Fibroids

Basic Information

Fibroids are benign (or non-cancerous) tumors that accumulate in a woman's uterus. They are often called "uterine myomas". Fibroids are most often diagnosed in women that have reached at least thirty years of age. They affect approximately 30 percent of all reproductive age women. They are the most common type of pelvic tumor in women. Many doctors believe that more than half of all reproductive age women have fibroids, but are unaware due to the asymptomatic (or non-symptom causing) nature of most cases. Fibroids are very defined growths, and appear in groups that contain up to seven tumors. They are made up of smooth muscle tissue and other solid cellular materials. Although they appear in different locations in the uterus, they are always attached to the uterine myometrium (or the smooth muscle lining).

There is some evidence that high levels of estrogen promote the development of fibroids. The fact that estrogen production drops off during menopause may explain why fibroids tend to reduce in size after women enter the menopausal phase of their reproductive cycle. The high estrogen levels in oral contraceptives (or the "pill") has also led some doctors to advise women with fibroids to discontinue their use.

Although the actual cause of fibroids is unknown, there is evidence that it may be genetic in nature. For example, women of African descent are five times more likely to develop fibroids than white women. Obesity also increases a woman's chances of developing fibroids.

It is unknown whether or not fibroids is life-threatening. Most healthcare experts do not believe it is possible for a fibroid to transform into a cancerous tumor. There is evidence, however, that a weak relationship exists between extremely large fibroids and the presence of uterine cancer. As a result, many doctors advise surgical removal when a fibroid becomes very large.

Fibroids can result in reproductive problems, including sterility, miscarriage, premature labor, and labor complications. Such developments are rare, and occur when the fibroids severely alter the shape of the uterus. In order to prevent reproductive complications, fibroids are typically removed when they are large or when they greatly disturb the shape of uterus.

Types of Fibroids

There are several types of fibroids. They are usually categorized according to location. Location also determines both the kind of symptoms produced and the method of treatment required. Fibroids that are attached inside the cavity of the uterus are called "intracavitary fibroids". These fibroids often cause irregular bleeding between periods and severe cramping. They are rarely asymptomatic. Bleeding between periods is called "metrorrhagia". Submucous fibroids are located part in the cavity and part in the uterine wall. These fibroids are associated with both irregular bleeding between periods and heavy menstrual bleeding. Finally, intramural fibroids are found along the wall of the uterus. They range in size, anywhere from undetectable to bigger than a baseball. Intramural fibroids are the most common type, and they usually do not cause symptoms. As a result, treatment is not often required. When a fibroid is attached to the outside of the uterine wall, it is called a "subserous" fibroid.

Intramural fibroids account for almost all instances of fibroids. In most cases, however, fibroids do not rigidly remain in any one part of the uterus. As a result, most often fibroids are combinations of all these different types. For instance, almost all of a fibroid may be attached to the wall of the uterus, but part of it might connect to the uterine cavity. This type of fibroid is called a "hybrid".

Symptoms

Most women who have fibroids are asymptomatic. This is because intracavitary and submucous fibroids (the two types that always produce symptoms) make up only 5 percent of all fibroid cases. Some researchers suggest that as few as 20 percent of women with fibroids experience symptoms.

The most prevalent symptom is irregular bleeding. Some women with fibroids are affected by menorrhagia. It is also called "hypomenorrhea". It is characterized by either heavy menstrual bleeding or prolonged menstrual bleeding. Women with fibroids might discharge such heavy volumes of blood during their period that they have to constantly change sanitary protection. At the same time, whereas most women have periods that last 4 to 5 days, a woman with fibroids may bleed for over a week. Although less common, metrorrhagia may also be associated with fibroids. Metrorrhagia refers to when a woman bleeds between periods. Both menorrhagia and metrorrhagia are more likely to happen in women who have either intracavitary or submucous fibroids.

Another common symptom of fibroids is atypical pelvic pressure. Fibroids can develop to be quite large and they exert pressure onto the uterine wall. In fact, a uterus containing fibroids can grow to be as large as a mid-pregnancy uterus. Sometimes this pressure is the result of an oddly-shaped fibroid pressing up against the uterine wall. Other times it is due to a fibroid directly exerting force on an organ (such as the bladder). In some cases, this pressure can cause improper functioning of certain organs. Some women with fibroids experience difficulty with their bladder control or with bowel movements. In extreme instances, kidney dysfunction can develop.

Diagnosis

The presence of fibroids in the uterus is often detected though a pelvic examination. During this examination, the doctor will ascertain the size and shape of the uterus, looking for any irregularities. The technique for this basic procedure involves the doctor inserting two fingers into the vagina while feeling the woman's abdomen with the other hand. A uterus that is abnormally large or that is oddly-shaped can be a sign of fibroids. Another sign of possible fibroids is when the woman is not pregnant and the uterus can be felt above the pubic bone.

Many doctors do not rely on pelvic examinations to diagnose fibroids. One reason for this is that another condition called "adenomyosis" also causes the uterus to enlarge. A doctor may confuse the two conditions during a pelvic examination.

An ultrasound, on the other hand, is a very effective means to diagnose fibroids. An ultrasound uses sound waves to create an image of the uterus. It is a fast procedure that is completely non-invasive. It is useful in differentiating between fibroids and adenomyosis. Whereas an adenomyosis shows up on an ultrasound as a consistent thickening of the uterine wall, an image displaying fibroids reveals well-defined fibroid groupings scattered throughout the uterus.

