Uterine Fibroids

Uterine Fibroids - What are Uterine Fibroids?

A uterine fibroid (also uterine leiomyoma, myoma, fibromyoma, leiofibromyoma, fibroleiomyoma, and fibroma) is a benign (non-cancerous) tumor that originates from the smooth muscle layer (myometrium) and the accompanying connective tissue of the uterus.

Fibroids are the most common benign tumors in females and typically found during the middle and later reproductive years. While most fibroids are asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency.

Uterine fibroids is the major indication for hysterectomy in the US. Fibroids are often multiple and if the uterus contains too many leiomyomatas to count, it is referred to as uterine leiomyomatosis. The malignant version of a fibroid is uncommon and termed a leiomyosarcoma.

About 20–40% of women will be diagnosed with leiomyoma. Estrogen receptors on fibroids cause them to respond to estrogen stimulation during the reproductive years. During hypoestrogenic states, such as after menopause, leiomyoma are expected to shrink. Leiomyoma are more common in overweight women (because of increased estrogen from adipose aromatase activity).

Uterine fibroids appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance on histological section.

The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall.

Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whorled).

These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and mitotically active.

For decades, Estrogen has been known to stimulate fibroids, but more recent studies have also revealed a possible role of progesterone and progestins to fibroid growth as well, and applicability of progestin agonists as part of treatment are currently being considered.

In very rare cases, malignant (cancerous) growths, leiomyosarcoma, of the myometrium can develop.

Fibroids that lead to heavy vaginal bleeding lead to anemia and iron deficiency. Due to pressure effects gastrointestinal problems are possible such as constipation and bloatedness. Compression of the ureter may lead to hydronephrosis. Fibroids may also present alongside endometriosis, which itself may cause infertility.Adenomyosis may be mistaken for or coexist with fibroids.

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Uterine Fibroids Location

Growth and location are the main factors that determine if a fibroid leads to symptoms and problems. There may also be pain during intercourse, depending on the location of the fibroid. During pregnancy they may be the cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus.

Fibroids, particularly when small, may be entirely asymptomatic. The U.S. Department of Health & Human Services states that "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."

While fibroids are common, they are not a typical cause for infertility accounting for about 3% of reasons why a woman may not have a child. Typically in such cases a fibroid is located in a submucosal position and it is thought that this location may interfere with the function of the lining and the ability of the embryo to implant. Biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, surgery is generally indicated.

Other imaging techniques that may be helpful specifically in the evaluation of lesions that affect the uterine cavity are hysterosalpingography or sonohysterography.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Uterine fibroids" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

Uterine Fibroids Treatment

Expectant management

The presence of fibroids does not mean that they need to be treated; lesions can be managed expectantly depending on the symptomatology and presence of related conditions. Thus most cases of fibroids are managed by "watchful waiting" which includes periodic sonographic assessment. After menopause fibroids shrink and it is unusual for fibroids to cause problems.

The presence of symptomatic uterine fibroids can be solved by:

Surgery

Surgery: Surgical removal of a uterine fibroid usually takes place via hysterectomy, in which the entire uterus is removed, or myomectomy, in which only the fibroid is removed. It is possible to remove multiple fibroids during a myomectomy. Although a myomectomy cannot prevent the recurrence of fibroids at a later date, such surgery is increasingly recommended, especially in the case of women who have not completed bearing children or who express an explicit desire to retain the uterus. There are three different types of myomectomy:

