Uterine Fibroids

Fibroids in the uterus are growths that are not cancerous. They are very common in premenopausal women and are rarely serious. In fact, three of four women will develop uterine fibroids in their lifetimes, and in most cases, there will be no symptoms to indicate their existence. They are usually discovered during an ultrasound examination.

In only a few cases do fibroids become a problem. This typically results in pain, heavy menstrual bleeding, bleeding in between periods, and/or painful sexual intercourse. If the bleeding becomes severe enough, it can lead to anemia. Bladder problems and constipation may also be an indication of uterine fibroids. All of these symptoms can point to a number of conditions, though, so a thorough medical examination is required to determine the cause.

While fibroids do not generally interfere with pregnancy, they have the ability to grow large enough to create a fallopian tube obstruction, which can impede conception. Fibroids also create a slightly higher risk of miscarriage and premature delivery, although the risk is not great unless the fibroids are particularly severe.

In very rare cases, a fibroid loses its blood supply and dies inside the body, which can then lead to infection, or a fibroid grows to such a large size that it stretches the uterus, even occasionally expanding it up to the rib cage and causing an enlarged abdomen. Most fibroids remain inside the uterus (submucosal fibroids), while some protrude outside of the uterus (subserosal fibroids), putting pressure on the bladder. If they protrude out the back of the uterus, they can cause back pain and constipation from the pressure on the rectum and spine. In these severe cases, surgery may be necessary to remove the fibroids, or a hysterectomy may be required to remove the entire cervix and uterus.

A less invasive type of surgery which may be performed depending upon the severity of the fibroids is called uterine artery embolization or uterine fibroid embolization. In this procedure, the physician, usually a radiologist, inserts a thin tube into the uterine arteries that are connected to the problem fibroids, injecting them with particles that cut off their blood supply and cause them to die. This procedure is not without some risk, however, with up to five percent of women developing complications afterward. Other organs can be damaged by accident, or infection can result. This procedure may not be recommended for women with subserosal fibroids, as these can break off after the blood supply is ceased, causing an infection.

Another minimally invasive procedure is called ultrasound surgery. This operation requires no incision and no hospitalization, as it utilizes an MRI (magnetic resonance imaging) scanner and ultrasound waves to destroy the fibroids. The waves are very focused so that they pinpoint the fibroids through the skin without destroying any of the surrounding tissue. A magnetic resonance imaging (MRI) scanner is utilized for the procedure. Ultrasound surgery may not be effective for all types of fibroids. Only a medical examination can determine if the patient is a candidate for this procedure, which can take up to three hours. This surgery is performed with the patient under a sedative and pain medication rather than an anesthetic. The treatment is not generally painful, but a stop button is supplied for the woman to press if she experiences discomfort.

The causes of uterine fibroids are unknown, but there is evidence that a hormonal connection exists since fibroids contain more estrogen than the other cells of the uterus. Obesity may be another factor that puts a woman at greater risk of developing fibroids, while oral contraceptives and pregnancy seem to make women less likely to develop uterine fibroids. Genetics may also be a factor, as African American women seem to be more prone to these fibroids than women of other races. They even tend to suffer from fibroids that are larger, and they often develop them at a younger age.

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