Fibroids

Fibroids are tumors consisting of an overgrowth of muscle and connective tissue. Fibroids may grow into the uterine cavity, from the uterine wall to the outside of the uterus, or may be confined within the uterine wall. Under most circumstances, they are benign. Twenty-five to fifty percent of women have fibroids and the incidence increases with age. (20% in their 20's, 30% in their 30's, 40% in their 40's).

Risk Factors

Fibroids tend to run in families. If another member of your family has fibroids, you are at an increased risk of getting them. The risk increases if you are heavy for your height, but decreases if you smoke or have had a child.

Causes

Fibroid growth seems to be related to estrogen production, but the experts are not clear why some women develop them and other women do not. Fibroids are slow growing during the reproductive years, but may increase in size with pregnancy. In women who don't use estrogen replacement therapy after menopause, the fibroids begin to shrink in size. The estrogen only affects the fibroid, though, after it has already developed. What causes the initial fibroid to develop is unknown. There may be a genetic component. Researchers are now investigating chromosome abnormalities that may play a part in the production of fibroids.

Symptoms

Many women with fibroids never have any symptoms at all. The two most common symptoms are abnormal uterine bleeding and pelvic pressure. Menstrual periods with fibroids may be very long and very heavy. There may be pressure in the pelvic region from the enlarged uterine size caused by the fibroids. Symptoms from the pressure are often related to where the fibroid is exerting pressure. There may be urinary frequency, constipation or difficulty with bowel movements.

The presence of fibroids in the uterus can cause a variety of reproductive problems - recurrent miscarriage, infertility, premature labor or complications of labor.

Diagnosis

A pelvic exam by the healthcare provider is usually the first step towards diagnosing fibroids. The uterus will feel enlarged or irregular. He or she may describe the uterus as being "12 weeks" or "14 weeks" meaning it is the size of a twelve week pregnancy.

Once your uterus has been identified as being enlarged or irregularly shaped, the presence of fibroids can be seen by ultrasound. An ultrasound can specify the number and size of the tumors. A hysteroscopy may be recommended - with this procedure the physician can see inside the uterine cavity by inserting a small telescope-like instrument (hysteroscope) through the cervix into the uterus.

Treatment

One of the first treatments tried for the abnormal uterine bleeding associated with fibroids may be oral contraceptives or progestins. GnRH agonists (gonadotropin-releasing hormone) has been shown to temporarily shrink fibroids by blocking estrogen production. This class of hormone causes menstrual symptoms, such as hot flashes, vaginal dryness, and bone loss. Using a low dose of estrogen and progesterone along with the GnRH agonist may prolong the length of time the medication can be used.

The only cure for fibroids is a hysterectomy. This may be too high a price to pay, though, if you are still considering childbearing. Hysterectomies can be performed abdominally (through an incision in the abdomen), vaginally (through an incision in the vagina), or through a laparoscope abdominally, and then finished vaginally (laparoscopically assisted vaginal hysterectomy or LAVH). The type of hysterectomy best for your situation will be based on the size of your uterus and your medical history.

A myomectomy procedure removes only the fibroids, leaving the uterus intact. This procedure can be performed by laparoscopy or through an open incision in the abdomen (laparotomy). The type performed depends on whether the fibroids are superficial or deep. Another consideration is whether or not you plan to bear children. A myomectomy is major surgery and may be more complicated than a hysterectomy. A myomectomy may take as long or longer than a hysterectomy, cause more blood loss with a greater risk of need for a transfusion. Scarring of the uterus following a myomectomy may cause fertility problems. The procedure does not prevent the growth of new fibroids and the need for future surgery.

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