Causes, diagnosis, treatment of fibroids

Fibroids

Medically Reviewed by Mark R.

Laflamme, M.D. on December 11, 2015 — Written by Brindles Lee Macon & Winnie Yu

What Are Fibroids?

1
Fibroids are abnormal growths that develop in or on a woman’s uterus.

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It is unclear why fibroids develop, but several factors may influence their formation, such as hormones and family history.

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About 70 to 80 percent of women experience fibroids by the age of 50.
Fibroids are abnormal growths that develop in or on a woman’s uterus . Sometimes, these tumours become quite large and cause severe
abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign (non cancerous). The cause of fibroids is unknown.
According to the National Institutes of Health (NIH), about 70 to 80 percent of women have them by the age of 50, but most women do not have any symptoms.

Types of Fibroids
Different fibroids develop in different locations in and on the uterus.
Intra mural Fibroids
Intra mural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intra mural fibroids may grow larger and can stretch your womb.
Subserosal Fibroids
Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.
Pedunculated Fibroids
When subserosal tumours develop a stem (a slender base that supports the tumour), they become pedunculated fibroids.
Submucosal Fibroids
These types of tumours develop in the middle muscle layer (myometrium) of your uterus. Submucosal tumours are not as common as other types, but when they do develop, they may cause heavy menstrual bleeding and
trouble conceiving .
CAUSES
What Causes Fibroids?
It is unclear why fibroids develop, but several factors may influence their formation.
Hormones
Oestrogen and progesterone are the hormones produced by the ovaries . They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.
Family History
Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.
Pregnancy
Pregnancy increases the production of oestrogen and progesterone in your body. Fibroids may develop and grow rapidly while you are pregnant.

RISK FACTORS
Who Is at Risk for Fibroids?
Women are at greater risk for developing fibroids if they have one or more of the following risk factors:
• pregnancy
• a family history of fibroids
• being over the age of 30
• being of African-American descent
• having a high body weight

SYMPTOMS
What Are the Symptoms of Fibroids?
Your symptoms will depend on the location and size of the tumour(s) and how many tumours you have. If your tumour is very small, or if you are going through menopause, you may not have any symptoms. Fibroids may shrink during and after menopause.
Symptoms of fibroids may include:
• heavy bleeding between or during your periods that includes blood clots
• pain in the pelvis and/or lower back
• increased menstrual cramping
• increased urination
• pain during intercourse
• menstruation that lasts longer than usual
• pressure or fullness in your lower abdomen
• swelling or enlargement of the abdomen

DIAGNOSIS
How Are Fibroids Diagnosed?
You will need to see a gynaecologist to get a
pelvic exam. This exam is used to check the condition, size, and shape of your uterus. You may also need other tests, which include:
Ultrasound
An ultrasound uses high frequency sound waves to produce images of your uterus on a screen. This will allow your doctor to see its internal structures and any fibroids present. A
transvaginal ultrasound , in which the ultrasound wand (transducer) is inserted into the vagina, may provide clearer pictures since it is closer to the uterus during this procedure.
Pelvic MRI
This in-depth imaging testing produces pictures of your uterus, ovaries, and other pelvic organs.
TREATMENT
How Are Fibroids Treated?
Your doctor will develop a treatment plan based on your age, the size of your fibroid(s), and your overall health. You may receive a combination of treatments.
Medications
Medications to regulate your hormone levels may be prescribed to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), will cause your oestrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids.
Other options that can help control bleeding and pain, but will not shrink or eliminate fibroids, include:
• an intrauterine device (IUD) that releases the hormone progestin
• over-the-counter anti-inflammatory pain relievers , such as ibuprofen
• birth control pills
Surgery
Surgery to remove very large or multiple growths (myomectomy) may be performed. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopically, using a few small incisions into which surgical tools and a camera are inserted.
Your physician may perform a hysterectomy (removal of your uterus) if your condition worsens, or if no other treatments work. However, this means that you will not be able to bear children in the future.
Minimally Invasive Procedures
A newer and completely non-invasive surgical procedure is forced ultrasound surgery (FUS). You will lie down inside a special MRI machine that allows doctors to visualise the inside of your uterus. High-energy, high-frequency sound waves will be directed at the fibroids to destroy (ablate) them.
Similarly, myolysis shrinks fibroids using an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial ablation involves inserting a special instrument into your uterus to destroy the uterine lining using heat, electric current, hot water, or microwaves.

What Can Be Expected in the Long Term?
Your prognosis will depend on the size and location of your fibroids. Fibroids may not need treatment if they are small or do not produce symptoms. If you are pregnant and have fibroids, or become pregnant and have fibroids, your physician will carefully monitor your condition. In most cases, fibroids do not cause problems during pregnancy. Speak with your doctor if you expect to become pregnant and have fibroids.

Source: Health online.com

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