Fibroids

Fibroids: Overview

Uterine fibroids or leiomyomata are areas of smooth muscle cells and fibrous connective tissue that develop in or on the uterine wall.  You can develop one fibroid or many of them.  Fibroids are the most frequently diagnosed tumor of the female pelvis and the most common reason for a woman to have a hysterectomy.  They are benign – not associated with cancer – and rarely become cancerous.

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Types of Fibroid:

  • Intramural fibroids are located in the wall of the uterus and are the most common.  They can cause the uterus to bulge
  • Submucous or Submucosal fibroids are found within the uterine lining and can protrude into the uterine cavity.  Generally these are ones that can cause the most problems.  Since they are located in the uterine endometrium, they can cause heavy or prolonged bleeding during menstruation
  • Subserous or Subserosal fibroids develop on the outside of the uterus and usually have the least symptoms.  Subserous fibroids can become pedunculated as they grow, meaning they can develop a stalk.  These fibroids can reach out to other organs to gain additional blood supply

Incidence; Causes and Development

It is estimated that at least 20-30% of women have fibroids.

The cause of fibroids has not been determined but most fibroids develop in women during their reproductive years.  Fibroids need a rich blood supply and estrogen stimulates their growth.  Once menopause has begun, fibroids generally stop growing and can begin to shrink due to the loss of estrogen.

Diagnosis and Tests

Uterine fibroids range in size and location.  It is their size and location that determine the possible symptoms you may have.  Fibroids can be found during a routine gynecologic examination.  Many women do not know they have fibroids because they do not experience any symptoms.  Some women only discover that they have fibroids when they become pregnant.

Treatment and Prevention

Sometimes it is recommended that you "wait and see" what will happen.  This approach is most practical when menopause is not far away and when symptoms are limited.  Fibroids generally continue to grow until menopause.

Complications

Fibroids may cause infertility, miscarriage and early labor.  However, many women have carried to term with fibroids.  If your doctor recommends getting pregnant while you have fibroids, you may wish to consider getting a second opinion.

Signs, symptoms & indicators of Fibroids:

Symptoms - Abdomen

Symptoms - Reproductive - General

Symptoms - Urinary

(Very) weak urine stream

Difficulty urinating is a symptom of uterine fibroids.

Counter-indicators
Strong/normal urine stream

Difficulty urinating is a symptom of uterine fibroids.

Conditions that suggest Fibroids:

Circulation

Iron Deficiency Anemia

Submucous fibroids are the type that most commonly cause significant problems; even small tumors located in or bulging into the uterine cavity may cause heavy bleeding, anemia, pain, infertility or miscarriage.

Digestion

Constipation

Mural fibroids (located in the uterine wall) and subserous fibroids (protrude outside the uterine wall) may reach a large size before causing symptoms.  These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy or irregular bleeding during periods.

Pain

Low Back Pain

Mural fibroids (located in the uterine wall) and subserous fibroids (protrude outside the uterine wall) may reach a large size before causing symptoms.  These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back pain and abdominal pain, as well as heavy bleeding.

Reproductive

Menorrhagia (Heavy Periods)

Fibroids can lead to heavier bleeding during periods.

Female Infertility

Submucous fibroids are the type that most commonly cause significant problems; even small tumors located in or bulging into the uterine cavity may cause heavy bleeding, anemia, pain, infertility or miscarriage.

Susceptibility To Miscarriages

Submucous fibroids are the type that most commonly cause significant problems; even small tumors located in or bulging into the uterine cavity may cause heavy bleeding, anemia, pain, infertility or miscarriage.

Symptoms - Reproductive - General

Uro-Genital

Increased Urinary Frequency

Mural fibroids (located in the uterine wall) and subserous fibroids (protruding outside the uterine wall) may reach a large size before causing symptoms.  These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy bleeding.

Nocturia

Fibroids can lead to increased urinary frequency and urgency.

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Risk factors for Fibroids:

Hormones

Progesterone Low or Estrogen Dominance

Estrogen levels have persistently been shown to be elevated in patients with uterine fibroids.

Symptoms - Reproductive - General

Unusual vaginal bleeding

The growth of uterine fibroids is estrogen dependent, which means that fibroids tend to stop growing – and often shrink – after menopause.

Recommendations for Fibroids:

Botanical

Vitex / Chasteberry

Vitex is used as a way to prevent repeat uterine fibroids.

Hormone

Estrogen-balancing Medications

Uterine fibroids are often associated with elevated levels of estrogens.

Natural Progesterone

Though systemic progesterone use is often indicated, intravaginal application of progesterone cream may provide higher doses to the area needing it, and counter an estrogen dominance at the site.

Surgery/Invasive

Neural Therapy

Injections into a nerve plexus near the uterus is said to stabilize and sometimes shrink fibroids.

Surgery

A new procedure called Uterine Artery Embolization is considered to be less invasive than other procedures and enjoys a high success rate.  It involves cutting off the blood supply to the fibroid by placing a catheter into the uterine arteries and injecting small particles.  This blocks the blood flow and causes the fibroid to degenerate, leaving the remainder of the organ intact.  Often this is a better approach than a hysterectomy.

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