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Fibroid tumors also referred to as fibroids, uterine leiomyomata,
or uterine myomas, are benign growths of smooth muscle tissue
in the uterus. They are extremely common, affecting one in five
(20 percent) of Caucasian women and up to one in three African-American
women. In a minority of cases, however, fibroids may interfere
with the appropriate implantation and early growth of a pregnancy,
resulting in decreased fertility or miscarriage.
In many women fibroids occur randomly, but sometimes they appear
to run in families. Fibroids that affect reproduction are most
common in older reproductive-age women (35-45), simply because
older women's bodies have had more time to create the large
fibroids that can affect fertility.
A fibroid arises from the abnormal growth of a single smooth
muscle cell in the wall of the uterus. For reasons largely
unknown, the cell receives the wrong growth signals and continues
to divide and multiply long after it should have stopped.
Over time, the single cell grows into a small ball and may
become quite large.
Usually fibroids cause no symptoms, and they are often found
during a woman's yearly gynecological exam. The most common
symptom of fibroids is heavy, prolonged, and/or painful menstrual
periods. However, prolonged or heavy menses with or without
pain can indicate a number of possible problems, not just fibroids.
Other less common symptoms of fibroids include a feeling of
abdominal pressure, abdominal distension (a woman might notice
her pants growing tighter despite no weight gain), recurrent
miscarriage, infertility, uterine pain even when a woman is
not premenstrual or menstrual, increased urgency or frequency
of urination, and loss of bladder control. Once again, most
women with fibroids have no significant symptoms.
There are three general locations for fibroids in the uterus.
The fibroids can lie within the cavity of the uterus, inside
the wall of the uterus, or on the external surface of the
uterus. If you have been diagnosed with fibroids but you have
no symptoms, this usually indicates that the fibroid(s) is
deep within the wall of your uterus or at the external surface
of the uterus. The location of the fibroid appears to be the
most important factor in whether or not it causes any symptoms
or has an adverse effect on reproduction. Fibroids within
the wall or at the external surface of the uterus usually
will not significantly affect the lining of the uterus (the
endometrium), where the pregnancy grows and the tissue is
shed during menstrual periods.
The fibroids that grow either in the uterine cavity or inside
the wall of the uterus, and become large enough to deform
or distort the uterine cavity and the endometrium, appear
to have the highest risk for causing menstrual disturbances,
miscarriage, and perhaps also decreased fertility. The endometrium
and uterine cavity may not work normally, leading to bleeding
problems, difficulty in implantation, and sometimes miscarriage.
The heavy bleeding and severe cramping that are the most common
symptoms of fibroids are usually responsive to medications such
as birth-control pills and nonsteroidal anti-inflammatory agents
(for example, ibuprofen or naproxen sodium). An ultrasound,
or a new ultrasound technique called sonohysterography or hydrosonography
are usually suggested to ascertain the size and location of
fibroids within the uterus. Unless your symptoms are untreatable
or refractory to medical treatment, your fibroids are very large,
or you have a history of adverse reproductive outcomes-such
as recurrent miscarriage or infertility-you would probably not
need surgery to remove fibroids.
When fibroids cause problems and conservative treatment measures
are not effective, then surgery is often suggested. In order
to retain your fertility you will need to make sure that you
receive a myomectomy, not
a hysterectomy. In a myomectomy the fibroids are removed but
the uterus is left in place. The myomectomy is usually done
through an incision in your abdomen, but sometimes can be performed
through laparoscopic surgery,
using a small cameral inserted through the naval, or hysteroscopic
surgery, with a small camera place through the vagina and
into the uterus. |
