsteroidal anti-inflammatory drugs reduce inflammation and help with cramping.
Hormonal Therapy
Hormone medications are an option if you are not trying to become pregnant. Synthetic hormones create an artificial menopause. The drugs shrink fibroids and diminish the pain by decreasing the supply of estrogen to the uterus. However, fibroids can return once the drugs are stopped. These drugs are often used to reduce fibroid size prior to surgery. These drugs are harmful to a developing fetus. You must use a barrier method of birth control while taking them.
Surgery
Surgery is considered if:
Surgical procedures include:
Myomectomy – removal of the fibroids only and leaving the uterus intact. This can be done by:
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Open surgery that involves a single large abdominal incision
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Laparoscopy, using a lighted fiberoptic tube and requiring only a few small incisions
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Hysteroscopy, which involves the insertion of a hysterescope through the cervix
Because it preserves the uterus, myomectomy is commonly performed on younger women who may want to have children. However, conceiving may remain difficult. The surgery is less successful if there are many fibroids, because some may grow back.
Uterine Fibroid Ablation – An alternative to surgical removal is Uterine Fibroid Ablation (a.k.a. Myolysis), which uses heat to disrupt the blood supply to the fibroid, causing it to shrink. This is a relatively new procedure and not available in all medical facilities.
Total Hysterectomy – removal of the entire uterus. This may be done through a vaginal or abdominal incision. Hysterectomy is the definitive treatment for fibroids, but it eliminates the possibility of having children.
Non-Surgical Options
Uterine Fibroid Embolization –Fibroids need an adequate supply of blood to grow. Without blood, the tumors shrink. Doctors can perform a uterine fibroid embolization (a.k.a. uterine artery embolization) to stop the blood flow. A specially trained doctor makes small cuts in the groin and threads a catheter into the arteries that supply the uterus with blood. Tiny particles of plastic or gelatin are passed through the catheter. The particles make their way to the fibroids and block blood from reaching the tumors.
Focused Ultrasound Therapy – Focused Ultrasound Therapy is a new, non-invasive treatment done under magnetic resonance imaging (MRI) guidance which recently completed successful clinical trials. It is available in a limited number of academic medical centers and may not be appropriate for patients who are significantly overweight, have very large fibroids, or extensive scars from prior abdominal surgeries.
Prevention
There are no guidelines for preventing fibroids because the cause is unknown.
RESOURCES:
The American College of Obstetricians and Gynecologists
http://www.acog.org
The InterNational Council on Infertility Information Dissemination
http://www.inciid.org
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/. Accessed October 13, 2005.
Cotran RS, Kumar V, Collins T, et al. Robbins Pathologic Basis of Disease, 6th ed. Philadelphia, PA: W.B. Saunders; 1999.
Hindely J, Gedroyc WM, Regan L, et al, MRI Guidance of focused ultrasound therapy of uterine fibroid: early results. Am J Roentgenol. 2004;183:1713-1719. Reviewed in: OBG Management, 2005;17(9):34-37.
National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/. Accessed October 13, 2005.
Rakel RE and Bope ET. Conn's Current Therapy 2001, 53rd ed. Philadelphia, PA: W.B. Saunders Company; 2001.
Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/. Accessed October 13, 2005.
