Uterine fibroidsg

Uterine fibroids (also known as leiomyomas, fibromyomas or myomas) are growths of muscle and fibrous connective tissue. They're nearly always benign (noncancerous).

Uterine fibroids may grow inside the uterine cavity, within the wall of the uterus, or protrude outside the uterus. Rarely, they may detach from the uterus and attach to other structures within the pelvic cavity. Uterine fibroids may be smaller than a pea or as big as a grapefruit.


Causes/associated factors
What causes uterine fibroids is unknown, but they're believed to be linked to estrogen levels. Uterine fibroids are most common during the reproductive years, when estrogen levels are highest. Increased estrogen levels during pregnancy or when certain hormone medications containing estrogen are taken may cause uterine fibroids to grow. Uterine fibroids rarely develop after menopause. In fact, they typically shrink when estrogen production diminishes.
At least 25 percent of women have uterine fibroids. Although the medical reasons are currently unclear, African-American women seem to have a higher risk of developing uterine fibroids. Obesity also seems to be a risk factor. Researchers are investigating the relationship between uterine fibroids and certain genetic, hormonal, immune system and environmental factors as well.


Signs/symptoms
Many women who have uterine fibroids have no symptoms. When symptoms appear -- often depending on how many fibroids are present, as well as their location and size -- they often include:
heavy, painful or prolonged menstruation
bleeding between periods or after sex
bleeding after menopause
pelvic or low back pain
pain during sex
abdominal discomfort, pain, cramps, fullness or pressure
abdominal swelling if the fibroids are large or numerous
frequent urination
rectal pressure or constipation

Diagnosis
Typically, uterine fibroids can be diagnosed with a pelvic and abdominal exam. If the diagnosis is in question, various tests may be needed. For example:
Ultrasound is the use of sound waves to create an image of internal organs. The ultrasound may be done through your abdomen or vagina.

Magnetic resonance imaging (MRI) is an imaging technique based on computer analysis of the body's response to a magnetic field. With an MRI, the doctor can identify the number, size and general location of fibroids.

Hysterosalpingogram is an X-ray of the uterus and fallopian tubes is taken after a special dye is injected into the uterine cavity through a small tube that's inserted through the vagina and cervix. The dye will outline these structures on the X-ray, which will help show any abnormalities inside the uterus.

Hysteroscopy is an inspection of the uterus with a special endoscope (a thin, flexible tube equipped with a camera lens and light used to see the inside of a hollow organ or cavity). With this procedure, the doctor can directly see the inside the uterus.

Laparoscopy is a surgical procedure used to examine the pelvic cavity. The doctor makes a small incision in the abdomen and inserts a laparoscope, a thin tube equipped with a camera lens and light. This allows the doctor to directly view any fibroids on the uterus.

Treatment
Make sure you understand your treatment options, as well as the risks and benefits. It's especially important to review these with your doctor before any surgical procedure.
Treatment depends on a variety of factors, including:

the severity of your symptoms
characteristics of the fibroid, such as size and rate of growth
your age and general health
your pregnancy status
your desire for future pregnancies
your personal preferences
Monitoring
If the uterine fibroids are small and cause no symptoms, your condition may be monitored with periodic pelvic exams.

Medication
When symptoms are mild, a nonsteroidal anti-inflammatory medication (such as ibuprofen) may be recommended to relieve pain. It may also help control excessive menstrual bleeding. In some cases, birth control pills may be prescribed to control menstrual bleeding.

Hormone medications called gonadotropin-releasing hormone (GnRH) agonists (Lupron, for example) may be prescribed to shrink uterine fibroids by creating a menopausal state. These medications are typically taken for no longer than six months due to their potent side effects and cost. The fibroids usually grow back to their pretreatment size within three to six months after the medication is stopped. For these reasons, GnRH agonists are typically taken before surgery to make the fibroids smaller and easier to remove. GnRH agonists are not used if you're pregnant or trying to become pregnant.

Treatment with an antihormonal medication, such as mifepristone, is being studied. These medications may be useful in slowing or stopping the growth of uterine fibroids.

Surgical treatment
Through a procedure called myomectomy, the fibroids are surgically removed but the uterus is left in place. Depending on the location of the fibroids, the procedure may be done by hysteroscopy or laparoscopy (as described above), or through an abdominal incision. Myomectomy may be recommended for women who wish to bear children in the future. Fibroids develop again in up to half of women who undergo myomectomy. Some of these women may require further surgical treatment. Complications of myomectomy may include postoperative bleeding, scarring, adhesions and uterine rupture during labor.

A vaginal or abdominal hysterectomy (surgical removal of the uterus) may be recommended if:

the fibroids are large or growing rapidly
your symptoms are severe
you don't want future pregnancies
Myolysis is a new technique being studied that uses a laser to shrink fibroid tissue through a laparoscope. Cryomyolysis is a similar procedure that shrinks the fibroids through a freezing agent applied directly to the fibroids. These procedures may lead to the formation of adhesions or scar tissue. The long-term risks and benefits haven't been determined.

Endometrial ablation (destruction of the tissue that lines the uterus) is another investigational procedure that may be used for women with fibroids and heavy bleeding. It's done at the same time that fibroids are removed by hysteroscopy.

Uterine artery embolization
Uterine artery embolization (UAE) is a new procedure occasionally used for the initial treatment of large symptomatic fibroids. With this procedure, a radiologist passes a small catheter to the arteries that supply the fibroid with blood and nutrients. Next, he or she injects a material that decreases blood flow to the fibroid. Soon, this decrease in blood flow will cause the fibroid to shrink, which can improve symptoms dramatically. The procedure takes about one to two hours and is usually done on an outpatient basis.

There is some exposure to both radiation and contrast dye, but the need for surgery may be avoided. Painful cramping often occurs for six to 12 hours after the procedure, but medication can often control the pain. You may also experience fever and a general feeling of illness for about a week. Complications may include infection, menopause and damage to other organs in the pelvis. Uterine artery embolization is not recommended for women who desire future pregnancies. The long-term benefits of the procedure are still being investigated.


Complications
Although most uterine fibroids don't cause significant problems, possible complications may include:
pain
nausea
fever
infection
heavy vaginal bleeding that leads to anemia
pregnancy-related problems (see below)
urinary or bowel obstructions from extremely large fibroids
Rarely, uterine fibroids may become cancerous. They're not considered a risk factor for cancer, however.


Pregnancy-specific information
Uterine fibroids may cause infertility if they block the fallopian tubes or prevent the fertilized egg from implanting in the uterine lining. Again, increased estrogen levels during pregnancy may cause uterine fibroids to grow. In some cases, the fibroids shrink. In many pregnancies, they stay the same size. Occasionally, they cause severe pain. Uterine fibroids can increase the risk of miscarriage, preterm labor or delivery. Uterine fibroids may also block the birth canal, causing breech presentation or the need for a C-section. Uterine fibroids may also interfere with uterine contractions after delivery, resulting in heavy bleeding or postpartum hemorrhage.

Senior-specific information
Growing older is not a risk factor for this condition. Again, uterine fibroids usually shrink after menopause.

Prevention
Maintaining a healthy body weight is associated with a lower risk of uterine fibroids. Bearing children also seems to offer protection from developing uterine fibroids.