UTERINE FIBROIDS

Fibroids are non-cancerous tumors that grow in or around the uterus. The growths may vary from small to very large in size, and consist of fibrous and muscle tissue. Fibroids are also known as myomas or lieomyomas (made of muscle tissue). Fibroids develop commonly during reproductive years, and are directly linked to estrogen, the female reproductive hormone. Uterine fibroids are not related to cancer, and almost never develop into cancer.Many women have uterine fibroids sometime during their lives. But most women don’t know they have uterine fibroids because they often cause no symptoms.

CAUSES:

The exact cause of fibroids is unknown. However, fibroids are linked to the female hormone, oestrogen. Oestrogen is the female reproductive hormone produced by the ovaries (the female reproductive organs).

Fibroids tend to increase in size when oestrogen levels are at their highest, such as during pregnancy. They are also known to shrink when oestrogen levels are low, such as after the menopause (when a woman’s monthly periods stop at around 50 years of age).

SIGNS AND SYMPTOMS

Many women who have fibroids don’t have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common symptoms of uterine fibroids include:

  • Heavy menstrual bleeding
  • Menstrual periods lasting more than a week
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains
 Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Sub-serosal fibroids project to the outside of the uterus.

COMPLICATIONS OF FIBROIDS

Most women with fibroids do not have any problems. However, in some cases, fibroids can cause significant problems.

Complications can occur as a result of the positioning of fibroids, and in cases where they are very large. Some possible complications are outlined below.

Heavy periods

If you have heavy periods (menorrhagia), it does not necessarily mean that there is anything seriously wrong. However, it can have a significant impact on your everyday life and lead to anxiety and depression.

In some cases, menorrhagia can cause iron-deficiency anaemia, resulting in symptoms such as tiredness, lethargy and shortness of breath (dyspnoea).

Pregnancy

During pregnancy, levels of the female reproductive hormone, oestrogen, can increase by as much as five times the normal amount. As fibroids are thought to develop due to high oestrogen levels, it may lead to complications with the development of the baby, or cause problems during labour.

In very rare cases, fibroids can cause miscarriage (the loss of pregnancy during the first 23 weeks).

Infertility

Infertility (the inability to become pregnant) may occur in cases where a woman’s fibroids are very large. Large fibroids can sometimes prevent a fertilised egg attaching itself to the lining of the womb.

If you have a submucosal fibroid (that grows from the muscle wall into the cavity of your womb) it may block a fallopian tube, making it harder for you to conceive (become pregnant).

DIAGNOSIS

Uterine fibroids are routinely diagnosed incidentally, especially when they cause little to no symptoms. If suspected on physical exam due to changes in shape or texture of uterus, Ultrasound is used to confirm the diagnosis. Lab tests such as full blood count may also be ordered to see if patient is suffering from iron deficiency anemia due to blood loss.

If ultrasound reveals insufficient or inconclusive results, other diagnostic tests such as hysteroscopy, MRI or hysterosalpingography may be performed.

TREATMENT

There’s no single best approach to uterine fibroid treatment — many treatment options exist.

Watchful waiting

Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option.

Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop.

Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. Medications include:

  • Gonadotropin-releasing hormone (Gn-RH) agonists. Medications called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves.

    Many women have significant hot flashes while using Gn-RH agonists. Gn-RH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

  • Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn’t shrink fibroids or make them disappear. It also prevents pregnancy.
  • Tranexamic acid. This nonhormonal medication is taken to ease heavy menstrual periods. It’s taken only on heavy bleeding days.
  • Other medications. Your doctor might recommend other medications. For example, oral contraceptives or progestins can help control menstrual bleeding, but they don’t reduce fibroid size.

    Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don’t reduce bleeding caused by fibroids. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia.

 

Dr. Annie

Physician, mom and wife

Leave a Reply

Your email address will not be published. Required fields are marked *