WHAT IS UTERINE FIBROID: SYMPTOMS, CAUSES, DIAGNOSIS, AND MORE

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Uterine fibroids are noncancerous uterine growths that commonly arise during reproductive years. Uterine fibroids, also known as leiomyomas or myomas, are not connected with an elevated risk of uterine cancer and usually never develop into malignancy.

Fibroids range in size from invisible seedlings to bulky masses that can deform and expand the uterus. You can have a single fibroid or several. Multiple fibroids can cause the uterus to enlarge so much that it approaches the rib cage and adds weight in severe situations.

Many women get uterine fibroids at some point in their lives. However, because uterine fibroids seldom cause symptoms, you may be unaware that you have them. During a pelvic exam or prenatal ultrasound, your doctor may uncover fibroids by chance.

WHAT ARE THE SYMPTOMS OF UTERINE FIBROID?

Many women with fibroids exhibit no symptoms. Symptoms can be altered by the location, size, and quantity of fibroids in persons who have them.

The following are the most prevalent signs and symptoms of uterine fibroids in women who have symptoms:

Heavy menstrual flow

Menstrual cycles that last more than a week

Pelvic pain or pressure

Urine frequency

Having trouble emptying the bladder

Constipation

Back pain or leg pain

A fibroid can occasionally produce intense discomfort when it outgrows its blood supply and begins to die.

Fibroids are categorized based on their location. Intramural fibroids develop within the uterine muscle wall. Submucosal fibroids protrude from the uterine cavity. Subserosal fibroids protrude from the uterus to the exterior.

WHAT ARE THE CAUSES OF UTERINE FIBROID?

Although doctors do not know what causes uterine fibroids, research and clinical experience point to the following factors:

Genetic alterations: Many fibroids have gene alterations that differ from those found in normal uterine muscle cells.

Hormones: Estrogen and progesterone, two hormones that drive the formation of the uterine lining in preparation for pregnancy throughout each menstrual cycle, appear to encourage the growth of fibroids.

Fibroids have more estrogen and progesterone receptors than uterine muscle cells in general. Because of a decrease in hormone synthesis, fibroids tend to diminish after menopause.

Other growth variables: Insulin-like growth factor and other substances that aid in tissue maintenance may influence fibroid growth.

ECM (extracellular matrix): ECM is the substance that holds cells together, similar to mortar between bricks. Fibroids have an increase in ECM, which makes them fibrous. ECM also stores growth factors and induces physiological changes in cells.

Doctors believe that uterine fibroids arise from a stem cell in the uterus' smooth muscle tissue (myometrium). A single cell divides repeatedly, resulting in a solid, rubbery mass distinct from surrounding tissue.

Uterine fibroids grow in a variety of ways; they might grow slowly or quickly, or they can stay the same size. Some fibroids develop rapidly, while others diminish on their own.

Many fibroids that were present throughout pregnancy diminish or disappear after delivery when the uterus returns to its normal size.

WHAT ARE THE RISK FACTORS FOR UTERINE FIBROID?

Other than being a woman of reproductive age, there are few established risk factors for uterine fibroids. Factors that can influence fibroid growth include:

Race: Although fibroids can occur in any woman of reproductive age, black women are more likely to have them than women of other races. Furthermore, black women experience fibroids at a younger age, and they are more likely to have more or larger fibroids, as well as more severe symptoms.

Heredity: You are more likely to acquire fibroids if your mother or sister had them.

Other factors: Starting your period at a young age, being obese, not getting enough vitamin D, eating a diet high in red meat and low in green vegetables, fruit, and dairy, and consuming alcohol, including beer, all tend to raise your risk of developing fibroids.

WHAT ARE THE COMPLICATIONS OF UTERINE FIBROID?

Although uterine fibroids are rarely hazardous, they can cause discomfort and may lead to issues such as a decline in red blood cells (anemia), which causes exhaustion, as a result of excessive blood loss. A transfusion is only required in rare cases owing to blood loss.

Fibroids and pregnancy

Fibroids normally do not prevent women from becoming pregnant. However, fibroids, particularly submucosal fibroids, may cause infertility or pregnancy loss.

Fibroids may also increase the risk of pregnancy problems such as placental abruption, fetal growth restriction, and premature birth.

HOW IS UTERINE FIBROID DIAGNOSED?

Uterine fibroids are frequently discovered by chance during a normal pelvic exam. Your doctor may see anomalies in the shape of your uterus, which could indicate the presence of fibroids.

If you have uterine fibroids symptoms, your doctor may request the following tests:

Ultrasound: If further proof is required, your doctor may request an ultrasound. It takes an image of your uterus using sound waves to confirm the diagnosis and map and measure fibroids.

To obtain images of your uterus, a doctor or technician moves the ultrasound equipment (transducer) over your abdomen (transabdominal) or inside your vagina (transvaginal).

Lab tests: If you experience unusual monthly bleeding, your doctor may prescribe additional testing to rule out possible reasons. A complete blood count (CBC) to see if you have anemia from continuous blood loss, as well as other blood tests to rule out bleeding disorders or thyroid problems, may be included.

