Fibroids

Alternative Names

• Leiomyoma
• Fibromyoma
• Myoma
• Fibroids

Uterine fibroid

Subserosal uterine fibroid

Myoma

Histopathology of a leiomyoma with fascicular growth

Definition

Uterine fibroids are benign tumors predominantly consisting of muscle and connective tissue. They originate within or get attached to the uterine wall, sometimes expanding substantially in size.

Causes, Incidence, and Risk Factors

The exact cause of these fibroid tumors remains elusive. Studies suggest that their growth might be influenced by estrogen therapy, including treatments like oral contraceptives, or even during pregnancy. Regular estrogen stimulation seems essential for fibroid growth, making them rare among women under 20 and postmenopausal women. They continue to grow - albeit at a sluggish pace - throughout a woman's menstruating years.

Fibroids can range from microscopic sizes to large masses filling the uterine cavity. They are notably the most common pelvic tumors, present in:

• 15 to 20% of women of reproductive age
• 30 to 40% of women aged over 30

A significant racial disparity exists, with African-American women being 3 to 9 times more susceptible than their Caucasian counterparts. Fibroids often start as tiny seedlings scattered within the uterus's muscular walls, growing larger and more nodular over time. Sometimes they invade the uterine cavity or extend beyond its regular boundary. In rare instances, fibroids can hang outside the uterus from a long stalk, leading to a condition called pedunculated fibroid. Such fibroids may twist, cutting off their blood supply, which could necessitate hospitalization and surgery.

Symptoms

• Feeling of fullness or pressure in the lower abdomen
• Pain or cramping in the pelvis during menstruation
• Abdominal bloating or gas
• Frequent urination
• Heavy menstrual bleeding, occasionally with blood clots
• Severe pain due to a pedunculated fibroid

However, it's worth noting that many women may experience no symptoms at all.

Diagnostic Methods

During a pelvic examination, an irregular, lumpy, or enlarged uterus often indicates fibroids. While this diagnosis is typically reliable, there can be exceptions, especially in obese individuals. At times, fibroid tumors may be confused with ovarian tumors, inflammatory processes of the tubes, or even pregnancy.

To confirm the diagnosis, the following might be recommended:

• Transvaginal ultrasound
• Pelvic ultrasound
• D and C procedure
• Pelvic laparoscopy

Treatment Options

The choice of treatment hinges on several factors: the severity of symptoms, age, pregnancy status, health, fibroid characteristics, and the woman's desire for future pregnancies.

Some possible treatments include:

• Monitoring: Regularly checking fibroid growth via pelvic exams or ultrasounds.
• Medications: Nonsteroidal anti-inflammatory drugs such as ibuprofen for pain relief or iron supplements to prevent anemia caused by heavy periods.
• Hormonal treatment: Drugs like injectable Depo Leuprolide can shrink fibroids but may induce side effects reminiscent of menopause.
• Hysteroscopic resection: An outpatient procedure to remove fibroids from the uterine cavity.
• Uterine artery embolization: This newer method aims to block the arteries supplying blood to the uterus, stunting fibroid growth.
• Myomectomy: Surgical removal of fibroids, preferred by women wanting more children.
• Hysterectomy: Removal of the uterus, providing a definitive solution.

Prognosis

Before menopause, fibroids generally grow at a gradual pace. While they don't typically hinder fertility, they might obstruct the fallopian tubes or prevent a fertilized egg from implanting in the uterus. Pregnancy can cause fibroids to enlarge due to increased blood flow and estrogen. Yet, post-delivery, they usually revert to their original size. Notably, after menopause, new fibroid development is uncommon, and existing ones tend to shrink.

Complications

• Potential fertility issues due to interference with conception or implantation
• Premature delivery risks
• Emergency surgeries resulting from severe pain or heavy bleeding
• Rarely, malignant transformations, primarily in postmenopausal women

Additional Resources

• OBGYN.net Fibroid Resource Center
• leiomyoma
• Fibroids: A Gynecologist's Second Opinion
• Causes & Symptoms of Uterine Fibroids

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