  • In a ''hysteroscopic'' myomectomy, the fibroid is removed by the use of a resectoscope, an endoscopic instrument that can use high-frequency electrical energy to cut tissue. Hysteroscopic myomectomies can be done as an outpatient procedure, with either local or general anesthesia used. Hysteroscopic myomectomy is most often recommended for submucosal fibroids. A French study collected results from 235 patients suffering from submucous myomas who were treated with hysteroscopic myomectomies; in none of these cases was the fibroid greater than 5 cm.
  • A ''laparoscopic'' myomectomy requires a small incision near the navel. The physician then inserts a laparoscope into the uterus and uses surgical instruments to remove the fibroids. Studies have suggested that laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does laparotomic myomectomy. As with hysteroscopic myomectomy, laparoscopic myomectomy is not generally used on very large fibroids. A study of laparoscopic myomectomies conducted between January 1990 and October 1998 examined 106 cases of laparoscopic myomectomy, in which the fibroids were intramural or subserous and ranged in size from 3 to 10 cm.
  • A ''laparotomic'' myomectomy (also known as an ''open'' or ''abdominal'' myomectomy) is the most invasive surgical procedure to remove fibroids. The physician makes an incision in the abdominal wall and removes the fibroid from the uterus. A particularly extensive laparotomic procedure may necessitate that any future births be conducted by Caesarean section. . A small catheter (1 mm in diameter) is inserted into the femoral artery at the level of the groin under local anesthesia. Under imaging guidance, the interventional radiologist will enter selectively into both uterine arteries and inject small (500 µm) particles that will block the blood supply to the fibroids. A patient will usually recover from the procedure within a few days. The UAE results in the supposed shrinking of the fibroids and of the uterus, thus alleviating the symptoms. However, it is important to note that significant adverse effects resulting from uterine artery embolization have been reported and documented in the medical literature including death, infection, misembolization, loss of ovarian function, unsuccessful fibroid expulsion, pain, foul vaginal odor, hysterectomy, and failure of embolization surgery frequency Ablation===

Radiofrequency Ablation: One of the newest minimally invasive treatments for fibroids is radiofrequency ablation . In this technique the fibroid is shrunk by inserting a needle-like device into the fibroid through the abdomen and heating it with low frequency electrical currents. This new treatment is still under investigation in a [http://trialx.com/clinicaltrial/85936/fibroids-laparoscopic-radiofrequency-ablation-symptomatic/?&qd=778317] Phase 3 clinical trial across 6 sites in the US. The treatment is a potential option for women who have fibroids, have completed child-bearing and want to avoid a hysterectomy.

Medication

Primary

Medical therapy: Currently, the only medication approved to reduce fibroids are the Gonadotropin-releasing hormone analogs. GNRH analogs, however, are short term treatments only because they lead to estrogen-deficiency and may cause osteoporosis.

Aromatase inhibitors have been used experimentally to reduce fibroids. Progesterone antagonists have been shown in small studies to decrease the size of uterine fibroids. Thus mifepristone was effective in a placebo-controlled pilot study. Selective progesterone receptor modulators, such as Progenta, have been under investigation.

Secondary

A number of secondary medications are in use to alleviate symptoms caused by fibroids. This allows an otherwise expectant approach to bring the patient hopefully to menopause when symptoms naturally regress. Thus oral contraceptive pills, either combination pills with low-dose estrogens or progestin-only, are prescribed in an effort to reduce uterine bleeding and cramps. Such medications seem to have little or no effect on the size of the lesions.

The use of vitex herbal medicine lacks supporting evidence.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Uterine fibroids" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

Uterine Fibroids Malignancy

About 1 out of 1000 lesions

  • In leiomyoma with vascular invasion, an ordinary-appearing fibroid invades into a vessel but there is no risk of recurrence.
  • In Intravenous leiomyomatosis, leiomyomata grow in veins with uterine fibroids as their source. Cardiac involvement can be fatal.
  • In benign metastasizing leiomyoma, leiomyomata grow in more distant sites such as the lungs and lymph nodes. The source is not entirely clear. Pulmonary involvement can be fatal.
  • In disseminated intraperitoneal leiomyomatosis, leiomyomata grow diffusely on the peritoneal and omental surfaces, with uterine fibroids as their source. This can simulate a malignant tumor but behaves benignly.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Uterine fibroids" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.