Uterine Fibroids

What are uterine fibroids?

Uterine fibroids are a non-cancerous growth in the uterine wall, ranging in size from microscopic to the size of a grapefruit.

What happens in the body?

Fibroids are round and firm lumps often in groups located in the walls of the uterus. They are made of muscle fibers and fibrous tissue. They respond to an increase in estrogen levels, which is one of the female hormones. An increase in hormonal values will result in accelerated growth of the fibroid.

This occurs in cases of:

• Hormone replacement therapy in menopause
• Use of contraceptives
• Pregnancy

After menopause, fibroids may shrink or disappear completely

What are the causes and risks?

The exact cause of fibroid formation is not known. Studies have shown that their growth is influenced by factors:

* Genetics as an important factor in the development of fibroids.
* They occur more frequently during the reproductive period when there is an increase in blood supply to the uterus.
* Estrogen and Progesterone, which are female hormones, seem to stimulate their growth. It has been observed that fibroids have more receptors for estrogen and progesterone.

Risk factors include:

* Heredity: especially if a mother or sister has fibroids.
* Racial Factor: black women suffer 3 times more, as well as larger size and number of fibroids than white women.

Signs and symptoms

Many women may not have any signs of the presence of fibroids. Symptoms depend on their number, size, and location:

• The number can range from one to several.
• Sizes vary from microscopic to the size of a grapefruit.
• Location can be superficial, internal, or intramural (as in the figure)

Symptoms:

• Anemia, or a decrease in the number of red blood cells as a result of prolonged and heavy bleeding
• Intermenstrual bleeding
• Pain during sexual intercourse
• Frequent urination caused by the pressure the tumor places on the bladder
• Heavy and prolonged menstrual periods
• Pain or pressure in the lower abdomen or back pain
• Painful menstrual cycles

Diagnosis & Tests

Fibroids are common in women over 35 years old. Rarely are they malignant or cancerous. Fibroids that grow on the outer surface of the uterus can be felt as lumps during a pelvic exam. Whereas fibroids that grow inside the uterus are harder to detect during this exam.

The diagnosis is confirmed through ultrasound examination. Rarely dilation and curettage (D&C) may be needed to take tissue samples from the inside of the uterine cavity.

The entirety of the uterine cavity is examined through Hysteroscopy, to exclude the existence of uterine cancer or endometrial polyps. Magnetic resonance imaging provides accurate dimensions, location, and helps in determining the method of treatment.

Prevention:

Since the causes of their formation are not known, there is no way to prevent their development.

• The presence of Fibroids can make conceiving a child more difficult
• During pregnancy, they can cause miscarriages or complications during childbirth
• Fibroids can twist and may require surgical intervention
• Fibroids are not contagious
• Fibroids can pose a risk to the fetus during pregnancy.

Treatment & Monitoring

Most fibroids do not cause symptoms and therefore do not need treatment.

Medications are often used to reduce the tumor by lowering estrogen levels in the blood such as GNRH agonists, androgens, nonsteroidal anti-inflammatory.

Women with heavy prolonged bleeding leading to anemia and not controllable by medication should undergo surgical intervention, which depending on the desire to have children can range from removal of only the fibroid to removal of the entire uterus.

If the fibroid is located in the uterine cavity, its removal can be done with a resectoscope, via the vaginal route.

Another procedure that can be used is arterial embolization during which a tube is placed in the uterine artery and small beads are injected that go towards the tumor. These block the flow in the target artery leading to shrinkage of the fibroid.

Treatment with laser, or MIOLYSIS, is another procedure that destroys the fibroid. 3-4 months prior, the woman should take some medications that cause the tumor to shrink and then laser treatment is done.

What are the side effects of treatment?

Surgical intervention carries the risk of bleeding, infections, or allergic reactions from anesthesia.

What happens after treatment?

If a hysterectomy is performed, there is no more risk of developing another fibroid.
If the ovaries are removed during the surgery, hormone replacement therapy should continue.
If a myomectomy (removal of only the fibroid) is performed, in about 10% of cases, there is further growth

How is monitoring done?

Women with fibroids should be examined every 6 months to monitor the size of the tumor and the blood circulation within it, as well as the appearance of various symptoms.