About all

Fibroids behind uterus. Fibroids Behind the Uterus: Symptoms, Causes, and Treatment Options

by alexxlab

What are uterine fibroids and how do they affect women’s health. How are fibroids diagnosed and what treatment options are available. Can fibroids impact fertility and pregnancy outcomes.

Содержание

Understanding Uterine Fibroids: An Overview

Uterine fibroids are non-cancerous tumors that develop in or around a woman’s uterus. These growths, also known as leiomyomas or myomas, are composed of muscle and fibrous tissue. While their exact cause remains unknown, factors such as hormones and genetics are believed to play a significant role in their development.

Fibroids can vary greatly in size, ranging from microscopic to several pounds in weight. They may occur as single growths or in clusters, and can be located in different parts of the uterus:

  • Intramural: Within the muscular wall of the uterus
  • Submucosal: Just beneath the uterine lining
  • Subserosal: On the outer surface of the uterus
  • Pedunculated: Attached to the uterus by a stalk-like structure

The prevalence of uterine fibroids is surprisingly high, with up to 20% of women experiencing them during their childbearing years. By age 50, approximately half of all women will have developed fibroids. It’s worth noting that these growths are more common in African American women compared to other ethnic groups.

Recognizing the Symptoms of Uterine Fibroids

While many women with fibroids may not experience any symptoms, others can face a range of challenges. The severity and type of symptoms often depend on the size, number, and location of the fibroids. Common symptoms include:

  • Heavy or prolonged menstrual bleeding
  • Bleeding between periods
  • Pelvic pain or pressure
  • Frequent urination
  • Constipation
  • Back or leg pain
  • Pain during intercourse

Do all women with fibroids experience symptoms? No, many women with fibroids are asymptomatic, and the growths are often discovered during routine pelvic exams or imaging studies. However, for those who do experience symptoms, the impact on quality of life can be significant.

Diagnosing Fibroids: Medical Approaches and Imaging Techniques

The diagnosis of uterine fibroids typically begins with a thorough medical history and physical examination. During a pelvic exam, a healthcare provider may detect changes in the shape or size of the uterus that suggest the presence of fibroids. However, additional tests are often necessary to confirm the diagnosis and gather more information about the growths.

Imaging Studies for Fibroid Detection

Several imaging techniques can be used to visualize fibroids and assess their size, number, and location:

  1. Ultrasound: This non-invasive technique uses sound waves to create images of the uterus and is often the first-line imaging method for diagnosing fibroids.
  2. Magnetic Resonance Imaging (MRI): MRI provides detailed images of the uterus and can be particularly useful in distinguishing between fibroids and other types of growths.
  3. Saline Infusion Sonogram: This procedure involves injecting saline into the uterus to enhance the visibility of the uterine cavity during an ultrasound.
  4. Hysteroscopy: A thin, lighted tube is inserted through the vagina and cervix to examine the inside of the uterus directly.

In some cases, particularly when abnormal bleeding is a concern, an endometrial biopsy may be performed to rule out other conditions such as endometrial cancer.

Treatment Options for Uterine Fibroids: From Watchful Waiting to Surgery

The treatment approach for uterine fibroids depends on various factors, including the severity of symptoms, the patient’s age, overall health, and desire for future fertility. Options range from conservative management to medical therapies and surgical interventions.

Conservative Management

For women with small, asymptomatic fibroids, watchful waiting may be appropriate. This involves regular monitoring through follow-up exams and ultrasounds to track the growth of the fibroids.

Medical Therapies

Several medications can help manage fibroid symptoms or even shrink the growths:

  • Hormonal birth control methods (pills, patches, or intrauterine devices)
  • Gonadotropin-releasing hormone (GnRH) agonists
  • Tranexamic acid for heavy bleeding
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief

Minimally Invasive Procedures

For women seeking alternatives to major surgery, several minimally invasive options are available:

  • Uterine artery embolization (UAE): This procedure blocks blood flow to the fibroids, causing them to shrink.
  • Myolysis: Uses heat, cold, or radiofrequency energy to destroy fibroid tissue.
  • Endometrial ablation: Removes the uterine lining to reduce heavy bleeding (suitable for small submucosal fibroids).

Surgical Interventions

In some cases, surgery may be the most appropriate treatment option:

  • Myomectomy: Removes fibroids while preserving the uterus, suitable for women who wish to maintain fertility.
  • Hysterectomy: Complete removal of the uterus, which eliminates fibroids permanently but ends fertility.

How do doctors determine the best treatment approach for fibroids? The decision is based on a combination of factors, including the patient’s symptoms, age, desire for future pregnancy, and personal preferences. A thorough discussion between the patient and healthcare provider is crucial to determine the most appropriate course of action.

Fibroids and Fertility: Navigating Reproductive Challenges

The relationship between uterine fibroids and fertility is complex and can vary depending on the size and location of the growths. While many women with fibroids can conceive and carry pregnancies to term without complications, others may face challenges.

