Uterine Fibroids

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What are fibroids?
Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is “leiomyoma” or just “myoma”. Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

Why should women know about fibroids?
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.

There are factors that can increase a woman’s risk of developing fibroids.
• Age – Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• Family history – Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
• Ethnic origin – African-American women are more likely to develop fibroids than white women.
• Obesity – Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
• Eating habits – Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.

Where can fibroids grow?
Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:
• Submucosal – fibroids grow into the uterine cavity.
• Intramural – fibroids grow within the wall of the uterus.
• Subserosal – fibroids grow on the outside of the uterus. Some fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus. They might look like mushrooms. These are called pedunculated fibroids.

What are the symptoms of fibroids?
Most fibroids do not cause any symptoms, but some women with fibroids can have:
• Heavy bleeding (which can be heavy enough to cause anemia) or painful periods
• Feeling of fullness in the pelvic area (lower stomach area)
• Enlargement of the lower abdomen
• Frequent urination
• Pain during sex
• Lower back pain
• Complications during pregnancy and labor, including a six-time greater risk of cesarean section
• Reproductive problems, such as infertility, which is very rare

What causes fibroids?
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:
• Hormonal (affected by estrogen and progesterone levels)
• Genetic (runs in families)
Because no one knows for sure what causes fibroids, we also don’t know what causes them to grow or shrink. We do know that they are under hormonal control — both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.

Can fibroids turn into cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman’s chances of getting other forms of cancer in the uterus.

What if I become pregnant and have fibroids?
• Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn’t mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:
• Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
• Baby is breech. The baby is not positioned well for vaginal delivery.
• Labor fails to progress.
• Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
• Preterm delivery.

if you have fibroids and become pregnant talk to Dr.Sankar DasMahapatra. Doctor can feel the fibroid with his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange.

There are tests that create a “picture” of the inside of your body without surgery. These tests might include:
• Ultrasound – Uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
• Magnetic resonance imaging (MRI) – Uses magnets and radio waves to produce the picture
• X-rays – Uses a form of radiation to see into the body and produce the picture
• Cat scan (CT) – Takes many X-ray pictures of the body from different angles for a more complete image
• Hysterosalpingogram (hiss-tur-oh-sal-PIN-juh-gram) (HSG) or sonohysterogram (soh-noh-HISS-tur-oh-gram) – An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.

You might also need uterine fibroid surgery for the removal of fibroids. There are two types of surgery to do this:

• Laparoscopy – Laparoscopic surgeon inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the Laparoscopic surgeon to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.
• Hysteroscopy – The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.