Other imaging tests

If regular ultrasound is insufficient, your doctor may arrange additional imaging examinations, such as:

Magnetic resonance imaging (MRI): This imaging examination can show the size and location of fibroids in greater detail, identify different types of tumors, and assist in determining appropriate treatment options. An MRI is most commonly utilized in women who have a bigger uterus or who are approaching menopause (perimenopause).

Hysterosonography: Hysterosonography, also known as a saline infusion ultrasonography, employs sterile salt water (saline) to expand the uterine cavity, making images of submucosal fibroids and the uterine lining easier to get in women seeking pregnancy or experiencing excessive menstrual flow.

Hysterosalpingography: A dye is used in hysterosalpingography to highlight the uterine cavity and fallopian tubes on X-ray pictures. If infertility is a concern, your doctor may advise you to try it. This test can tell your doctor whether your fallopian tubes are open or blocked, and it can also detect submucosal fibroids.

Hysteroscopy: Your doctor will put a small, illuminated telescope called a hysteroscope through your cervix into your uterus for this exam. Your doctor will next inject saline into your uterus, widening the uterine cavity and allowing your doctor to view the uterine walls and fallopian tube openings.

WHAT ARE THE TREATMENTS FOR UTERINE FIBROID?

There is no single optimum technique to uterine fibroid treatment; there are numerous possibilities. If you are experiencing symptoms, consult your doctor about symptom alleviation options.

Watchful waiting

Many women with uterine fibroids have no symptoms or only mildly bothersome symptoms that they can live with. If this is the case, watchful waiting may be your best option.

Fibroids do not cause cancer. They rarely cause problems during pregnancy. They typically grow slowly, if at all, and diminish after menopause, when levels of reproductive hormones drop.

Medications

Uterine fibroids medications target hormones that regulate your menstrual cycle, alleviating symptoms like heavy monthly bleeding and pelvic strain. They do not remove fibroids, although they may diminish them. Among the medications are:

Gonadotropin-releasing hormone (GnRH) agonists: GnRH agonists are medications that treat fibroids by suppressing the production of estrogen and progesterone, causing a brief menopause-like state. Menstruation ceases, fibroids decrease, and anemia frequently improves as a result.

Leuprolide (Lupron Depot, Eligard, and others) is a GnRH agonist, as is goserelin (Zoladex) and triptorelin (Trelstar, Triptodur Kit).

When utilizing GnRH agonists, many women experience substantial heat flashes. GnRH agonists are usually only taken for three to six months since symptoms recur when the medicine is withdrawn, and long-term use can cause bone loss.

A GnRH agonist may be prescribed by your doctor to lower the size of your fibroids prior to surgery or to aid in the transition to menopause.

Progestin-releasing intrauterine device (IUD): Heavy fibroids-related bleeding can be relieved with a progestin-releasing IUD. A progestin-releasing IUD merely relieves symptoms; it does not shrink or remove fibroids. It also helps to avoid pregnancy.

Tranexamic acid (Cyklokapron, Lysteda): This nonhormonal medicine is used to relieve painful menstrual periods. It is only used when there is a lot of bleeding.

Other drugs: Other medications may be suggested by your doctor. Oral contraceptives, for example, can help manage menstrual bleeding but do not diminish fibroid size.

Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal pharmaceuticals, may be useful in alleviating fibroids-related pain, but they may not diminish fibroids-related bleeding. If you have excessive menstrual bleeding and anemia, your doctor may also advise you to take vitamins and iron.

Noninvasive procedure

Focused ultrasound surgery (FUS) guided by MRI is:

A noninvasive treatment option for uterine fibroids that does not require an incision and is performed as an outpatient procedure.

A treatment that is administered while you are inside an MRI scanner outfitted with a high-energy ultrasound transducer. The photos show your doctor exactly where the uterine fibroids are. When the fibroid's position is determined, the ultrasound transducer directs sound waves (sonications) into the fibroid, heating and destroying small sections of fibroid tissue.

A newer technology, so researchers are starting to learn more about the long-term effectiveness and safety. However, data obtained thus far indicate that FUS for uterine fibroids is both safe and effective.

Minimally invasive procedures

Certain methods can kill uterine fibroids without removing them surgically. They are as follows:

Uterine artery embolization: Small particles (embolic agents) are injected into the uterine arteries, cutting off blood flow to fibroids and causing them to shrink and die.

This approach has the potential to be useful in reducing fibroids and alleviating the problems they cause. If the blood flow to your ovaries or other organs is disturbed, complications may ensue. However, studies suggest that the consequences are comparable to surgical fibroid treatments, and the danger of transfusion is significantly reduced.

Radiofrequency ablation: Radiofrequency energy is used in this therapy to eliminate uterine fibroids and decrease the blood arteries that feed them. This is possible during a laparoscopic or transcervical operation. Cryomyolysis, a similar treatment, freezes the fibroids.