Impact on Conception

Fibroids can potentially affect fertility in several ways:

  • Altering the shape of the uterine cavity, which may interfere with sperm movement or embryo implantation
  • Blocking the fallopian tubes
  • Affecting the blood supply to the uterine lining
  • Changing the normal contractions of the uterus, which help sperm travel to the fallopian tubes

Fibroids During Pregnancy

For women who do become pregnant, fibroids may pose certain risks:

  • Increased risk of miscarriage
  • Higher likelihood of preterm labor
  • Greater chance of cesarean delivery
  • Potential for postpartum hemorrhage

Can fibroids grow during pregnancy? Yes, due to increased blood flow and higher estrogen levels during pregnancy, fibroids may grow. However, they typically return to their pre-pregnancy size after delivery.

Living with Fibroids: Lifestyle Modifications and Coping Strategies

While medical treatments are often necessary for managing fibroids, certain lifestyle changes and coping strategies can help women deal with symptoms and improve their overall quality of life.

Dietary Considerations

Some studies suggest that certain dietary choices may influence fibroid growth and symptoms:

  • Increasing consumption of fruits and vegetables
  • Reducing red meat intake
  • Maintaining a healthy body weight
  • Limiting alcohol consumption

Stress Management

Chronic stress may exacerbate fibroid symptoms. Incorporating stress-reduction techniques can be beneficial:

  • Regular exercise
  • Meditation or mindfulness practices
  • Yoga
  • Adequate sleep

Pain Management

For women experiencing pain related to fibroids, several strategies can provide relief:

  • Using heating pads or warm baths
  • Practicing relaxation techniques
  • Taking over-the-counter pain relievers as recommended by a healthcare provider

How can women best cope with the emotional impact of living with fibroids? Support groups, counseling, and open communication with healthcare providers and loved ones can all play important roles in managing the emotional aspects of this condition.

Advances in Fibroid Research: New Treatments on the Horizon

The field of fibroid research is continually evolving, with scientists and medical professionals working to develop new and improved treatment options. Some promising areas of research include:

Targeted Drug Therapies

Researchers are investigating new medications that specifically target fibroid growth without affecting other tissues:

  • Selective progesterone receptor modulators (SPRMs)
  • Aromatase inhibitors
  • Antiprogestin agents

Non-Invasive Treatments

Advanced technologies are being developed to treat fibroids without the need for surgery:

  • High-intensity focused ultrasound (HIFU)
  • Magnetic resonance-guided focused ultrasound (MRgFUS)

Genetic Research

Studies into the genetic factors contributing to fibroid development may lead to new preventive strategies and treatments:

  • Identifying genetic markers associated with fibroid risk
  • Developing gene therapies to prevent or treat fibroids

What potential breakthroughs in fibroid treatment can we expect in the coming years? While it’s difficult to predict with certainty, the ongoing research suggests that more targeted, less invasive, and potentially even preventive treatments may become available in the future.

Fibroids in Special Populations: Considerations for Different Life Stages

The impact and management of uterine fibroids can vary significantly depending on a woman’s life stage and individual circumstances. Understanding these differences is crucial for providing appropriate care and support.

Fibroids in Adolescents and Young Women

While fibroids are rare in women under 20, they can occur. Special considerations for this age group include:

  • Preserving fertility potential
  • Managing symptoms that may interfere with education or early career development
  • Addressing psychological impacts on body image and self-esteem

Fibroids During Perimenopause

As women approach menopause, hormonal fluctuations can affect fibroid growth and symptoms:

  • Increased likelihood of heavy or irregular bleeding
  • Potential for rapid growth of existing fibroids
  • Consideration of treatment options in light of approaching menopause

Fibroids in Postmenopausal Women

After menopause, fibroids typically shrink due to decreased estrogen levels. However, some women may still experience issues:

  • Monitoring for any unusual growth, which could indicate a rare cancerous transformation
  • Managing any residual symptoms
  • Considering the risks and benefits of hormone replacement therapy

How does the approach to fibroid management differ across these life stages? Treatment strategies must be tailored to each woman’s unique situation, taking into account factors such as symptom severity, desire for future fertility, and overall health status.

In conclusion, uterine fibroids represent a significant health concern for many women, with potential impacts on quality of life, fertility, and overall well-being. While challenges remain, ongoing advancements in diagnosis, treatment, and understanding of this condition offer hope for improved outcomes. As research continues to unveil new insights into the nature of fibroids, women can look forward to more personalized and effective management strategies in the future.

Uterine fibroids: MedlinePlus Medical Encyclopedia

Uterine fibroids are tumors that grow in a woman’s womb (uterus). These growths are typically not cancerous (benign).

Uterine fibroids are common. As many as one in five women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.

Fibroids are rare in women under age 20. They are more common in African Americans than White, Hispanic, or Asian women.

No one knows exactly what causes fibroids. They are thought to be caused by:

  • Hormones in the body
  • Genes (may run in families)

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

Fibroids can grow:

  • In the muscle wall of the uterus (myometrial)
  • Just under the surface of the uterine lining (submucosal)
  • Just under the outside lining of the uterus (subserosal)
  • On a long stalk on the outside the uterus or inside the uterus (pedunculated)

Common symptoms of uterine fibroids are:

  • Bleeding between periods
  • Heavy bleeding during your period, sometimes with blood clots
  • Periods that may last longer than normal
  • Needing to urinate more often
  • Pelvic cramping or pain with periods
  • Feeling fullness or pressure in your lower belly
  • Pain during intercourse

Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.

