Uterine fibroids

Uterine fibroids

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What are fibroids?

Fibroids are tumors that grow from muscle cells in the uterus. They're rarely cancerous but can sometimes cause symptoms like pain and bleeding and they may interfere with the ability to get pregnant. Fibroid are found in up to 10 percent of women during pregnancy and are most common in women aged 30 to 40.

Doctors call fibroids leiomyomas or myomas of the uterus. Fibroids can grow on the outside or the inside the uterus, or in the tissue of the uterine wall.

Fibroids can be as small as a raisin or as large as a grapefruit. A large fibroid or cluster of fibroids can change the shape of the uterus or put pressure on the bladder or intestine.

Why do women get fibroids?

No one knows for sure what causes fibroids. It's likely genetics and hormones are involved. For example, fibroids can grow more when estrogen and progesterone levels are high during pregnancy. And as a woman gets close to menopause and these hormones decline, fibroids can shrink or stop growing.

Researchers don't know why, but fibroids are more common in African American women. Fibroids in these women develop at an earlier age and are more severe. By menopause, about 80 percent of African American women have had fibroids, compared with 70 percent of Caucasian women.

Women with a family history of fibroids also have a higher risk of developing them. It's likely that inherited genes in these women increase the odds of having fibroids.

What are the symptoms of fibroids?

Most women have no symptoms and may never even know they have fibroids. In other women symptoms include:

  • Heavy or prolonged bleeding during a period (may lead to iron deficiency, or anemia)
  • Feeling of fullness, pain, or pressure in the lower abdomen
  • Painful cramps during a period
  • More frequent or uncomfortable urination
  • Pain during sex
  • Constipation or painful bowel movements
  • Difficulty getting pregnant

How are fibroids diagnosed?

Most fibroids are found during routine pelvic exams. A doctor may suspect them if she notices that a woman has a lumpy or irregularly shaped uterus.

If a woman has painful or recurring symptoms, the doctor may also do an ultrasound of the uterus and ovaries. Sometimes fibroids are found on a routing ultrasound exam during pregnancy.

What's the treatment for fibroids?

Most fibroids don't need to be treated, but your doctor may recommend it based on:

  • Your discomfort
  • Blood loss during your periods
  • How quickly the fibroids grow
  • Your age

If you do need treatment, you have several options, all with benefits and risks. The right treatment depends on such factors as your symptoms, your treatment goals, and whether you want to have children.

Myomectomy. During a myomectomy, the doctor removes fibroids, but leaves the uterus in place. Myomectomy is generally recommended for women who have severe fibroid-related symptoms and those having trouble getting pregnant because of fibroids.

A myomectomy can relieve symptoms and preserve (or even improve) fertility for some women. However, it can lead to scarring of the pelvis or uterus, which also affects fertility. Women who get pregnant after having a myomectomy may have an increased risk of uterine rupture during labor.

Depending on the size, location, and number of fibroids, a provider might do the surgery through the cervix, using a laparoscope with thin instruments and a lighted microscope inserted through several small cuts in the abdomen, or through a larger cut in the lower abdomen.

A woman still has a 30 percent chance of developing a new fibroid within 10 years of a myomectomy, especially if she had multiple tumors.

Hysterectomy. With a hysterectomy, the doctor removes the entire uterus. The advantage of a hysterectomy is that fibroids can't grow back. But not having a uterus also means not being able to get pregnant.

A hysterectomy used to be the standard treatment for fibroids because it stopped the heavy bleeding typically associated with them. It's now generally reserved for women who don't want to get pregnant, who have severe symptoms, or who are in menopause.

Medication. Medications can lower estrogen levels to shrink or temporarily stop fibroids from growing, especially before surgery. However, these drugs can cause menopause-like symptoms such as hot flashes, vaginal dryness, and reduced bone density, so doctors prescribe the drugs for six months or less. After that, fibroids will probably grow again.

Blocking the blood supply. Another technique is uterine artery embolization (UAE) or uterine fibroid embolization (UFE). In this procedure, a radiologist uses a thin tube (a catheter) to inject material into the arteries leading to the uterus. This blocks the blood supply, which "starves" and shrinks the fibroid.

Since doctors aren't sure how UAE affects fertility, this treatment isn't recommended for women who want to have children.

UAE is less invasive than a myomectomy or hysterectomy. (There's just one very small cut at the artery near the groin.)

What are new treatments for fibroids?

In recent years, doctors have developed several less invasive ways to treat fibroids. But these procedures aren't widely available, and they're not likely to be covered by insurance. They're still being evaluated for long-term health risks and benefits, and they aren't recommended for women who want to become pregnant.

These aren't yet considered standard treatments, so if you decide to pursue one, have a detailed conversation with your doctor. Ask her how much experience she has with the procedure, and be sure you understand all the possible health risks.

Focused ultrasound. One new procedure is focused ultrasonic treatment. In this procedure, an MRI is used to pinpoint the exact location of a fibroid. Then, high-energy ultrasound waves are focused on the fibroid, heating it and killing cells, causing the fibroid to shrink.

To learn more about this procedure or find out whether it's available near you, visit the Focused Ultrasound Foundation's website.

Thermal or freezing techniques. Another relatively new treatment is called myolysis. This involves laparoscopically inserting needle probes directly into a fibroid. Then an electric current or laser destroys it and the surrounding blood vessels using heat energy. A similar treatment called cryomyolysis works the same way except that it destroys the fibroid and blood supply by freezing them.

What can I do to feel better if I have fibroids?

If pain or bleeding during your period is caused by fibroids and is an ongoing or worsening problem, call your doctor. You may want to ask about birth control, which can help with symptoms such as heavy bleeding, cramps, and pain during your period.

Here are some suggestions for easing pain immediately:

  • Rest on a comfortable couch or in bed when you're in pain.
  • Put a hot water bottle or heating pad on your abdomen.
  • Ask your doctor about taking prescription or over-the-counter pain medication.
  • To lower the risk of anemia caused by heavy bleeding during your period, eat foods high in iron, such as lean red meat and spinach, and take iron supplements if your doctor recommends them.

Is it possible to prevent fibroids?

No, there's no way to prevent fibroids from developing unless you have a hysterectomy.

Some companies sell supplements and natural remedies that claim to prevent or eliminate fibroids, but your provider isn't likely to recommend these products. There's no evidence to show that nutrition has any effect on fibroids, and the safety of these products is unknown.

Swap stories and advice about fibroids with other parents in the our site Community.

Use the Society for Maternal-Fetal Medicine’s Find an MFM Specialist tool to locate a high-risk pregnancy doctor near you.

Visit the Society for Maternal-Fetal Medicine's website for more information.

Watch the video: Dr. Harris Narrates A 3-D Animation of a Uterine Fibroid Embolization UFE (July 2022).


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