WHAT ARE FIBROIDS?<\/strong><\/p>\nFibroid is the common term that is used for what is really a MYOMA of the uterus or womb.\u00a0 In fact, it is more properly called a leiomyoma, but fibroid is easier and shorter, so it\u2019s o.k. if you continue to call it that.\u00a0 They are masses affecting the womb in various locations and are made up of smooth muscle and, to a lesser extent, fibrous connective tissue.<\/p>\n
While they can occur as isolated microscopic growths, they are more commonly multiple and may reach enormous proportions, weighing more than 100 pounds. So quite often when women have large waistlines, and think it\u2019s just fat, on occasion it may be a fibroid or fibroids.\u00a0 I have seen them the size of watermelons in women\u2019s abdomens.\u00a0 They become malignant ( cancerous) less than 0.5% of the time, or, put another way, less than 0.5% of fibroids become cancerous.<\/p>\n
Fibroids are thought to grow under the influence of estrogen, the main female hormone, although they are not known to actually cause them.\u00a0 The evidence for the other female hormone, progesterone, is less convincing.\u00a0 This is why fibroids tend to grow in pregnancy; because more estrogen is around to maintain the pregnancy.\u00a0 And it\u2019s also why they tend to decrease in size or even disappear after menopause.<\/p>\n
TYPES OF FIBROIDS<\/strong><\/p>\nFibroids are classified by their location, which affects the symptoms they may cause and how they can be treated.\u00a0 Those that are inside the cavity of the uterus will usually cause bleeding between periods (metrorrhagia) and often cause sever cramping.\u00a0 These are intracavitary.\u00a0 Submucous myomas (fibroids, leiomyomata) are partially in the wall of the uterus.\u00a0 They too cause heavy menstrual periods (menorrhagia) as well as metrorrhagia (above).<\/p>\n
Intramural ones are in the wall of the womb.\u00a0 They may range in size from microscopic to larger than a grapefruit. Many cause no problems except when they become quite large.\u00a0 There are a number of alternatives for treating these, but often they require no treatment at all.\u00a0 Subserous fibroids are on the outside wall of the uterus, and may even be connected to it by a stalk (pedunculated myoma).\u00a0 These do not need treatment unless they grow large, but those on a stalk can twist and cause pain.\u00a0 This type is easiest to remove by laparoscopy (cute, fancy surgery where you get one, or at most, two small cuts).<\/p>\n
SYMPTOMS OF FIBROIDS<\/strong><\/p>\nA fibroid does not necessarily produce symptoms, and even large ones may go undetected by the patient, especially if she is obese.\u00a0 As we\u2019ve just said, symptoms depend on their locations; but also their size, and whether or not the patient is pregnant.\u00a0 In any event, 35-50% of patients with fibroids will have symptoms which include:<\/p>\n
1)\u00a0\u00a0\u00a0 Abnormal endometrial bleeding (the endometrium is the lining of the womb).\u00a0 This is the most important manifestation of fibroids and is present in about 30% of patients, particularly those with the intracavitary or submucous varieties.\u00a0 Commonly, remember, there will be prolonged heavy menses, but a woman may display any variant from the entire spectrum of abnormal bleeding.\u00a0 Premenstrual spotting is common, as is prolonged staining following menses.\u00a0 Remember that some fibroids will cause metrorrhagia, bleeding between periods.<\/p>\n
2)\u00a0\u00a0\u00a0 Pain.\u00a0 This is uncommon with fibroids, per se, but may result from degeneration within a tumor (fibroid) after circulatory occlusion from degeneration or infection, torsion or a pedunculated fibroid, or uterine contractions to expel a subserous fibroid from the womb cavity.\u00a0 Large fibroids may produce a sensation of heaviness in the pelvic area or what may be described as the \u2018bearing-down\u2019 feeling.\u00a0 Some may press on nerves and cause pain in the back and lower limbs.\u00a0 Pain from torsion of a pedunculated fibroid can be excruciating and may appear to be a severe surgical abdominal problem.<\/p>\n
3)\u00a0\u00a0\u00a0 Pressure effects.\u00a0 Some fibroids may distort or obstruct other organs.\u00a0 Again, depending on type or location, one may get a watery- bloody vaginal discharge, vaginal bleeding, pain during sex, and infertility.\u00a0 Sometimes the bladder or rectum or the tubes from the kidney to the bladder may be displaced.\u00a0 In this case, urine gets backed up.\u00a0 One may get constipation, retention of urine, swelling of the legs or ankles, incontinence of urine and other unpleasant symptoms.<\/p>\n
4)\u00a0\u00a0\u00a0 Infertility.\u00a0 Fibroids are the sole cause of infertility in only 2-10% of patients.\u00a0 I would say this is a high enough number, though.<\/p>\n
5)\u00a0\u00a0\u00a0 Spontaneous abortion.\u00a0 The incidence of this is probably 2-3 times in women with fibroids as opposed to pregnant women without fibroids.<\/p>\n
DIAGNOSIS OF FIBROIDS<\/strong><\/p>\nFibroids may be felt during a pelvic exam, but may often be missed, even when causing symptoms, if the examiner relies only on this.\u00a0 Also, other conditions such as adenomyosis –\u00a0 don\u2019t bother your head for the time being \u2013 or ovarian cysts may be mistaken for fibroids.\u00a0 This is why it is wise to do an ultra sound scan.\u00a0 Whether by the skin or vaginally, it only takes a few minutes, and can also rule out a pregnancy if one is not previously otherwise sure there is one.<\/p>\n
X-rays are done sometimes if symptoms suggest there is compression, distortion, or displacement of other organs. Fibroids may appear as soft tissue masses or, if calcification occurs, then the study would have been very useful.\u00a0 Other studies such as hysteroscopy or hysterography can be done as well.\u00a0 Of course, these will be done by your gynecologist.<\/p>\n
FIBROIDS AND PREGNANCY<\/strong><\/p>\nRemoval of fibroids can result in as much as a 40% incidence of pregnancy occurring in someone who had been previously infertile.<\/p>\n
In the second and third trimesters, fibroids may cause pain and localized tenderness.\u00a0 Remember that they will grow in pregnancy.<\/p>\n
During labor, fibroids may cause the uterus not to contract, may cause abnormal presentation of the fetus, or obstruction of the birth canal.\u00a0 Some fibroids may allow a relatively normal vaginal delivery, others, of course, may require a caesarian section, to be performed.\u00a0 After delivery, they may interfere with effective contraction of the womb, so hemorrhage must therefore be anticipated.<\/p>\n
TREATMENT OF FIBROIDS<\/strong><\/p>\nRemember that most fibroids do not cause symptoms and don\u2019t require treatment.\u00a0 They do, however, in the following circumstances.<\/p>\n
A)\u00a0\u00a0\u00a0 Fibroids are causing pressure on other organs, such as the bladder.
