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Uterine Fibroids

What are uterine fibroids?
Who is most likely to have fibroids?
What are symptoms of fibroids?
What complications can occur with fibroids?
How are fibroids diagnosed?
When is treatment necessary for fibroids?
Can medication be used to treat fibroids?
What types of surgery may be done to treat fibroids?
Are there other treatments besides medication and…

What are uterine fibroids?

  • Uterine fibroids are benign growths that develop from the muscle tissue of the uterus
    • They also are called leiomyomas or myomas
    • The size, shape, and location of fibroids can vary greatly
    • They may be present inside the uterus
    • Can be on its outer surface or within its wall, or attached to it by a stem-like structure
    • A woman may have only one fibroid or many of varying sizes
    • A fibroid may remain very small for a long time
    • May suddenly grow rapidly, or grow slowly over a number of years

Who is most likely to have fibroids?

  • Most common in women aged 30?40 years, but they can occur at any age
  • Occur more often in African American women than in white women
  • Also, fibroids occur at a younger age and grow more quickly in African American women

What are symptoms of fibroids?

  • Fibroids may have the following symptoms:
    • Changes in menstruation
      • Longer, more frequent, or heavy menstrual periods
      • Menstrual pain (cramps)
    • Vaginal bleeding at times other than menstruation
    • Anemia (from blood loss)
    • In the abdomen or lower back ranging from dull to sharp
    • Pain during sex
    • Internal pressure
      • Difficulty urinating or frequent urination
      • Constipation, rectal pain, or difficult bowel movements
    • Abdominal cramps
    • Enlarged uterus and abdomen
    • Miscarriages
    • Infertility
  • Fibroids also may cause no symptoms at all
  • Fibroids may be found during a routine pelvic exam or during tests for other problems

What complications can occur with fibroids?

  • Fibroids that are attached to the uterus by a stem may twist
    • They can cause pain, nausea, or fever
  • Fibroids that grow rapidly, or those that start breaking down, also may cause pain
    • Rarely, they can be associated with cancer
  • A very large fibroid may cause swelling of the abdomen
    • This swelling can make it hard to do a thorough pelvic exam
  • Fibroids may cause infertility, although other causes are more common
  • Other factors should be explored before fibroids are considered the cause of a couple?s infertility
  • When fibroids are thought to be a cause, many women are able to become pregnant after they are treated

How are fibroids diagnosed?

  • May be detected during a routine pelvic exam
  • Other tests may show more information about fibroids:
    • Ultrasonography
      • This uses sound waves to create a picture of the uterus and other pelvic organs
    • Hysteroscopy
      • This uses a slender device (the hysteroscope) to see the inside of the uterus
      • It is inserted through the vagina and cervix
      • This permits the doctor to see fibroids inside the uterine cavity
    • Hysterosalpingography
      • This is a special X-ray test
      • It may detect abnormal changes in the size and shape of the uterus and fallopian tubes
    • Sonohysterography
      • This is a test in which fluid is put into the uterus through the cervix
      • Ultrasonography is then used to show the inside of the uterus
      • The fluid provides a clear picture of the uterine lining
    • Laparoscopy
      • This uses a slender device (the laparoscope) to help the doctor see the inside of the abdomen
      • It is inserted through a small cut just below or through the navel
      • The doctor can see fibroids on the outside of the uterus
    • Imaging tests, such as magnetic resonance imaging and computed tomography scans
  • Some of these tests may be used to track the growth of fibroids over time.

When is treatment necessary for fibroids?

  • Women who are nearing menopause often do not require treatment
  • Signs and symptoms that may signal the need for treatment include:
    • Heavy or painful menstrual periods that cause anemia or that disrupt a woman?s normal activities
    • Bleeding between periods
    • Uncertainty whether the growth is a fibroid or another type of tumor
    • Rapid increase in growth of the fibroid
    • Infertility
    • Pelvic pain

Can medication be used to treat fibroids?

  • Drug therapy is an option
    • Medications may reduce the heavy bleeding
    • May reduce painful periods
    • They may not prevent the fibroid growth
    • Surgery is often needed later
  • Drug treatment for fibroids includes the following options:
    • Birth control pills and other types of hormonal birth control methods
      • These drugs are used to control heavy bleeding and painful periods
    • Gonadotropin-releasing hormone (GnRH) agonists
      • These drugs stop the menstrual cycle and can shrink fibroids
      • Sometimes they are used before surgery to reduce the risk of bleeding
      • GnRH agonists have many side effects so they are used for short periods
      • Once treatment stops, fibroids tend to return to previous size
    • Progestin?releasing intrauterine device
      • This option is for women with fibroids that do not distort the inside of the uterus
      • It reduces heavy and painful bleeding but does not treat the fibroids themselves

What types of surgery may be done to treat fibroids?

  • Myomectomy
    • This is the surgical removal of fibroids while leaving the uterus in place
    • Because a woman keeps her uterus, she may still be able to have children
    • Fibroids do not regrow after surgery, but new fibroids may develop
    • If they do, more surgery may be needed
  • Hysterectomy
    • This is the removal of the uterus
    • The ovaries may or may not be removed
    • This is done when other treatments have not worked or are not possible or the fibroids are very large
    • A woman is no longer able to have children after having a hysterectomy

Are there other treatments besides medication and…

  • Hysteroscopy
    • This technique is used to remove fibroids that protrude into the cavity of the uterus
    • A resectoscope is inserted through the hysteroscope
    • The resectoscope destroys fibroids with electricity or a laser beam
    • It cannot remove fibroids deep in the walls of the uterus
      • It can often control the bleeding these fibroids cause
    • This procedure can be performed as an outpatient procedure
  • Endometrial ablation
    • This procedure destroys the lining of the uterus
    • It is used to treat women with small fibroids (less than 3 centimeters)
    • There are several ways to perform endometrial ablation
      • Uterine artery embolization (UAE)
        • In this procedure, tiny particles are injected into the blood vessels that lead to the uterus
        • The particles cut off the blood flow to the fibroid and cause it to shrink
        • UAE can be performed as an outpatient procedure
  • Magnetic resonance imaging-guided ultrasound surgery
    • In this new approach, ultrasound waves are used to destroy fibroids
    • The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging.
    • Studies show that women have improved symptoms up to 1 year after having the procedure
    • Whether this approach provides long-term relief is currently being studied

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