Your provider will perform a pelvic exam. This may show that you have a change in the shape of your womb.

Fibroids are not always easy to diagnose. Being obese may make fibroids harder to detect. You may need these tests to look for fibroids:

  • Ultrasound uses sound waves to create a picture of the uterus.
  • MRI uses powerful magnets and radio waves to create a picture.
  • Saline infusion sonogram (hysterosonography) — Saline is injected into the uterus to make it easier to see the uterus using ultrasound.
  • Hysteroscopy uses a long, thin tube inserted through the vagina and into the uterus to examine the inside of the uterus.
  • Endometrial biopsy removes a small piece of the lining of the uterus to check for cancer if you have unusual bleeding.

What type of treatment you have depends on:

  • Your age
  • Your general health
  • Your symptoms
  • Type of fibroids
  • If you are pregnant
  • If you want children in the future

Treatment for the symptoms of fibroids may include:

  • Intrauterine devices (IUDs) that release hormones to help reduce heavy bleeding and pain.
  • Tranexamic acid to reduce the amount of blood flow.
  • Iron supplements to prevent or treat anemia due to heavy periods.
  • Pain relievers, such as ibuprofen or naproxen, for cramps or pain.
  • Watchful waiting — You may have follow-up pelvic exams or ultrasounds to check the fibroid’s growth.

Medical or hormonal therapies that may help shrink fibroids include:

  • Birth control pills to help control heavy periods.
  • A type of IUD that releases a low dose of the hormone progestin into the uterus each day.
  • Hormone shots to help shrink fibroids by stopping ovulation. Most often, this therapy is used only for a short time to shrink fibroids before surgery. They can also be used longer when small amounts of estrogen hormone are added back to reduce side effects.

Surgery and procedures used to treat fibroids include:

  • Hysteroscopy — This procedure can remove fibroids growing inside the uterus.
  • Endometrial ablation — This procedure is sometimes used to treat heavy bleeding associated with fibroids. It works best when the fibroids are small in size. It often stops menstruation completely.
  • Uterine artery embolization — This procedure stops the blood supply to the fibroid, causing it to shrink and die. This may be a good option if you wish to avoid surgery and are not planning to become pregnant.
  • Myomectomy — This surgery removes the fibroids from the uterus. This also may be a good choice if you want to have children. It will not prevent new fibroids from growing.
  • Hysterectomy — This surgery removes the uterus completely. It may be an option if you do not want children, medicines do not work, and you cannot have any other procedures.

Newer treatments, such as the use of focused ultrasound, are being evaluated in clinical studies.

If you have fibroids without symptoms, you may not need treatment.

If you have fibroids, they may grow if you become pregnant. This is due to the increased blood flow and higher estrogen levels. The fibroids usually return to their original size after your baby is born.

Complications of fibroids include:

  • Severe pain or very heavy bleeding that needs emergency surgery.
  • Twisting of the fibroid — This can cause blocked blood vessels that feed the tumor. You may need surgery if this happens.
  • Anemia (not having enough red blood cells) from heavy bleeding.
  • Urinary tract infections — If the fibroid presses on the bladder, it can be hard to empty your bladder completely.
  • Infertility, in rare cases.

If you are pregnant, there’s a small risk that fibroids may cause complications:

  • You may deliver your baby early because there is not enough room in your womb.
  • If the fibroid blocks the birth canal or puts the baby in a dangerous position, you may need to have a cesarean section (C-section).
  • You may have heavy bleeding right after giving birth.

Contact your provider if you have:

  • Heavy bleeding, increased cramping, or bleeding between periods
  • Fullness or heaviness in your lower belly area

Leiomyoma; Fibromyoma; Myoma; Fibroids; Uterine bleeding – fibroids; Vaginal bleeding – fibroids

  • Hysterectomy – abdominal – discharge

  • Hysterectomy – laparoscopic – discharge

  • Hysterectomy – vaginal – discharge

  • Uterine artery embolization – discharge

  • Pelvic laparoscopy

  • Female reproductive anatomy

  • Fibroid tumors

  • Uterus

Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Dolan MS, Hill CC, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Manyonda I, Belli AM, Lumsden MA, et al. Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med. 2020 ;383(5):440-451. PMID: 32726530. pubmed.ncbi.nlm.nih.gov/32726530/.

Moravek MB, Bulun SE. Uterine fibroids. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 131.

Stewart EA. Clinical practice. Uterine fibroids. N Engl J Med. 2015;372(17):1646-1655. PMID: 25901428 pubmed.ncbi.nlm.nih.gov/25901428/.

Verpalen IM, Anneveldt KJ, Nijholt IM, et al. Magnetic resonance-high intensity focused ultrasound (MR-HIFU) therapy of symptomatic uterine fibroids with unrestrictive treatment protocols: a systematic review and meta-analysis. Eur J Radiol. 2019;120:108700. doi: 10.1016/j.ejrad.2019.108700. PMID: 31634683. pubmed.ncbi.nlm.nih.gov/31634683/.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Uterine Fibroids

This summary discusses:

  • Fibroids

  • Uterine Fibroids

  • Uterus – Womb

  • What causes fibroids?

  • Can fibroids turn into cancer?

  • Who usually develops fibroids?

