Uterine Fibroids

Uterine fibroids or leiomyomas  are non-cancerous growths of the uterus. They usually appear during the child bearing years of the majority of  women and are not associated with an increased risk of having uterine  cancer. Uterine fibroids develop from the myometrium (smooth muscle of the uterus).

Uterine fibers differ in their pattern of growth- some grow fast, others slow and others remain the same size. Some fibroids might even shrink on their own. The size of fibroids ranges from bulky masses that enlarge and deform the uterus to microscopic sizes that are undetectable to the human eye.

There are different types of fibroids depending on their location in the uterus:                                                                                                        

• Submucosal fibroids, which  grow into the inner cavity opf the uterus.                                                                  
• Subserosal fibroids, which project to the outside of the uterus.                                                                               
• Intramural fibroids, which grow within the muscular wall of the uterus.                                                                    
• Most women are unaware of uterine fibroids due lack of symptoms.

Most women with uterine fibroids do not experience any symptoms. However, when  signs and symptoms are present they may include:

• heavy menstraution                                                                                                                                        
• menstrual periods longer than 7 days                                                                                                              
• pelvic pain                                                                                                                                                  
• painful urination                                                                                                                                              
• constipation                                                                                                                                                  
• backache and leg pains                                                                                                                                  

Pain and fever can be present if  the byproducts of a degenerating fibroid move into the surrounding tissue.                          

Submucosal fibroids cause prolonged and heavy menstraul bleeding, subserosal fibroids cause urinary symptoms and backache and intramural fibroids distort the the shape of the uterus , prolong the duration of menstraution and also cause heavy menstraul bleeding. Intramural fibroids also cause pain and pressure.

Although the exact cause of uterine fibroids is not known, doctors believe it may be caused by the following factors:                        

• Genetic changes  due to mutations.                                                                                                                  
• Hormonal imbalances especially imbalances of the level of estrogen and progesterone. These two hormones stimulate the development of the lining of the uterus during the menstrual cycle in anticipation of pregnancy. Fibroids contain more estrogen and progesterone receptors. They usually shrink after menopause because there is a decreased production of estrogen and progesterone during this period.                                          

Other substances that maintain the tissues of the body like insulin-like growth factor may also contribute to the growth of fibroids.

If the symptoms of uterine fibroids are present, the following tests may be carried out in order to make a diagnosis:                                                      

• Imaging tests like ultrasound, MRI, hysterosonography and hysteroscopy:
  • MRI is used to identify the location and size of the fibroids.
  • In hysterosonography, sterile saline is used to expand the uterine cavity and fallopian tubes so that they can be easily during an ultrasound.
  • In hysteroscopy a small tube with a lighted telescope is inserted into the uterus through the cervix. This helps doctors to examine the uterine wall and openings of the fallopian tubes.            

Another imaging test that can be used is hysterosalpingography in which a dye is used to highlight the uterine cavity and fallopian tubes on X-ray images.                                                                                                                                

Lab tests to check the levels of certain hormones like estrogen and progesterone. A complete blood count may also be include to check if the woman has anemia due to chronic blood loss.

Most fibroid do not require treatment since they are not cancerous and can rarely affect pregnancy. Several treatments are available for women who need treatment. This includes medications and surgical procedures to remove the fibroids.                  

Medications treat the symptoms of heavy bleeding and pelvic pressure. They target the hormones that regulate the menstrual cycle. However, they do not eliminate the fibroids. Medications include; NSAIDs like acetaminophen (Tylenol) and gonadotropin-releasing hormone ( GnRH) agonist like Lupron and Synarel. A progestin-releasing intrauterine device (IUD) can be used to relieve the heavy bleeding caused by fibroids.                                                                                                              

Surgical procedures include:                                                                                                                                      

Abdominal myomectomy in which fibroids are removed and hysterectomy in which the whole uterus is removed. Hysterectomy prevents a woman from having children.                                                                                                              

Other treatments include:

• MRI-guided focused ultrasound surgery , a procedure that requires no incisions. Sound waves are used to destroy fibroids.
• Uterine artery embolization, blood supply to the uterus is blocked causing the fibroids to shrink and die.
• Myolysis, an electric current or laser is used to shrink the vessels that supply the fibroids.
• Laparoscopic or robotic myomectomy, in which instruments are inserted into the abdominal cavity through small holes made on the abdomen. With the help of a camera that is attached to one of the instruments, doctors are able to remove the fibroids.

Alternative remedies for uterine fibroids include specific dietary recommendations, enzymes and hormones. There is currently no evidence to shoe that these treatments are effective.

There are several risks and complications associated with uterine fibroids.

The risks factors of having uterine fibroids include:

• being as woman in the reproductive age
• having a family history of uterine fibroids
• being black since black women are more likely to have fibroids
• starting menstraution at an early age
• eating a diet with higher amounts of red meat and lower amount of vegetables and fruits                                                  
• consuming a lot of alcohol

Although uterine fibers are harmless, they can also cause some complications.

The most common complications are infertility and miscarriages. This usually if a woman has submucosal fibroids since they prevent the imlantation and growth of an embryo. Sometimes fibroid can block the fallopian tubes and this can interfere with fertilization of the egg by the sperm.