What are fibroids?
Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.
Why should women know about fibroids?
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.Who gets fibroids?
There are factors that can increase a woman's risk of developing fibroids.- Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
- Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
- Ethnic origin. African-American women are more likely to develop fibroids than white women.
- Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
- Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
Where can fibroids grow?
Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:- Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.
- Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.
- Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.
What are the symptoms of fibroids?
Most fibroids do not cause any symptoms, but some women with fibroids can have:- Heavy bleeding (which can be heavy enough to cause anemia) or painful periods
- Feeling of fullness in the pelvic area (lower stomach area)
- Enlargement of the lower abdomen
- Frequent urination
- Pain during sex
- Lower back pain
- Complications during pregnancy and labor, including a six-time greater risk of cesarean section
- Reproductive problems, such as infertility, which is very rare
What causes fibroids?
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:- Hormonal (affected by estrogen and progesterone levels)
- Genetic (runs in families)
Can fibroids turn into cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.What if I become pregnant and have fibroids?
Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn't mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:- Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
- Baby is breech. The baby is not positioned well for vaginal delivery.
- Labor fails to progress.
- Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
- Preterm delivery.
How do I know for sure that I have fibroids?
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.Your doctor can do imaging tests to confirm that you have fibroids. These are tests that create a "picture" of the inside of your body without surgery. These tests might include:
- Ultrasound – Uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
- Magnetic resonance imaging (MRI) – Uses magnets and radio waves to produce the picture
- X-rays – Uses a form of radiation to see into the body and produce the picture
- Cat scan (CT) – Takes many X-ray pictures of the body from different angles for a more complete image
- Hysterosalpingogram (hiss-tur-oh-sal-PIN-juh-gram) (HSG) or sonohysterogram (soh-noh-HISS-tur-oh-gram) – An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.
- Laparoscopy (lap-ar-OSS-koh-pee) – The doctor inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.
- Hysteroscopy (hiss-tur-OSS-koh-pee) – The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.
What questions should I ask my doctor if I have fibroids?
- How many fibroids do I have?
- What size is my fibroid(s)?
- Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?
- Can I expect the fibroid(s) to grow larger?
- How rapidly have they grown (if they were known about already)?
- How will I know if the fibroid(s) is growing larger?
- What problems can the fibroid(s) cause?
- What tests or imaging studies are best for keeping track of the growth of my fibroids?
- What are my treatment options if my fibroid(s) becomes a problem?
- What are your views on treating fibroids with a hysterectomy versus other types of treatments?
How are fibroids treated?
Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:- Whether or not you are having symptoms from the fibroids
- If you might want to become pregnant in the future
- The size of the fibroids
- The location of the fibroids
- Your age and how close to menopause you might be
Medications
If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.
Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.
Other drugs used to treat fibroids are "gonadotropin releasing hormone agonists" (GnRHa). The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pain. Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. This can be a big relief to women who have heavy bleeding. It also allows women with anemia to recover to a normal blood count. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.
Surgery
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
- Myomectomy (meye-oh-MEK-tuh-mee) – Surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.
- Hysterectomy (hiss-tur-EK-tuh-mee) – Surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.
- Endometrial Ablation (en-doh-MEE-tree-uhl uh-BLAY-shuhn) – The lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding. But, a woman cannot have children after this surgery.
- Myolysis (meye-OL-uh-siss) – A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
- Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization
(UAE) – A thin tube is thread into the blood vessels that supply blood
to the fibroid. Then, tiny plastic or gel particles are injected into
the blood vessels. This blocks the blood supply to the fibroid, causing
it to shrink. UFE can be an outpatient or inpatient procedure.
Complications, including early menopause, are uncommon but can occur.
Studies suggest fibroids are not likely to grow back after UFE, but more
long-term research is needed. Not all fibroids can be treated with UFE.
The best candidates for UFE are women who:
- Have fibroids that are causing heavy bleeding
- Have fibroids that are causing pain or pressing on the bladder or rectum
- Don't want to have a hysterectomy
- Don't want to have children in the future
Are other treatments being developed for uterine fibroids?
Yes. Researchers are looking into other ways to treat uterine fibroids. The following methods are not yet standard treatments; so your doctor may not offer them or health insurance may not cover them.- MRI-guided ultrasound surgery shrinks fibroids using a high-intensity ultrasound beam. The MRI scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy the fibroid. The ExAblate® 2000 System is a medical device that uses this method to destroy uterine fibroids.
- Some health care providers use lasers to remove a fibroid or to cut off the blood supply to the fibroid, making it shrink.