  • Symptoms

  • How do you know you have a fibroid?

  • Diagnostic Procedures

  • Fibroids and Pregnancy

  • Treatments

  • Development of New Treatments

Fibroids

Uterine Fibroids are common non-cancerous (benign) tumors of the uterus and are the most frequent reason for recommending a hysterectomy. They grow from the muscular wall of the uterus and are made up of muscle and fibrous tissue. Many women over 35 have fibroids, but usually have no symptoms.

In some women, however, fibroids (myomas) may cause heavy bleeding, pelvic discomfort and pain and occasionally exert pressure on other organs. These symptoms may require treatment. Treatment may take the form of medication to control pain and bleeding, hormone therapy to shrink the tumor, surgery to remove the tumor or occasionally a hysterectomy. There are promising new experimental drugs that may temporarily shrink the tumors. These drugs may have serious side effects and are generally very costly. There is a type of abdominal surgery (myomectomy) that removes the myoma without removing the uterus (see Alternatives for additional information). These treatments may be sufficient or they may offer temporary relief and enable a woman to postpone having a hysterectomy, especially if she still wishes to bear children. In most severe cases a hysterectomy may be recommended.

Some women choose to do nothing since fibroids will often shrink in size as a woman goes through menopause.

What is a fibroid?

A fibroid is a non-cancerous growth (tumor) made up of mostly fibrous tissue, like muscle. Fibroids grow in or around the uterus (womb). They are the most common type of growth in a woman’s pelvic area (the pelvis is the bony structure at the bottom of the spine).

Uterine Fibroids

According to the U.S. National Institutes of Health (NIH), 20-25% of women of reproductive age have fibroids. By the age of 50, up to 80% of black women and up to 70% of white women have fibroids. Uterine fibroids are most common in women who are in their 40s and early 50s, although some women may develop fibroids at a younger age. At least 25% of women have uterine fibroids which can cause problems. Many women with fibroids never have a problem and never know they have a fibroid.

Uterus – Womb

The uterus (womb) is a pear-shaped organ located in the lower part of a woman’s body. It is made up of the muscle wall, endometrium (lining) and the cervix (opening). In women who are not pregnant, the lining is shed monthly as part of the menstrual cycle (period). In women who are pregnant, the uterus is where a fetus will grow and develop.

Figure 1. Female Reproductive System

Are there different types of fibroids?

A fibroid can be very small, the size of a seed, or large, the size of a grapefruit. The medical term for a fibroid is a leiomyoma or myoma. A woman may have one fibroid or many. A fibroid may be inside the uterus (submucosal), outside the uterus (subserosal), or in the wall of the uterus (intramural). Most fibroids grow in the wall of the uterus. Fibroids can also grow out from the uterus on stalks called peduncles.

Figure 2. Illustration of Uterine Fibroids from the US Health and Human Women’s Health Web site

What causes fibroids?

Fibroids begin when cells overgrow in the wall of the uterus. However, the cause of uterine fibroids is not known. Researchers have many ideas of what may cause fibroids, but none of these are seen as definite causes of fibroid tumors. Some of these ideas include:

  • Fibroids may be genetic (runs in families).

  • Female hormones, estrogen and progesterone, cause fibroids to grow.

Fibroids grow rapidly during pregnancy, when hormone levels are high and shrink when anti-hormone medicine is used. Fibroids also stop growing or shrink once a woman reaches menopause.

Can fibroids turn into cancer?

Fibroids are usually benign (not cancerous). Having fibroids does not increase a woman’s risk of developing cancer. In less than 1 in 1,000 cases a cancerous fibroid will occur. A cancerous fibroid is called leiomyosarcoma.

Who usually develops fibroids?

Age, race, lifestyle and genetics may play a part in the development of fibroids. Here are the few known risk factors:

  • Having a family member with fibroids increases the risk. If a woman’s mother had fibroids, her risk of having fibroids is about 3 times higher than average.

  • African-Americans are 2-3 times more likely to present with symptomatic (problems such as pain or bleeding) uterine fibroids and will often develop fibroids at a younger age than the rest of the population of women with uterine fibroids.

  • Asian women have a lower incidence of symptomatic uterine fibroids.

  • Obesity is associated with uterine fibroids. The risk of obese women developing fibroids is 2-3 times greater than women of average weight.

  • Eating beef, red meat (other than beef), and ham has been linked with having uterine fibroids, while eating green vegetables seems to protect women from developing fibroids.

What are the symptoms of fibroids?

For most women fibroids do not cause symptoms. At least 25% of women who have uterine fibroids do have symptoms which may include:

  • Heavy bleeding or painful periods

  • Bleeding between periods

  • Cramping

  • Bloating of the lower belly (abdomen or pelvic area)

  • Feeling of fullness in the pelvic area

  • Pain during sex

  • Low back pain

  • Frequent urination

Fibroids can also cause infertility (being unable to get pregnant), miscarriages, or premature labor (labor before 37 weeks of pregnancy).

How do you know you have a fibroid?

You may not know if you have fibroids if they are not causing any problems. A health care provider may find a fibroid on a routine exam, or you may see your health care provider if you are having symptoms. The health care provider may:

  • Do a physical exam of your uterus (pelvic exam) to check the size of your uterus (womb), and may feel the fibroid as a lump on your uterus during the pelvic exam.

