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Pelvic laparoscopy
Pelvic laparoscopy


Female reproductive anatomy
Female reproductive anatomy


Fibroid tumors
Fibroid tumors


Uterus
Uterus


Definition:

Uterine fibroids are noncancerous tumors that develop within or attach to the wall of the uterus, a female reproductive organ.



Alternative Names:

Leiomyoma; Fibromyoma; Myoma; Fibroids



Causes, incidence, and risk factors:

Uterine fibroids are the most common pelvic tumor . Fibroids may be seen in as many as 1 in every 5 women in their childbearing years (the time after starting menstruation for the first time and before menopause).

Fibroids usually affect women over age 30. They are rare in women under 20 or in those who have gone through menopause. They are more common in African-Americans than Caucasians.

The cause of uterine fibroid tumors is unknown. However, fibroid growth seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.

Fibroids can be so tiny that you need a microscope to see them. However, they can also grow very large. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there is more than one.

Sometimes, a fibroid hangs from a long stalk, which is attached to the outside of the uterus. This is called a pedunculated fibroid.



Symptoms:
  • Abdominal fullness, gas
  • Bleeding between periods or very prolonged bleeding with periods
  • Increase in urinary frequency
  • Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots
  • Pelvic cramping or pain with periods
  • Sensation of fullness or pressure in lower abdomen
  • Sudden, severe pain due to a pedunculated fibroid

Note: There are often no symptoms.



Signs and tests:

A pelvic examination may reveal an irregularly shaped, lumpy, or enlarged uterus. Frequently, this diagnosis is reliable. In some cases, diagnosis of fibroids is difficult, especially in obese women. Fibroid tumors have been mistaken for ovarian tumors, inflammation of the fallopian tubes, and pregnancy.

A transvaginal ultrasound or pelvic ultrasound may be done to confirm the diagnosis of fibroids.

An endometrial biopsy (biopsy of the uterine lining) or a pelvic laparoscopy may be needed to rule out cancer.



Treatment:

Treatment depends on various factors, including:

  • Age
  • General health
  • Severity of symptoms
  • Type of fibroids
  • Whether you are pregnant
  • If you want children in the future

Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid's growth.

Treatment for fibroids may include:

  • Birth control pills (oral contraceptives) to help control heavy periods
  • Iron supplements to prevent anemia due to heavy periods
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn for cramps or pain with menstruation

Some women may need hormonal therapy (depot leuprolide injections) to shrink the fibroids. This medicine reduces the production of the hormones estrogen and progesterone. The hormones create a situation in the body that is very similar to menopause . Side effects can be severe and may include hot flashes, vaginal dryness, and loss of bone density. Hormone treatment may last several months. Fibroids will begin to grow as soon as treatment stops. In some cases, hormone therapy is used for a short period of time before surgery or when the woman is expected to reach menopause soon.

Surgery and procedures used to treat fibroids include:

  • Hysteroscopic resection of fibroids: This outpatient procedure may be needed for women with fibroids growing inside the uterine cavity. In this procedure, a small camera and instruments are inserted through the cervix into the uterus to remove the fibroid tumors.
  • Uterine artery embolization: This procedure stops the blood supply to the fibroid, causing it to die and shrink. The long-term effects of this procedure are still unknown, and the safety of pregnancy after this procedure is a concern.
  • Myomectomy: This surgery removes the fibroids. It is frequently the chosen treatment for women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids have. More fibroids can develop after myomectomy.
  • Hysterectomy : This invasive surgery may be an option if medicines do not work and other surgeries and procedures are not an option.

See also: Fibroid treatment



Support Groups:

National Uterine Fibroid Foundation - www.nuff.org



Expectations (prognosis):

A pedunculated fibroid can become twisted and cause a kink in the blood vessels feeding the tumor. This type of fibroid may require surgery.

A fibroid sometimes blocks the fallopian tubes and prevents sperm from reaching and fertilizing eggs, which may cause fertility problems. In some cases, fibroids may prevent a fertilized egg from implanting in the uterine lining. However, proper treatment may restore fertility.

After a pregnancy develops, existing fibroids may grow due to the increased blood flow and estrogen levels. The fibroids usually return to their original size after the baby is delivered.

Most women are able to carry their babies to term, but some of them end up delivering prematurely because there is not enough room in the uterus.

Some pregnant women with fibroids may need a cesarean section because fibroids can occasionally block the birth canal or cause the baby to be positioned wrong.



Complications:

Fibroids may cause infertility . They may also cause premature delivery.

Severe pain or excessively heavy bleeding with fibroids may require emergency surgery.

In rare cases, cancerous changes may occur. These usually take place after menopause.



Calling your health care provider:

Call your health care provider if gradual changes in your menstrual pattern occur, including a heavier flow, increased cramping, or bleeding between periods , or if fullness or heaviness develops in your lower abdomen.



Prevention:



References:

Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:pp. 441-447.

Viswanathan M, Hartmann K, et al. Management of uterine fibroids: an update of the evidence. Evid Rep Technol Assess. 2007;154:1-122.

Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 2007; 75(10):1503-1508.

Griffiths A, D'Angelo A, et al. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2006;3:CD003857.

Hehenkamp WJ, Volkers NA, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol. 2005;193(5):1618-1629.




Review Date: 5/26/2008
Reviewed By: Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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