Fibroids are benign growths in the uterus and are the most common growth in the female pelvis, with about 20-25% of women having fibroids. Most women who have fibroids do not realize they have them because they are small and do not cause symptoms. Whether or not fibroids cause problems depends on their size, number and location. As with any other growth, fibroids should be checked by a doctor.
Types of fibroids
Fibroids grow from the cells that make up the muscle layer of the uterus.
Fibroids can vary greatly in size, shape and location. They can grow into the uterine cavity, on the surface of the uterus, within the uterine muscle wall, or attached to the uterus with the help of a tip-like structure.
The size of fibroids varies greatly and can range from the size of a small pea to the size of a large round 14-15 cm. As fibroids grow, they can grow into the uterus or outside the uterus, and sometimes they can grow so large that they fill the pelvic cavity or even the abdominal cavity.
A person can have just one fibroid or multiple fibroids of varying sizes. It is difficult to predict whether they will be single or multiple. They can remain small for a long time at first and then suddenly grow rapidly, or they can grow slowly over many years. Because it is difficult to predict how fast they will grow, fibroids can be difficult to manage.
Causes
Although fibroids can occur in women of any age, they are most common in women in their 30s and 40s.
Although fibroids are very common, very little is known about what causes them to occur. The female hormone estrogen, seems to increase its growth. The level of estrogen in the body naturally fluctuates, going up and down. For example, pregnancy causes an increase in estrogen, while menopause causes a decrease. In addition, medication can also cause changes in estrogen levels.
Symptoms
Most fibroids, even large ones, are usually asymptomatic. When symptoms do occur, the following are often present.
(1) Menstrual changes: increased bleeding, prolonged menstrual period or shortened menstrual cycle, menstrual pain (abdominal cramps), non-menstrual bleeding, anemia (caused by excessive bleeding)
(2) Pain: abdominal or back pain (usually dull, but sometimes severe or even sharp), sometimes also painful intercourse
(3) pressure symptoms: difficulty urinating or increased urination, constipation, rectal pain or difficult bowel movements, abdominal cramps
(4) Miscarriage and infertility
These symptoms can also be caused by other problems, so if you have any of these symptoms, you should see your doctor promptly.
Diagnosis
During a routine pelvic exam, it may be the first time that a fibroid is detected. There are many tests that can provide detailed information about fibroids.
(1) Ultrasound: sound waves are used to form images of the uterus or pelvic organs
(2) Hysteroscopy: A thin device (hysteroscope) is used and placed through the vagina and cervix (the opening of the uterus) to help the doctor see some of the fibroids in the uterine cavity.
(3) Hysterosalpingography: a special X-ray test that can detect abnormal changes in the size and shape of the uterus and fallopian tubes.
(4) Laparoscopy: A slender device (laparoscope) is used to make a small incision below or through the belly button and the laparoscope is inserted to help the doctor see fibroids on the outer surface of the uterus and some fibroids between the muscle walls of the uterus.
Hysteroscopy or laparoscopy is sometimes used in combination to diagnose fibroids.
Imaging tests, such as magnetic resonance imaging (MRI) and CT scans, are sometimes used to diagnose fibroids, but it is only rarely necessary to apply these tests. When these or other tests are used to diagnose some other problem or symptom, sometimes leiomyosarcoma may also be found. There are some tests that may be helpful to check the growth rate of leiomyosarcoma.
Complications
Although most fibroids do not cause problems, complications can still occur. Fibroids that are attached by a tip and stuck to the uterus may twist, which can cause pain, nausea or fever. Infection may also occur with fibroids. In most cases, this occurs only in areas that are already infected. In rare cases, the rapid growth of the fibroid and the presence of other symptoms may suggest malignancy.
Oversized fibroids can cause abdominal distention, which can make it difficult to perform a complete pelvic examination.
Myomas can also cause infertility, but before they are considered to be the cause of a couple’s infertility, they should be examined for other factors causing infertility. When fibroids are thought to be the cause of infertility, most women are able to become pregnant after treatment.