Other procedures for detecting fibroids include hysterosalpingography, sonohysterography, laparoscopy, and hysteroscopy. All of these procedures can be performed during a single office visit. These techniques involve either cameras that are directly inserted into the uterine cavity, or X-ray pictures that are made especially clear by a dye that is flushed into the uterus. They allow for an extremely vivid visualization of the uterine cavity. They are useful when the woman has submucous fibroids, which are not always detected by an ultrasound. In fact, fibroids that cause symptoms are often missed by pelvic examinations and ultrasounds.

Treatment

In most cases of fibroids, treatment is not necessary. As women get older, the hormonal changes that come with menopause tend to reduce the size of the fibroids. Treatment is only required if the fibroids are extremely large and disturbing nearby organs, if they are growing rapidly, if they are causing irregular bleeding, or if there is some danger that they may result in infertility. At the same time, the method of treatment depends on the exact location of the fibroids.

While there are no medical treatments that permanently cure or reduce the size of fibroids, medicines do exist that eliminate symptoms. Medicines that lower estrogen levels help decrease the size of fibroids. A group of chemicals (called "GnRH agonists) in particular create an artificial menopause-like state, in which estrogen production significantly drops. GnRH agonists relieve symptoms such as heavy bleeding and pressure-induced pains caused by large fibroids.

Unfortunately, the effects of GnRH agonists are temporary. Fibroids usually grow back to their pre-treatment size immediately following the cessation of GnRH agonist treatment. Another drawback is that long-term use of this treatment can result in osteoporosis. Osteoporosis occurs because bone development requires estrogen, which is decreased by the medical treatment. As a result, GnRH agonist treatment rarely lasts longer than three months. It is typically used as a way to reduce the size of the fibroids before operation.

Besides options involving medicines, surgery can also be used to treat fibroids. While there are several different types of surgery available, the most common method is a hysterectomy. Almost 200,000 people each year have their fibroids surgically treated by a hysterectomy in the United States. During a hysterectomy, the entire uterus is removed. The advantage of a hysterectomy is that it permanently ends both abnormal bleeding and fibroid development. The drawback is that it eliminates the possibility of the woman having a child in the future.

Hysterectomies vary according to where the incision is made and whether or not a laparoscope (a small camera directly inserted into the uterus) assists during the procedure. The type of hysterectomy that is used depends on the size of the fibroids, the location of the fibroids, and the woman's medical history.

A myomectomy is used if the woman wants to maintain her ability to have children. During a myomectomy, only the fibriods are removed from the uterus. Around 18,000 women have myomectomies each year in the United States. They are very successful in eliminating the problem of heavy bleeding. The majority of myomectomies involve an incision into the woman's abdomen, through which the fibroid is removed. After the fibroids have been successfully removed, both the abdomen and the uterus are stitched up with sutures. Although the surgeon can remove the fibroids quickly, it usually takes several weeks for the sutures to heal.

Another type of surgical treatment is a hysteroscopic myomectomy. If the woman has submucous fibroids, an incision may not be needed. Using an instrument called a hysteroscope, the surgeon can remove the fibroids through the vagina. It is particularly useful when the woman is experiencing abnormal bleeding, or when she has pregnancy-related complications.

A laparoscopic myomectomy is used if the woman has fibroids on the exterior of her uterus. During a laparoscopic myomectomy, a laparoscope is inserted into the uterus through the belly button. A laparoscope is a small camera that also has the ability to cut up and remove fibroids. The advantage of a laparoscopic procedure is that an incision is not required, and hence, the woman recovers much faster. Drawbacks include the prolonged time it takes to cut up large fibroids into pieces that can be removed through the belly button, the risk of infertility, and the possibility that small fibroids will not be detected.

Another problem with myomectomies is the possibility that fibroids will redevelop post-operation. About a fourth of all women who have a myomectomy experience a recurrence of fiboids within ten years of the initial operation.

Other types of procedures focus on destruction of the fibroids rather than removal. During a myolysis, an electric current is sent to the fibroid in an attempt to destroy the fibroid's blood supply. A laparoscope is used to guide the electric current to the intended site. Once the electric charge is delivered, the fibroid instantly becomes dead tissue. Although a myolysis can take a long time to successfully eliminate every fibroid, recovery from the procedure is rapid. A cryomyolysis is a similar procedure where a freezing device is used rather than an electrical charge. Both of these treatment methods have disadvantages such as undetected malignant tissue and organ deformation.

Uterine artery embolization is the newest method for treating fibroids. This method involves placing a catheter into the artery in the leg and directing it into the uterine arteries. Once the catheter reaches the uterine arteries, tiny inserts are placed to obstruct the bloody supply of the fibroids. The fibroids eventually shrink or disappear. In some instances, the woman experiences pain for a short while post-operation. Anesthetics are sometimes required to eliminate the pain.

Outcome

Fibroids are rarely cancerous or symptom-producing. Although there is some risk of infertility, in most cases the fibroids do not cause enduring complications. Rather, they either remain small in size, or are successfully shrunk or removed. It is very important to thoroughly consult with medical experts before opting for a particular treatment method. The predominant forms of treatment include a hysterectomy, a myomesectomy, or medicines that induce low estrogen levels in the body.