\nB)\u00a0\u00a0\u00a0 Fibroids are growing rapidly.
\nC)\u00a0\u00a0\u00a0 Fibroids are causing abnormal bleeding.
\nD)\u00a0\u00a0\u00a0 Fibroids are causing fertility problems.<\/p>\n
TREATMENT WITH MEDICINES<\/strong><\/p>\nNone are currently available that will permanently shrink fibroids.\u00a0 Often heavy bleeding can be controlled with birth control pills.\u00a0 A family of drugs called GNRH agonists will decrease the estrogen which fibroids need to grow, but this will induce menopause and the effect is temporary anyway because the fibroids rapidly grow back once the medication is discontinued, because it can only be used for about three months.<\/p>\n
RU-486, the \u201cFrench abortion pill\u201d decreases their size and stops abnormal bleeding.<\/p>\n
SURGICAL TREATMENT<\/strong><\/p>\nI will merely mention the procedures for the different types of fibroids that are recommended by experts.<\/p>\n
(Intracavitary fibroids)
\nHysteroscopy will usually take care of these.<\/p>\n
(Submucous)
\nHysteroscopy as well.\u00a0 Sometimes, what we call endometrial ablation may be done at the same time.<\/p>\n
(Intramural and Pedunculated fibroids)
\nThree types of procedures are essentially done for these: remove them, destroy them, or remove the uterus (hysterectomy).\u00a0 All of the surgical options available are variations on one of these themes.<\/p>\n
HYSTERECTOMY<\/strong><\/p>\nThis is the only one with a guarantee: no more bleeding, and no regrowth of fibroids.\u00a0 And no cancer of the womb later either. But consider whether your fibroids are symptomatic and how close you are to menopause.\u00a0 There are advantages, but there are disadvantages too.\u00a0 ALWAYS DISCUSS AT LENGTH WITH YOUR GYNECOLOGIST.<\/p>\n
REMOVAL OF THE FIBROIBS<\/strong><\/p>\nThis is called myomectomy.\u00a0 Usually, a couple of nights in hospital, a few weeks, and you\u2019re back to work.<\/p>\n
DESTRUCTION OF THE FIBROIDS<\/strong><\/p>\nMyolysis is done through a laparoscope.\u00a0 A laser fiber or electrical device is placed into the fibroid and the fibroid or blood vessels feeding it, are coagulated. Cool, huh!<\/p>\n
UTERINE ARTERY EMBOLIZATION<\/strong><\/p>\nThis is relatively new.\u00a0 A small catheter is placed in an artery in the groin and directed to the blood supply of the fibroid.\u00a0 The arteries are blocked by injecting little plugs; essentially we\u2019re cutting off the fibroid\u2019s blood supply and shrinking it.<\/p>\n
Fibroid is a word on almost every woman\u2019s tongue.\u00a0 It\u2019s almost as if everyone expects to get a fibroid.\u00a0 Many will, but don\u2019t worry; your gynecologist can handle it.\u00a0 Talk to him and discuss your options.<\/p>\n
See you next week.<\/p>\n","protected":false},"excerpt":{"rendered":"Fibroids are common in women in their 20\u2019s and 30\u2019s and sometimes even into their 40\u2019s.\u00a0 In fact, fibroids affect more than 30% of women of reproductive age, and women of African origin are much more prone to having them…","protected":false},"author":15,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_cbd_carousel_blocks":"[]","footnotes":""},"categories":[49],"tags":[],"class_list":["post-41106","post","type-post","status-publish","format-standard","hentry","category-health-talk"],"acf":[],"yoast_head":"\n
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Fibroids are common in women in their 20\u2019s and 30\u2019s and sometimes even into their 40\u2019s.\u00a0 In fact, fibroids affect more than 30% of women of reproductive age, and women of African origin are much more prone to having them than are Caucasians; the reason is\u00a0 unknown but they are 3-9 times more common in black women.<\/p>\n