  • Send you for a procedure to get a “picture” of your uterus.

  • Do blood tests to check your blood count for anemia (low iron in your blood due to heavy periods or bleeding between periods) or for other problems.

The pelvic exam and the tests help your health care provider find out if you have fibroids, where they are and how large they are.

What kind of procedures may be done to find out if you have fibroids?

Your health care provider can do an imaging examination to produce a picture to confirm that you have fibroids. These might include:

  • Ultrasound (US) – uses sound waves to produce a picture to see if you have fibroids. An ultrasound probe can be placed on the abdomen or it can be placed inside the vagina during the ultrasound.

  • Magnetic Resonance Imaging (MRI) – magnets and radio waves are used to produce the picture.

  • X-rays – uses a form of radiation to produce the picture.

  • Cat Scan (CT) – takes many X-ray pictures of the body from different angles for a more complete picture.

  • Hysterosalpingogram (HSG)
  • Sonohysterogram – an ultrasound test that uses saline and ultrasound to look at the uterus and pelvic area.

You might also need additional procedures to know for sure if you have fibroids. There are two types of procedures to do this:

  • Diagnostic Laparoscopy or Gynecologic Laparoscopy – surgery in which the doctor makes a cut into the abdomen and inserts a thin lighted tube with a small camera attached. This allows the doctor to see inside the abdomen to look at the uterus, ovaries and pelvic area.

  • Hysteroscopy – The doctor passes a long, thin tube with a light through the vagina and cervix into the uterus. The hysteroscope has a light and camera attached to it so your doctor can see the inside of the uterus on a video screen.

Will I have trouble getting pregnant if I have fibroids?

In some cases, fibroids are severe enough to prevent a woman from becoming pregnant (infertility). If a woman is pregnant, fibroids can cause problems (complications) during pregnancy, labor and delivery. Since fibroids are controlled by hormone levels they grow rapidly during pregnancy. Hormone levels are high during pregnancy.

What kinds of problems will fibroids cause in pregnancy?

The most common complications caused by fibroids during pregnancy are:

  • Labor does not progress – this can happen if the uterus (womb) does not contract as it should and the baby does not move out through the birth canal to be born.

  • Baby is breech – the baby is coming out bottom first. The usual position of a baby is for the head to come out first, but breech babies are in the bottom or feet-first position.

  • Placenta abruption – the placenta pulls away from the uterus (womb) before delivery.

  • Preterm delivery – the baby is born before 37 weeks of pregnancy.

  • Cesarean section (C-section) – a cut (incision) is made in the mother’s abdomen (belly) and uterus (womb) and the baby is lifted out.
    • www.health.ny.gov/community/pregnancy/what_will_giving_birth_be_like.htm#section

What are the treatments for fibroids?

If a woman is having heavy bleeding which could cause a low blood count, or is experiencing severe cramping, painful periods, infertility or bladder or bowel problems, she will need treatment.

Before deciding on a treatment, it is important to talk with your health care provider to get more information. Ask your health care provider:

  • How many fibroids do I have and will they grow bigger?

  • Where are they located and will they cause problems?

  • Do I need treatment if I am not having any problems?

  • What are my choices for treatment?

  • Can I try other options such as medications or hormone therapy before I try surgery?

  • What are the treatment options other than hysterectomy?

  • What are the risks and benefits of these treatment options?

If you need more information before deciding on a treatment, you can ask your health care provider to refer you to another doctor for a second opinion to be sure you are making the best decision.

There are many options for treatment of uterine fibroids including:

  • Medications

  • Hormone Therapy

  • Surgery

  • Embolization

Medications

For occasional mild to moderate pain or discomfort, an over-the-counter medication such as ibuprofen or acetaminophen can be taken. Over the counter nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen, if used during early pregnancy, may cause miscarriage.

For symptoms of heavy bleeding, which can cause anemia, taking an iron supplement and an iron-rich diet can help to prevent anemia or treat anemia. More serious symptoms may require stronger drugs available by prescription from your health care provider.

Hormone Therapy

Birth control pills (oral contraceptives) can be used to treat the bleeding symptoms of fibroids. Low-dose birth control pills or progesterone-like injections (such as Depo-Provera) do not make fibroids grow and can help control heavy bleeding. An intrauterine device (IUD) which contains a small amount of progesterone-like medication (such as Mirena IUD) can also control fibroid symptoms and provide birth control.

Gonadotropin-releasing hormone agonists (GnRHa)

Some fibroids are treated with GnRHa, a hormone that reduces the amount of estrogen to shrink the fibroids and control symptoms. Sometimes GnRHa is used before surgery to make fibroids easier to remove. Most women can take GnRHa without any problems, but using GnRHa causes menopause-like side effects such as:

  • Hot flashes

  • Depression or mood swings

  • Decreased sexual interest

  • Insomnia (not being able to sleep)

  • Headaches

  • Bone thinning

  • Joint pain

The side effects go away when the GnRHa is stopped, and once you stop taking the drugs the fibroids often grow back quickly. Most women don’t get a period when taking GnRHa. This can relieve the symptoms of heavy bleeding and improve the low blood count (anemia) which can happen with heavy bleeding. Since GnRHa can cause bone thinning, it is generally used for six months or less.

