Fibroids: Causes, Symptoms and Treatments

A woman undergoing an ultrasound scan
An ultrasound scan can often be used to diagnose fibroids. 


Fibroids: Causes, Symptoms and Treatments

Fibroids are non-cancerous (benign) tumors that grow from the muscle layers of the uterus (womb). They are also known as uterine fibroids, myomas, or fibromyomas. The singular of uterine fibroids is Uterine Fibroma. Fibroids are growths of smooth muscle and fibrous tissue. Fibroids can vary in size, from that of a bean to as large as a melon.
Fibroids affect at least 20% of all women at sometime during their life. Women aged between 30 and 50 are the most likely to develop fibroids. Overweight and obese women are at significantly higher risk of developing fibroids, compared to women of normal weight.
Malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb. However, this is extremely rare.
 

Four types of fibroids
There are four types of fibroids and these are:
                                                                                  
                                                                   A Diagram of the female reproductive organ

Diagram of female reproductive system
Intramural
These are located in the wall of the uterus. These are the most common types of fibroids.

Subserosal fibroids
These are located outside the wall of the uterus. They can develop into pedunculated fibroids (stalks). Subserosal fibroids can become quite large.

Submucosal fibroids
These are located in the muscle beneath the lining of the uterus wall.   
                                                     
Cervical fibroids
These are located in the neck of the womb (the cervix).

Causes of fibroids
Experts cannot come to a common consensus about why fibroids occur.
During a woman's reproductive years her estrogen and progesterone levels are high. When estrogen levels are high, especially during pregnancy, fibroids tend to swell. When estrogen levels are low fibroids may shrink, e.g. during a woman's menopause.
Heredity may also be a factor. Women whose mothers and/or sisters have/had fibroids have a higher risk of developing them too.
Symptoms of uterine fibroids

Most women have no symptoms. That is why most patients with fibroids do not know they have them. When symptoms do develop, they may include:
Anemia (as a result of heavy periods)
Backache
Constipation
Discomfort in the lower abdomen (especially if fibroids are large)
Frequent urination
Heavy painful periods
Pain in the legs
Painful sex
Swelling in the lower abdomen (especially if fibroids are large)

Other possible symptoms of uterine fibroids include:
Labor problems
Pregnancy problems
Fertility problems
Repeated miscarriages

Diagnosis of fibroids

In most cases, the symptoms of fibroids are rarely felt and the patient does not know she has them. They are usually discovered during a vaginal examination.
A woman undergoing an ultrasound scan
An ultrasound scan can often be used to diagnose fibroids.

Ultrasound
If the doctor thinks fibroids may be present he/she may use an ultrasound scan to find out. Ultrasound can also eliminate other possible conditions which may have similar symptoms. Ultrasound scans are often used when the patient has heavy periods and blood tests have revealed nothing conclusive.
Trans-vaginal scan
A small scanner is inserted into the patient's vagina so that the uterus can be viewed close up.
Hysteroscopy
This is a small telescope that examines the inside of the uterus. During this procedure, if necessary, a biopsy can be taken of the lining of the uterus (womb).
Laparoscopy
A laparoscope is a small device that looks at the outside of the uterus - where the doctor examines its size and shape. A laparoscope is a small flexible tube. During this procedure, if necessary, a biopsy can be taken of the outer layer of the uterus.
Biopsy
A small sample of the lining of the uterus is taken and then examined under a microscope.


Treatments for fibroids

If the woman has no symptoms and the fibroids are not affecting her day-to-day life she may receive no treatment at all. Even women who have heavy periods and whose lives are not badly affected by this symptom may also opt for no treatment. During the menopause symptoms will usually become less apparent, or disappear altogether as the fibroids usually shrink at this stage of a woman's life.
When treatment is necessary it may be in the form of medication or surgery.

Treating fibroids with medication

GnRHA
GnRHA (gonadotropin released hormone agonist), administered by injection. GnRHAs make the woman's body produce much lower quantities of estrogen, which makes the fibroids shrink. GnRHA stops the woman's menstrual cycle. It is important to remember that GNRHAs are not contraceptives, and they do not affect a woman's fertility when she stops treatment.
GNRHAs are also very helpful for women who have heavy periods and discomfort in their abdomen. GNRHAs may have menopause-like symptoms as their main side-effect, this might include hot flashes (UK: flushes), a tendency to sweat more, and vaginal dryness. Although thinning of the bones (osteoporosis) is also a possible side-effect, it is rare.
GnRHAs may be administered to the patient before surgery in order to shrink the fibroids. GNRHAs are for short-term, not long-term use.
GNRHAs combined with HRT (hormone replacement therapy) are sometimes prescribed to prevent menopause-like symptoms.
Other drugs may be used to treat fibroids; however, they are less effective for larger fibroids. These include:
  • Tranexamic acid
    These are presented in tablet form and are taken by the patient from the day pre menstrual period starts for up to 4 days. This is done each month. If symptoms do not improve within three months the patient should stop taking this medication. Tranexamic acid helps blood in the uterus clot, which reduces bleeding. A woman's fertility will not be affected by this treatment as soon as it is over.
  • Anti-inflammatory drugs
    These medications are taken for a few days during the patient's menstrual period. They may include such drugs as mefanamic and ibuprofen. Anti-inflammatory medications reduce the amount of prostaglandins the body produces. Prostaglandins are hormones which are associated with heavy periods. These drugs are also painkillers. They do not affect a woman's fertility.
  • The contraceptive pill
    These are used to stop menstruation from occurring.
  • LNG-IUS (Levonorgestrel intrauterine system)
    This is a plastic device which is placed inside the uterus. LNH-IUS releases levonorgestrel (progestogen hormone). This hormone stops the lining of the uterus from growing too fast, which effectively reduces bleeding. One of the side-effects of this treatment is irregular bleeding for up to six months, headaches, breast tenderness, and acne. In very rare cases it can stop the woman's periods.

Surgery to treat fibroids

When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
  • Hysterectomy - removing the uterus. This is only ever considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes considered as an option to stop recurrences of fibroids (stop them coming back). Hysterectomies have two possible side-effects: 1. Reduced libido. 2. Early menopause.
  • Myomectomy - the fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant (as opposed to a hysterectomy). Women with large fibroids, as well as those whose fibroids are located in particular parts of the uterus may not be able to benefit from this procedure.
  • Endometrial ablation - this involves removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus. This procedure is considered as an effective alternative to a hysterectomy.
  • UAE (Uterine Artery Embolization) - this treatment stops the fibroid from getting its blood supply. UAE is generally used for women with large fibroids. UAEs effectively shrink the fibroid. A chemical is injected through a catheter into a blood vessel in the leg - it is guided by X-ray scans.
  • Magnetic-resonance-guided percutaneous laser ablation - an MRI (magnetic resonance imaging) scan is used to locate the fibroids. Then very fine needles are inserted through the patient's skin and pushed until they reach the targeted fibroids. A fiber-optic cable is inserted through the needles. A laser light goes through the fiber-optic cable, hits the fibroids and shrinks them.
  • Magnetic-resonance-guided focused ultrasound surgery -" an MRI (magnetic resonance imaging) scan locates the fibroids, and then sound waves are aimed at them. This procedure also shrinks the fibroids.

    Most experts say Magnetic-resonance-guided percutaneous laser ablation and Magnetic-resonance-guided focused ultrasound surgery are both effective - however, there is some uncertainty regarding their benefits vs. risks.

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