Sunday, August 30, 2009
Fibroids
Uterine fibroids are benign (not cancer) growths in the uterus. They are the most common type of growth found in a woman’s pelvis. In some women, fibroids remain small and do not cause symptoms or problems. However, in some women, fibroids can cause problems because of their size, number, and location.
Types of Fibroids
Uterine fibroids are growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas.
The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure.
Fibroids can range in size from small, pea-sized growths to large, round ones that may be more than 5–6 inches wide. As they grow, they can distort the inside as well as the outside of the uterus. Sometimes fibroids grow large enough to completely fill the pelvis or abdomen.
A woman may have only one fibroid or many of varying sizes. Whether fibroids will occur singly or in groups is hard to predict. They may remain very small for a long time, suddenly grow rapidly, or grow slowly over a number of years.
Causes
Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.
It is not clear what causes fibroids. Some research suggests that they develop from misplaced cells present in the body before birth. The female hormones estrogen and progesterone appear to be involved in their growth. Levels of these hormones can increase or decrease throughout a woman’s life. For instance, menopause causes a decrease in estrogen. Fibroids often shrink when a woman enters menopause. Hormonal drugs that contain estrogen, such as birth control pills, may cause fibroids to grow.
Symptoms
Fibroids may cause the following symptoms:
Changes in menstruation
Longer, more frequent, or heavy menstrual periods
Menstrual pain (cramps)
Vaginal bleeding at times other than menstruation
Anemia (from blood loss)
Pain
In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
During sex
Pressure
Difficulty urinating or frequent urination
Constipation, rectal pain, or difficult bowel movements
Abdominal cramps
Enlarged uterus and abdomen
Miscarriages
Infertility
These symptoms also may be signs of other problems. Therefore, you should see your doctor if you have any of these symptoms.
Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.
Complications
Although most fibroids do not cause problems, there can be complications. Fibroids that are attached to the uterus by a stem may twist and can cause pain, nausea, or fever. Fibroids that grow rapidly, or those that start breaking down, also may cause pain. Rarely, they can be associated with cancer.
A very large fibroid may cause swelling of the abdomen. This swelling can make it hard to do a thorough pelvic exam.
Fibroids also may cause infertility, although other causes are more common. Other factors should be explored before fibroids are considered the cause of a couple’s infertility. When fibroids are thought to be a cause, many women are able to become pregnant after they are treated.
Diagnosis
The first signs of fibroids may be detected during a routine pelvic exam. A number of tests may show more information about fibroids:
Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
Hysteroscopy uses a slender device (the hysteroscope) to see the inside of the uterus. It is inserted through the vagina and cervix (opening of the uterus). This permits the doctor to see fibroids inside the uterine cavity.
Hysterosalpingography is a special X-ray test. It may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
Sonohysterography is a test in which fluid is put into the uterus through the cervix. Ultrasonography is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
Laparoscopy uses a slender device (the laparoscope) to help the doctor see the inside of the abdomen. It is inserted through a small cut just below or through the navel. The doctor can see fibroids on the outside of the uterus with the laparoscope.
Imaging tests, such as magnetic resonance imaging and computed tomography scans, may be used but are rarely needed. Some of these tests may be used to track the growth of fibroids over time.
Treatment
Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal the need for treatment:
Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
Bleeding between periods
Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
Rapid increase in growth of the fibroid
Infertility
Pelvic pain
There are many treatment options for fibroids. The choice of treatment depends on factors such as your own wishes and your doctor’s medical advice about the size and location of the fibroids.
Medications
Drug therapy is an option for some women with fibroids. Medications may reduce the heavy bleeding and painful periods that fibroids sometimes cause. But, they may not prevent the growth of fibroids. Surgery often is needed later. Drug treatment for fibroids includes the following options:
Birth control pills and other types of hormonal birth control methods. These drugs often are used to control heavy bleeding and painful periods. A drawback is that this treatment may cause the fibroids to increase slightly in size. For some women, the benefits of hormonal contraception outweigh the risk of this side effect.
Gonadotropin–releasing hormone (GnRH) agonists. These drugs stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. GnRH agonists have many side effects, including bone loss, osteoporosis, vaginal dryness, and night sweats. For these reasons, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
Progestin–releasing intrauterine device. This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.
In addition to these drugs, many others are being studied for the treatment of fibroids.
Myomectomy
Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. If a woman does become pregnant after a myomectomy, the baby may need to be delivered by cesarean birth. Sometimes, though, a myomectomy causes internal scarring that can lead to infertility.
Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.
Myomectomy may be done in a number of ways:
Laparotomy
A surgical procedure in which an incision is made in the abdomen.
Laparoscopy
A surgical procedure in which a slender, light-transmitting telescope, the laparoscope, is used to view the pelvic organs or perform surgery.
Hysteroscopy.
A surgical procedure in which a slender, light-transmitting telescope, the hysteroscope, is used to view the inside of the uterus or perform surgery.