Surgery

There are three surgical treatments for fibroids:

  • Myomectomy – cutting fibroids from the uterus,

  • Endometrial Ablation – removing or destroying the lining of the uterus, or

  • Hysterectomy – removing the entire uterus (womb).
    • www.health.ny.gov/community/adults/women/hysterectomy/

The surgical method used depends on the size, location, and number of fibroids.

Myomectomy

Myomectomy is removing fibroids without taking out the uterus, which makes pregnancy possible for some women. A woman who has had a myomectomy can have problems with the placenta or can make a cesarean delivery more likely if she becomes pregnant. Fibroids may also develop again, even after a myomectomy.

Myomectomy can be done by:

  • Laparoscopy – making one or more small cuts in the abdomen and inserting a lighted viewing instrument to remove the fibroids through the small cuts,

  • Hysteroscopy – using a lighted viewing instrument going through the vagina and into the uterus to remove the fibroids, or

  • Laparotomy – major surgery done by making a larger cut into the abdomen and the uterus.

The type of operation done for the myomectomy depends on the size and location of the fibroids.

Endometrial Ablation

Endometrial Ablation is when the lining of the uterus is removed or destroyed by using laser, wire loops, freezing or other methods to control very heavy bleeding. This procedure is usually considered minor surgery and can be done on an outpatient basis. A woman having this procedure will be unable to have children. Complications can occur, but are not common.

Hysterectomy

A hysterectomy an operation to remove the uterus (womb). The only absolute cure for uterine fibroids is a hysterectomy. This procedure results in permanent infertility; a woman will be unable to have children. A hysterectomy is major surgery. All of the possible risks of surgery listed above are the same for hysterectomy.

  • Hysterectomy

Embolization

Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE) – a nonsurgical procedure that blocks blood flow to fibroids in the uterus. Embolization is done with local anesthesia, and there are no incisions or cuts in the skin. A thin flexible tube is threaded into the blood vessels that supply blood to the fibroid; a solution is then injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. Fibroids treated with embolization shrink by half or more. Normal uterine tissue usually remains unharmed, because it is supplied by other arteries.

Pregnancy is possible after embolization, but the risks to pregnancy after embolization are not fully known. Embolization is a procedure for women who do not want to have children in the future.

Women who are considered the best candidates for embolization are women who:

  • Have fibroids that are causing heavy bleeding

  • Have fibroids that are causing pain or pressing on the bladder or rectum

  • Don’t want to have a hysterectomy

  • Don’t want to have children in the future

Complications of embolization are not common, but can occur. They are:

  • Infection – the most serious, potentially life-threatening complication of embolization. See your doctor immediately if you have a high fever and feel ill or notice pus in your vaginal discharge. In rare cases, emergency hysterectomy is needed to treat an infected uterus.

  • Loss of menstrual periods

  • Premature menopause

  • Scar tissue formation

It is important to note though that all women are different and treatment may vary. Only your health care provider can provide you with the best options to treat uterine fibroids.

Are new treatments for uterine fibroids being developed?

There are several new ways of destroying fibroid tissue or removing fibroids. These methods are not yet standard treatments so your health care provider may not offer them and your health insurance may not pay for them.

If your doctor offers one of these procedures, ask:

  • How many of the procedures he or she has done,

  • How successful they have been,

  • What kinds of problems can result, and

  • Whether your insurance covers the procedure.

Myolysis

Myolysis is the destruction of muscle tissue. Myolysis is generally recommended for smaller fibroids. It is not recommended for women who hope to have children. These treatments can cause serious pregnancy complications, such as uterine scarring and infection; these can be dangerous to both mother and fetus.

  • Laser (myolysis) – usually done by laparoscopy. A laser is used to remove the fibroid or clot the blood supply to the fibroid, causing the fibroid to shrink and eventually die.

  • Cold (cryomyolysis) – usually done by laparoscopy. Liquid nitrogen is used to freeze the fibroid.

  • Electric current – Myoma coagulation (myolysis) – usually done by laparoscopy. An electrical needle is passed directly into the fibroid delivering high-temperature energy to destroy both the fibroid and the blood vessels feeding it.

  • High-frequency focused ultrasound – Using a high-intensity ultrasound beam, the Magnetic Resonance Imaging (MRI) scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy it.

New Medications

New anti-hormonal drugs and other medications are being studied for treatment of fibroids, but none are yet available or Federal Drug Administration (FDA)-approved for us in the US.

It is important you talk with your health care provider to fully understand your options for uterine fibroids that are causing you problems. If your health care provider is recommending a hysterectomy, be sure to ask why other options are not right for you. Remember, you can ask for a second opinion to be sure the treatment option is right for you.

Additional Information About Uterine Fibroids:

  • www.niehs.nih.gov/health/topics/population/whealth/index.cfm

  • www.womenshealth.gov

Uterine fibroids – causes, symptoms, signs, diagnosis, treatment (removal)

Causes

Symptoms

Diagnosis

What to do

Treatment

Uterine fibroids is a benign tumor-like formation that develops in the muscular layer of the organ. The tumor is one of the most common among those diagnosed, as a rule, in women of childbearing age.