- Mifepristone®, and other anti-hormonal drugs being developed, could provide symptom relief without bone-thinning side effects. These are promising treatments, but none are yet available or FDA approved.
- Other medications are being studied for treatment of fibroids.
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Fibroids are non-cancerous (benign) tumors that grow from the muscle layers of the uterus (womb). They are also known as uterine fibroids, myomas, or fibromyomas. The singular of uterine fibroids is Uterine Fibroma. Fibroids are growths of smooth muscle and fibrous tissue. Fibroids can vary in size, from that of a bean to as large as a melon.
Fibroids affect at least 20% of all women at sometime during their life. Women aged between 30 and 50 are the most likely to develop fibroids. Overweight and obese women are at significantly higher risk of developing fibroids, compared to women of normal weight.
Malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb. However, this is extremely rare.
There are four types of fibroids
• Intramural These are located in the wall of the uterus. These are the most common types of fibroids.
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• Subserosal fibroids These are located outside the wall of the uterus. They can develop into pedunculated fibroids (stalks). Subserosal fibroids can become quite large.
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• Submucosal fibroids These are located in the muscle beneath the lining of the uterus wall.
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• Cervical fibroids These are located in the neck of the womb (the cervix).
What are the symptoms of uterine fibroids?
Most women have no symptoms. That is why most patients with fibroids do not know they have them. When symptoms do develop, they may include:
• Anemia (as a result of heavy periods)
• Backache
• Constipation
• Discomfort in the lower abdomen (especially if fibroids are large)
• Frequent urination
• Heavy painful periods
• Pain in the legs
• Painful sex
• Swelling in the lower abdomen (especially if fibroids are large)
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• Other symptoms may include:
• Labor problems
• Pregnancy problems
• Fertility problems
• Repeated miscarriages
What are the causes of fibroids?
We are not exactly sure why fibroids occur.
During a woman's reproductive years her estrogen and progesterone levels are high. When estrogen levels are high, especially during pregnancy, fibroids tend to swell. When estrogen levels are low fibroids may shrink, e.g. during a woman's menopause.
Heredity may also be a factor. Women whose mothers and/or sisters have/had fibroids have a higher risk of developing them too.
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How are fibroids diagnosed?
In most cases, the symptoms of fibroids are rarely felt and the patient does not know she has them. They are usually discovered during a vaginal examination.
• Ultrasound If the doctor thinks fibroids may be present he/she may use an ultrasound scan to find out. Ultrasound can also eliminate other possible conditions which may have similar symptoms. Ultrasound scans are often used when the patient has heavy periods and blood tests have revealed nothing conclusive.
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• Trans-vaginal scan A small scanner is inserted into the patient's vagina so that the uterus can be viewed close up.
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• Hysteroscopy This is a small telescope that examines the inside of the uterus. During this procedure, if necessary, a biopsy can be taken of the lining of the uterus (womb).
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• Laparoscopy A laparoscope is a small device that looks at the outside of the uterus - where the doctor examines its size and shape. A laparoscope is a small flexible tube. During this procedure, if necessary, a biopsy can be taken of the outer layer of the uterus.
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• Biopsy A small sample of the lining of the uterus is taken and then examined under a microscope.
What are the treatments for fibroids?
If the woman has no symptoms and the fibroids are not affecting her day-to-day life she may receive no treatment at all. Even women who have heavy periods and whose lives are not badly affected by this symptom may also opt for no treatment. During the menopause symptoms will usually become less apparent, or disappear altogether as the fibroids usually shrink at this stage of a woman's life.
When treatment is necessary it may be in the form of medication or surgery.
Treating fibroids with medication
• GnRHA GnRHA (gonadotropin released hormone agonist), administered by injection. GnRHAs make the woman's body produce much lower quantities of estrogen, which makes the fibroids shrink. GnRHA stops the woman's menstrual cycle. It is important to remember that GNRHAs are not contraceptives, and they do not affect a woman's fertility when she stops treatment. GNRHAs are also very helpful for women who have heavy periods and discomfort in their abdomen. GNRHAs may have menopause-like symptoms as their main side-effect, this might include hot flashes (UK: flushes), a tendency to sweat more, and vaginal dryness. Although thinning of the bones (osteoporosis) is also a possible side-effect, it is rare. GnRHAs may be administered to the patient before surgery in order to shrink the fibroids. GNRHAs are for short-term, not long-term use. GNRHAs combined with HRT (hormone replacement therapy) are sometimes prescribed to prevent menopause-like symptoms.
