Types of Fibroids

Fibroids are generally classified by their location - intramural fibroids grow within the muscular uterine wall; submucosal fibroids bulge into the uterine cavity; while as subserosal fibroids project to the outside of the uterus.

Signs and symptoms

Many women who have fibroids don't have any symptoms. However, in women who have symptoms, the most common signs and symptoms of uterine fibroids include:

??Heavy menstrual bleeding.

??Menstrual periods lasting more than a week.

??Pelvic pressure or pain.

??Frequent urination.

??Difficulty emptying the bladder.

??Constipation.

??Backache or leg pains.

??Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Causes of fibroids

The cause of fibroids is unknown, but research and clinical experience point to these factors:

??Genetic changes:Many fibroids contain changes in genes that differ from those in typical uterine muscle cells.

??Hormones:Oestrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more oestrogen and progesterone receptors than typical uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

??Growth factors: Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

??Extracellular matrix (ECM): ECM is the material that makes cells stick together, like mortar between bricks. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes biologic changes in the cells themselves.

Risk factors

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Factors that can have an impact on fibroid development include:

??Race:Although all women of reproductive age could develop fibroids, black women are more likely to have fibroids than are women of other racial groups. In addition, black women have fibroids at younger ages, and they're also likely to have more or larger fibroids, along with more-severe symptoms.

??Heredity: If a women's mother or sister had fibroids, she is at increased risk of developing them.

??Other factors:Onset of periods at an early age; obesity; vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol appear to increase a women's risk of developing fibroids.

Complications

Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as a drop in red blood cells (anaemia), which causes fatigue, from heavy blood loss. Rarely, a transfusion is needed due to blood loss.

Pregnancy and fibroids

Fibroids usually don't interfere with getting pregnant. However, it has been noted that submucosal fibroids could cause infertility or pregnancy loss. Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, foetal growth restriction and preterm delivery.

Diagnosis

Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids. If you have symptoms of uterine fibroids, your doctor may order these tests:

??Lab tests: These might include a complete blood count (CBC) to determine if you have anaemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

??Ultrasound:It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. A doctor or technician moves the ultrasound device (transducer) over your abdomen (transabdominal) or places it inside your vagina (transvaginal) to get images of your uterus.

??Magnetic resonance imaging (MRI):This imaging test can show in more detail the size and location of fibroids, identify different types of tumors, and help determine appropriate treatment options.

??Hysterosonography:Also called a saline infusion sonogram, uses sterile salt water (saline) to expand the uterine cavity, making it easier to get images of submucosal fibroids and the lining of the uterus in women attempting pregnancy or who have heavy menstrual bleeding.

??Hysterosalpingography:It uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. This test can help your doctor determine if your fallopian tubes are open or are blocked and can show some submucosal fibroids.

??Hysteroscopy:For this exam, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. Your doctor then injects saline into your uterus, expanding the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.

Watchful waiting

Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that's the case for you, watchful waiting could be the best option. Moreover, fibroids aren't cancerous and they rarely interfere with pregnancy. They usually grow slowly or not at all and tend to shrink after menopause, when levels of reproductive hormones drop.

Treatment

Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:

??Gonadotropin-releasing hormone (GnRH) agonists treat fibroids by blocking the production of oestrogen and progesterone, putting you into a temporary menopause-like state. As a result, menstruation stops, fibroids shrink and anaemia often improves. GnRH agonists include leuprolide, goserelin and triptorelin. Many women have significant hot flashes while using GnRH agonists. These are typically used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

??Progestin-releasing intrauterine device (IUD) can relieve heavy bleeding caused by fibroids. These provide symptomatic relief only and doesn't shrink fibroids or make them disappear. And these also prevent pregnancy.

??Tranexamic acid – non-hormonal medication is taken to ease heavy menstrual periods. It is taken only on heavy bleeding days.

??Other medications - for example, oral contraceptives can help control menstrual bleeding, but they don't reduce fibroid size.

??Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anaemia.

Non-invasive procedure: MRI-guided focused ultrasound surgery (FUS) is a non-invasive treatment option for uterine fibroids that preserves your uterus, requires no incision and is done on an outpatient basis.

Minimally-invasive procedures: Certain procedures can destroy uterine fibroids without actually removing them through surgery. These include:

??Uterine artery embolization:Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die.

??Radiofrequency ablation:In this procedure, radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. This can be done during a laparoscopic or transcervical procedure. A similar procedure called cryomyolysis freezes the fibroids.

??Laparoscopic or robotic myomectomy: In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place.

??Hysteroscopic myomectomy: This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.

??Endometrial ablation:This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow.

Invasive surgical procedures

??Abdominal myomectomy:If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.

??Hysterectomy:This surgery removes the uterus. It remains the only proven permanent solution for uterine fibroids. Hysterectomy ends your ability to bear children. If you also elect to have your ovaries removed, the surgery brings on menopause and the question of whether you'll take hormone replacement therapy. Most women with uterine fibroids may be able to choose to keep their ovaries.

A hysterectomy is the surgical removal of the uterus. A hysterectomy is major surgery, but with new technological advances, the discomfort, risk of infection and recovery time has all been decreased. There are currently three surgical approaches to hysterectomies. These include:

??Open Traditional Hysterectomy:It involves a six to twelve inch incision made in the abdominal wall.

??Vaginal Hysterectomy: It involves removing the uterus through the vagina. This approach is better than the open, traditional hysterectomy, but still does not allow the surgeon a full view of the surrounding organs, including the bladder.

??Robotic-Assisted Radical Total Laparoscopic Hysterectomy: Using a state-of-the art robotic platform allows the surgeon a full view of the surrounding organs and more precise control over incisions.

Prevention

There is little scientific evidence available regarding prevention of uterine fibroids. However, by making healthy lifestyle choices such as maintaining a healthy weight and eating a healthy diet containing adequate quantities of fruits and vegetables, women may be able to decrease their fibroid risk.

Seeking medical attention

If you witness the following things, it is important to seek medical attention:

??If you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

??Pelvic pain that doesn't go away.

??Overly heavy, prolonged or painful periods.

??Spotting or bleeding between periods.

??Difficulty emptying your bladder.

??Unexplained low red blood cell count (anaemia)