Laparoscopic radiofrequency ablation (Acessa), also known as Lap-RFA, is performed by inserting a slim viewing equipment (laparoscope) with a camera at the tip through two small incisions in the belly. Your doctor locates fibroids to be treated using a laparoscopic camera and a laparoscopic ultrasound instrument.

After finding a fibroid, your doctor will insert multiple little needles into it with a specialized equipment. The needles heat up and kill the fibroid tissue. The damaged filament instantly changes consistency, for example, from hard like a golf ball to soft like a marshmallow. The fibroid continues to diminish over the next three to twelve months, alleviating discomfort.

Lap-RFA is considered a less invasive option to hysterectomy and myomectomy because no uterine tissue is cut. After 5 to 7 days of recovery, most women who had the surgery resume their normal activities.

Of detect fibroids, the transcervical — or via the cervix — technique to radiofrequency ablation (Sonata) also employs ultrasound guidance.

Laparoscopic or robotic myomectomy: Your surgeon will remove the fibroids while leaving the uterus in situ during a myomectomy.

If the fibroids are low in number, you and your doctor may choose a laparoscopic or robotic operation that removes the fibroids from your uterus using slender devices entered through small incisions in your belly.

Larger fibroids can be removed through smaller incisions by breaking them into pieces (morcellation) within a surgical bag or by extending one incision to remove the fibroids.

A small camera linked to one of the equipment allows your doctor to observe your abdominal area on a monitor. Robotic myomectomy provides your surgeon with a magnified, 3D image of your uterus, allowing for greater precision, flexibility, and dexterity than previous procedures.

Hysteroscopic myomectomy: If the fibroids are contained within the uterus, this treatment may be a possibility (submucosal). Fibroids are accessed and removed by your surgeon utilizing devices put through your vagina and cervix into your uterus.

Endometrial ablation: This therapy, which is done with a specialized instrument placed into your uterus, uses heat, microwave energy, hot water, or electric current to destroy the lining of your uterus, either terminating or lowering menstruation.

Endometrial ablation is usually efficient at stopping irregular bleeding. Submucosal fibroids can be removed during hysteroscopy for endometrial ablation, although this does not affect fibroids outside the uterine lining.

Although women are unlikely to become pregnant after endometrial ablation, birth control is required to prevent a pregnancy from forming in a fallopian tube (ectopic pregnancy).

There is a danger of new fibroids growing and causing problems with any treatment that does not remove the uterus.

Traditional surgical procedures

Traditional surgical treatments have the following options:

Abdominal myomectomy: If you have many fibroids, very large fibroids, or very deep fibroids, your doctor may remove them using an open abdominal surgical operation.

Many women who have been advised that hysterectomy is their sole option can instead have an abdominal myomectomy. However, scarring from surgery can have an impact on future fertility.

Hysterectomy: The uterus is removed during this surgery. It is still the only permanent therapy for uterine fibroids.

Your ability to bear children is terminated after a hysterectomy. If you also choose to have your ovaries removed, you will experience menopause and must decide whether to need hormone replacement treatment. The majority of women with uterine fibroids may be able to maintain their ovaries.

Morcellation during fibroid excision

Morcellation, which involves splitting fibroids into tiny pieces, may increase the chance of cancer spreading if a previously undetected malignant mass is morcellated during myomectomy. There are numerous techniques to lower that risk, including assessing risk factors before to surgery, morcellating the fibroid in a bag, or extending an incision to avoid morcellation.

All myomectomies entail the risk of cutting into an undetected cancer, but younger, premenopausal women are at a lesser risk than older women.

Furthermore, risks from open surgery are more common than the possibility of spreading an undiscovered malignancy in a fibroid with a less invasive technique. Before undergoing morcellation, discuss your personal risks with your doctor.

The Food and Drug Administration (FDA) advises against using a device to morcellate the tissue (power morcellator) for most women undergoing myomectomy or hysterectomy to remove fibroids. The FDA specifically advises women who are approaching or have entered menopause to avoid power morcellation. Women in or approaching menopause may be at a higher risk of developing cancer, and women who are no longer concerned about preserving their fertility have additional treatment options for fibroids.

If you are trying to conceive or may wish to have children

Hysterectomy and endometrial ablation will prevent you from having a future pregnancy. Furthermore, uterine artery embolization and radiofrequency ablation may not be the greatest options for optimizing future fertility.

If you wish to keep your ability to become pregnant, talk to your doctor about the risks and benefits of these procedures. If you're actively attempting to conceive, a comprehensive fertility evaluation is required before settling on a fibroids treatment strategy.

If you need fibroid therapy and want to keep your fertility, a myomectomy is usually the best option. All treatments, however, have both risks and advantages. Consult your doctor about these.

Risk of getting new fibroids

Seedlings — microscopic tumors that your doctor doesn't notice during surgery — could someday grow and create symptoms that require treatment for all operations except hysterectomy. This is commonly referred to as the recurrence rate. New fibroids can form, which may or may not necessitate therapy.

Furthermore, some techniques, such as laparoscopic or robotic myomectomy, radiofrequency ablation, or MRI-guided focused ultrasound surgery (FUS), may only treat some of the fibroids that are present at the time of therapy.