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• Other drugs may be used to treat fibroids; however, they are less effective for larger fibroids. These include:
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• Tranexamic acid - they are presented in tablet form and are taken by the patient from the day pre menstrual period starts for up to 4 days. This is done each month. If symptoms do not improve within three months the patient should stop taking this medication. Tranexamic acid helps blood in the uterus clot, which reduces bleeding. A woman's fertility will not be affected by this treatment as soon as it is over.
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• Anti-inflammatory drugs - these medications are taken for a few days during the patient's menstrual period. They may include such drugs as mefanamic and ibuprofen. Anti-inflammatory medications reduce the amount of prostaglandins the body produces. Prostaglandins are hormones which are associated with heavy periods. These drugs are also painkillers. They do not affect a woman's fertility.
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• The contraceptive pill - these are used to stop menstruation from occurring.
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• LNG-IUS (Levonorgestrel intrauterine system) - this is a plastic device which is placed inside the uterus. LNH-IUS releases levonorgestrel (progestogen hormone). This hormone stops the lining of the uterus from growing too fast, which effectively reduces bleeding. One of the side-effects of this treatment is irregular bleeding for up to six months, headaches, breast tenderness, and acne. In very rare cases it can stop the woman's periods.
Surgery to treat fibroids
When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
• Hysterectomy - removing the uterus. This is only ever considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes considered as an option to stop recurrences of fibroids (stop them coming back). Hysterectomies have two possible side-effects: 1. Reduced libido. 2. Early menopause.
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• Myomectomy - the fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant (as opposed to a hysterectomy). Women with large fibroids, as well as those whose fibroids are located in particular parts of the uterus may not be able to benefit from this procedure.
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• Endometrial ablation - this involves removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus. This procedure is considered as an effective alternative to a hysterectomy.
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• UAE (Uterine Artery Embolization) - this treatment stops the fibroid from getting its blood supply. UAE is generally used for women with large fibroids. UAEs effectively shrink the fibroid. A chemical is injected through a catheter into a blood vessel in the leg - it is guided by X-ray scans.
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• Magnetic-resonance-guided percutaneous laser ablation - an MRI (magnetic resonance imaging) scan is used to locate the fibroids. Then very fine needles are inserted through the patient's skin and pushed until they reach the targeted fibroids. A fiber-optic cable is inserted through the needles. A laser light goes through the fiber-optic cable, hits the fibroids and shrinks them.
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• Magnetic-resonance-guided focused ultrasound surgery -" an MRI (magnetic resonance imaging) scan locates the fibroids, and then sound waves are aimed at them. This procedure also shrinks the fibroids. Most experts say Magnetic-resonance-guided percutaneous laser ablation and Magnetic-resonance-guided focused ultrasound surgery are both effective - however, there is some uncertainty regarding their benefits vs. risks.
Interesting Related Articles
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Some Newer Treatments For Uterine Fibroids Improve Recovery Time
Uterine Fibroid Embolization Highly Effective In Cases Where Focused Ultrasound To Treat Uterine Fibroids Failed
Noninvasive Ultrasound Treatment Shrinks Fibroids
Major Surgery No Longer Needed For The Removal Of Uterine Fibroids
New MR Sequence Helps Radiologists More Accurately Evaluate Abnormalities Of The Uterus And Ovaries
What are the complications of fibroids?
It is important to stress that in the vast majority of cases fibroids do not result in complications for patients. However, for a tiny minority they do. Complications may include:
• Menorrhagia (heavy periods) - the most common complication being a disruption of the woman's ability to function normally when periods are present, and also the possibility of depression because of this. In some cases, menorrhagia can lead to anemia and fatigue.
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• Abdominal pains - if the patient's fibroids are large she may experience swelling and discomfort in the lower abdomen. She may also have a sensation of being constipated. Some women with large fibroids say their bowel movements are painful.
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• Premature birth, labor problems, miscarriages - as estrogen levels rise significantly during pregnancy, and as estrogen can speed up fibroid growth, some women may experience early labor, miscarriages or complications during labor.
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• Infertility - in some cases fibroids can make it more difficult for the fertilized egg to attach itself to the lining of the uterus. A fibroid that grows outside the uterus (submucosal fibroid) may change the uterus' shape, making it harder for the woman to get pregnant.
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• Leiomyosarcoma - this is extremely rare. This is a form of cancer, and it can develop inside the fibroids.
Written by Christian Nordqvist
Copyright: Medical News Today
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