This is a chronic pathology characterized by the appearance in the uterus of single or multiple nodes with different localization.

The size of uterine fibroids can vary from small to a large tumor weighing several kilograms. Such a formation can easily be felt through the abdominal wall. Often, several nodes are found in one patient, and each of them is located in different parts of the uterus and has its own development scenario.

At the moment, there are no precisely established causes of uterine fibroids, although it was previously believed that its development is associated with hormonal disorders. However, this issue has not been fully explored.

It has been established that the development of a tumor is often combined with extragenital pathologies. In most cases, women simultaneously with fibroids are diagnosed with diseases of the cardiovascular system, endocrinopathies, obesity, and neuroses.

Causes of uterine fibroids

Pathology is practically not observed before the onset of puberty and after the onset of menopause. During the postmenopausal period, the tumor-like formation undergoes a reverse development.

According to most scientists, the appearance of a tumor is caused by hormonal disruptions in a woman’s body, as well as increased production of estrogens. However, pathology can occur with a normal hormonal status, and with an unchanged menstrual cycle.

Factors that may influence the formation of fibroids:

  • microtrauma of the muscular layer of the uterus;
  • endocrine pathologies;
  • gynecological diseases;
  • absence of childbirth and pregnancy.

During gynecological manipulations (curettage of the uterine cavity), damage to the myometrium is possible. As a result of the inflammatory response, cells undergo morphological changes and can become a source of tumor development.

Obesity, late menarche are accompanied by a violation of the formation of sex hormones. The damaging mechanism of the muscular layer of the uterus has not been identified, but the presence of some patterns can be traced. In more than 50% of women, the formation of a tumor is combined with excess weight.

During menstruation, spasmodic vessels prevent normal blood flow in the organ, which leads to cell hypoxia. The onset of pregnancy is a protective reaction that helps to reduce the number of periods in a woman’s life. As a result, the risk of morphological changes in myometrial cells is minimized.

Chronic gynecological diseases, endometriosis, endometrial hyperplasia lead to hormonal imbalance, having a damaging effect on the myometrium. Hypersecretion of progesterone and estrogens is especially dangerous.

What are the symptoms of uterine fibroids

The disease is quite common. The development of symptoms is influenced by the location of the tumor, its size. The farther from the uterine cavity is the formation, the less symptoms the pathology will manifest.

Clinical manifestations of fibroids:

  • heavy periods;
  • frequent urination due to uterine pressure on the bladder area;
  • increase in the size of the abdomen;
  • feeling of pressure on the rectum;
  • soreness on sexual contact;
  • pain in the lumbar region, abdomen;
  • problems with pregnancy;
  • impossibility of conception.

One of the symptoms of pathology is menorrhagia. This is an increase in the volume of blood released during menstruation, as well as their duration. The danger of this condition is that a large blood loss can provoke the development of anemia. Against the background of this pathology, acyclic bleeding, which is called “metrorrhagia”, is often observed.

The growth and development of education affect the work of organs adjacent to the uterus: the rectum and bladder. When the tumor grows towards these organs, they are compressed, resulting in dysfunction. As a result, there are frequent urges to urinate or difficult urine output, with pressure on the rectum, the act of defecation is disturbed.

The presence of pain in the lower back and lower abdomen is also a characteristic sign of the development of uterine fibroids. The nature of the pain can be different. If the blood supply to the myomatous node is disturbed, the pain sensations intensify and are characterized by a sudden appearance.

If the tumor-like formation is slowly growing and large, then the pain becomes aching and pulling. With the growth of education in the mucous layer of the uterus, the pain becomes cramping. When squeezing the rectum, constipation occurs.

Deterioration of microcirculation in myoma can provoke its death (necrosis). In this case, the woman feels tired, her temperature rises, there is severe pain in the abdomen.

If the localization of fibroids is the cervix, then a woman may feel pain during a gynecological examination, as well as during sexual contact. In the case of a protrusion of the node into the cervical canal, there is a violation of the outflow of menstrual blood, which leads to the formation of large blood clots that are released from the cervix.

Diagnosis of uterine fibroids

At the beginning of tumor development, the process has an asymptomatic course. Fibroids are more often discovered by chance during a physical examination in a gynecological office. With the development of the tumor, symptoms appear that require a mandatory visit to a gynecologist.

Diagnosis is easy. The doctor can establish the presence of a tumor in the uterus during a routine examination in the gynecological chair. At the same time, the structure of the organ has a dense texture, often with a bumpy surface.

In the presence of heavy bleeding during menstruation, an ultrasound examination of the pelvic organs may be required. With the help of ultrasound, the localization of the nodes, their size and density are determined.

In most cases, an ultrasound is sufficient to make a diagnosis. But the study should be carried out using two sensors: abdominal and vaginal, in order to exclude or confirm the presence of subserous nodes located remotely from the uterus.

If the uterus is too large to assess its condition, an MRI of the pelvis is performed.

In the case of submucosal uterine fibroids, hysteroscopy (endoscopic method) is recommended. For diagnostic purposes, a special camera is introduced into the cavity, which allows visualizing the state of the organ from the inside. But not every patient can conduct this study, since this is an operative intervention that has a number of contraindications. In order to carry out this operation, intravenous anesthesia is required.