Treatment
Small fibroids that are asymptomatic, or that occur in women who are near menopause, often do not require treatment. However, the presence of some of the following signs and symptoms may suggest the need for treatment.
Excessive menstrual flow or pain during menstruation
Bleeding between menstrual periods
uncertainty as to whether the mass is a leiomyoma or another type of tumor, such as an ovarian tumor
rapid growth of fibroids
infertility
Pelvic pain
If you have fibroids, or have had them before, you should have regular checkups. If you have symptoms associated with fibroids, you should see your doctor immediately. There is no need to limit your sex life unless the fibroids are causing painful intercourse.
Treatment can be obtained by surgical removal of the fibroids. In addition, medications, such as gonadotropin-releasing hormone (GnRH) analogs, can be used to temporarily reduce the size of the fibroids and can control bleeding in preparation for surgery.
Myomectomy
Myomectomy is the surgical removal of fibroids and preservation of the uterus. Because the uterus is preserved, she will still be able to have children. If she becomes pregnant after myomectomy, she may need to deliver the baby by cesarean section (a surgical incision is made in the mother’s abdomen and uterus to deliver the baby). However, sometimes myomectomy may also cause pelvic adhesions that can lead to infertility.
Fibroids may reappear, even after myomectomy. If fibroids are indeed found again, 20-40% of patients will need to be treated with another surgery.
Open surgery
laparoscopic surgery
Hysteroscopic surgery
The surgical approach used depends on the location and size of the fibroids. For open surgery, the incision is made in the abdomen and then, the fibroid is removed through the incision. It is also possible to remove the fibroids through laparoscopy by looking inside the abdomen.
Hysteroscopy can be used to remove fibroids that protrude into the uterine cavity, but not those located deep in the uterine wall. Pain relief is usually required when performing hysteroscopy, but sometimes hospitalization is not necessary.
Hysterectomy
Hysterectomy is the removal of the uterus, and the ovaries may or may not be removed. Removal of the uterus may be necessary if there is
There is persistent pain or abnormal bleeding
The fibroids are large
Other methods of treatment are not possible
Women who no longer wish to have children
If your doctor believes that you need a hysterectomy, then other lesions of the uterus, such as endometrial disease, should be excluded first.
Uterine fibroids and pregnancy
A small percentage of pregnant women have fibroids. If you are pregnant and are found to also have fibroids, the fibroids will not usually affect you or your little one.
During pregnancy, fibroids can increase in size. Combined with the extra demands pregnancy places on your body, the growth of fibroids may cause discomfort, pressure or pain. Most fibroids shrink after pregnancy is over.
Fibroids may increase the risk of
Miscarriage (pregnancy ends before 20 weeks)
Premature birth
Breech position (one position different from head down)
In rare cases, large fibroids can block the opening of the uterus or prevent the baby from passing through the birth canal. In this case, a cesarean section is required. In most cases, when the uterus is swollen during pregnancy, even large fibroids do not obstruct the birth canal for delivery of the fetus. Pregnant women with large fibroids may have more bleeding after delivery.
Fibroids during pregnancy usually do not require treatment. If there are symptoms, such as pain or discomfort, your doctor will advise you to rest. Sometimes, pregnant women with combined fibroids need to stay in the hospital for a period of time because of pain, bleeding, or unavoidable preterm labor. In rare cases, myomectomy may also be performed in pregnant women. After myomectomy, a cesarean delivery may be required.
Summary
Uterine fibroids are benign growths that are very common in women. About one in four or five women age 35 will have fibroids. Fibroids can be asymptomatic and may not need treatment.
If you have fibroids or have had fibroids before, you should see your doctor for regular checkups. Regular checkups, as well as being alert to symptoms, will help you know what kind of changes are present that will require treatment.
P.S. The above is only meant to spread some knowledge about fibroids and is not a substitute for medical advice. The diagnosis or treatment of any disease should be based on individual circumstances, symptoms, physical examination, laboratory findings and other information deemed important by your doctor. It is always advisable to talk to your doctor before stopping, starting, or changing any of your treatments.