How to deal with uterine fibroids

When a tumor is found in a woman, treatment is not always necessary. If the pathology is asymptomatic, then monitoring the development of the tumor is sufficient.

Treatment of uterine fibroids is not necessary in the following cases:

  • the woman has no symptoms suggestive of anemia;
  • the patient is already 35 years old and does not plan pregnancy in the future;
  • there is no growth of nodes or an increase in the size of the tumor (intramural-serous or subserous localization) – no more than 1 cm per year.

Other cases of the disease require therapy.

Methods of treatment of uterine fibroids

Treatment of the disease can be conservative and operative.

Conservative treatment (treatment of fibroids without surgery) includes hygiene, diet enriched with fruits and vegetables, and iron supplements. In some cases, COCs or gestagens are prescribed, which prevent the growth of the tumor, excluding the irregular effect of estrogens and progesterone on it. Courses are electrophoresis with potassium iodide on the suprapubic area.

If the pathology is combined with other diseases (for example, with endometrial hyperplasia or endometriosis), then therapy is prescribed after hysteroscopy, WFD, histological examination of the obtained material. With the exclusion of intrauterine pathology, a course of hormonal therapy may be prescribed.

Surgery for uterine fibroids may be required in the following cases:

  • large fibroids;
  • if the size of the tumor is rapidly increasing;
  • if the disease is combined with other pathologies;
  • in the presence of severe pain;
  • for manifestations of tumor necrosis;
  • if the node is located under the mucous layer;
  • with a combination of uterine fibroids and heavy, frequent or irregular bleeding from the genital tract.

There are the following types of surgical treatment:

  • removal of fibroids together with the uterus – after this intervention, the woman loses the function of childbearing;
  • uterine artery embolization – this technique involves partial blockage of the uterine arteries, which leads to disruption of the blood supply to the node and its necrosis;
  • myomectomy (conservative method) with preservation of the uterus – the technology consists in “husking” the tumor. At the same time, the possibility of conception is preserved.

The author of the article:

Shklyar Aleksey Alekseevich

obstetrician-gynecologist, surgeon, candidate of medical sciences, head of the direction “Obstetrics and gynecology”

work experience 11 years

reviews leave feedback

Clinic

m. Sukharevskaya

Reviews

Inna

30.12.2021 21:55:20

Clinic

m. Sukharevskaya

Doctor

900 25 Shklyar Aleksey Alekseevich

Turned to Shklyar Aleksey Alekseevich I want to express my deepest gratitude to the entire staff of the operating room Aleksey Alekseevich Shklyar block. You are all doctors with a capital letter. I never tire of thanking God for bringing me to you. I came to you on the recommendation of Sorvacheva M.V. We got in touch with the doctor by phone and appointed the day of the operation. For the first time, I was pleasantly surprised how Alexey Alekseevich told me everything in detail and reassured me. A couple of weeks later, I arrived at the clinic at 10.00 with a complete list of tests, and already at 11 I was lying on the operating table, to be honest, I didn’t even have time to get scared) Then the anesthetist magician came and I fell asleep sweetly. I woke up already in bed, nothing hurt, there were no side effects, just a normal morning awakening. I would never have believed that this was even possible, I am very grateful for a wonderful dream. Before that, I had more than one general anesthesia in state hospitals, and now I understand for sure that they apparently wanted to kill me there, but it didn’t work out. For the next two hours, until it was impossible to get up, wonderful nurses came to me asking how I felt and if I needed something, they put droppers, and I lay and did not believe that everything terrible was over)) 2 hours after the operation, I was already getting up and drank delicious broth and tea. The rest of the time before sleep, I walked around the ward, I didn’t feel any pain at all, a little weakness and nothing more. The next morning I was fed deliciously and discharged home. After being discharged, Aleksey Alekseevich is constantly in touch, he worries about my well-being more than even my relatives. I needed further treatment, he even helps me with this by calling the best doctors and clinics, supporting me. And now I know for sure that I am in the most reliable hands. Thank you very much again. Prosperity to your clinic and low bow to all your doctors. You are the best!!!

Lilia

15.05.2021 15:21:57

Clinic

Sukharevskaya metro station

Doctor

Shklyar Alexey Alekseevich

On May 7, 2021, I did a minor gynecological operation in SOD, and I would like to express my gratitude to the attending physician, to the head of the gynecological department Shklyar Aleksey Alekseevich, – for high professionalism, and exceptionally friendly attitude, understandable recommendations. The doctor communicates very correctly, clearly and with explanations.
Special thanks to the anesthetist Alexey Valeryevich Fomin, for the quality of anesthesia (I was more afraid of anesthesia than the operation itself), but everything went well, I was “not present” at the operation, and the condition after anesthesia was normal, as after waking up in the morning, no “side effects” ‘ did not feel.
After the operation, nothing hurt after half an hour, and after an hour and a half, I went home.
The attitude in the hospital was the most friendly, including from the nurses and the administrator at the reception (unfortunately, I did not ask for names).
It’s been a week since the operation, and only the discharge summary # 140035314 reminds of it.
I’m very glad that I trusted the experience of the Polyclinic.

Services

  • Title
  • Primary appointment, consultation of an obstetrician-gynecologist3950