Uterine fibroids

Uterine fibroids are benign tumors in the middle layer of the uterus, the muscular layer that causes contractions during labor.

A tumor is an abnormal growth of cells and tissue. Benign tumors are non-cancerous and do not spread. Cancers are called malignant tumors because they do spread to other parts of the body.

Uterine fibroids are made of nodules of smooth muscle cells and fibrous tissue that develop in the wall of the uterus. Fibroids may grow as a single nodule or in clusters. They may range in size from 1/10 of an inch to 8 inches in diameter. Uterine fibroids may grow in the wall of the uterus, or they may project into the interior cavity or toward the outer surface of the uterus.


Symptoms
Most fibroids do not cause any symptoms and may be discovered during a routine examination.

Some women who have uterine fibroids may experience symptoms such as

    excessive or painful bleeding during menstruation
    bleeding between periods

    a feeling of fullness in the lower abdomen



Other symptoms of uterine fibroids include:

    frequent urination resulting from a fibroid that presses on the bladder
    pain during sexual intercourse

    low back pain




Complications
In rare cases, a fibroid may press on and block the fallopian tube, preventing fertilization and migration of the egg, which can result in infertility. After surgical removal of the fibroid, fertility is usually restored.


Causes

The factors that cause fibroids to grow in the uterus are not known.

Almost all fibroids occur in women of reproductive age or old enough to have periods. About 25% of women of reproductive age have fibroids.

Athletic women seem to have a lower prevalence of uterine fibroids than women who do not engage in any athletic activities.

Similarly, overweight women are more likely to have fibroids. Women who have given birth appear to be at a lower risk for fibroids.


Diagnosis
Family doctors and gynecologists can diagnose fibroids fairly easily after obtaining a detailed medical history and performing a pelvic exam. Fibroids are the most frequently diagnosed tumor of the female pelvis.

Ultrasounds of the pelvis may be needed in order to see the fibroids better.

MRIs and CAT scans may also be done.


Treatment
Most fibroids do not cause any symptoms and do not require treatment other than regular observation by a doctor.

For women who experience occasional pelvic pain or discomfort, a mild, over-the counter anti-inflammatory or painkilling drug is effective. Cases that are more bothersome may require stronger, prescription drugs.

If a fibroid is very painful or affects fertility, a surgeon can remove the tumor, leaving the uterus intact. This procedure, called leiomyomectomy, may weaken the wall of the uterus. Deliveries that occur after a leiomyomectomy usually must be by caesarean section.

At times, the surgeon may decide that taking the whole uterus out along with the fibroids may be the best treatment. Such an operation is called a hysterectomy.

After a hysterectomy, a woman is no longer able to have children. A woman considering hysterectomy should discuss the pros and cons thoroughly with her doctor.

In patients who do not respond to painkillers and who are not candidates for surgery, hormone therapy may be used. Hormone therapy medications reduce estrogen levels and seem to be effective in shrinking the uterus and the fibroids.

New treatment options have been developed to deal with fibroids these include the following

    Myolysis
    Uterine Fibroid Embolization or UFE
    Focused Ultrasound Ablation



Myolysis is a procedure in which an electrical needle is inserted into the uterus through a small incision in the abdomen to destroy the blood vessels feeding the fibroids.



Uterine Fibroid Embolization (UFE) Uterine fibroid embolization (UFE) is a treatment that cuts off the blood supply to the uterus and the fibroids so they shrink. UFE is proving to be an alternative to hysterectomy and myomectomy.



The recovery time is also shorter, and there is a much lower risk of needing a blood transfusion than for these surgeries. Many women can have UFE and go home the same day.



There is a small risk of infection in the treated fibroid, but these are usually managed with antibiotics. Recent studies also suggest that most fibroid tumors are not likely to re-grow after UFE, although more long-term data is needed.



Not all fibroids can be treated with UFE. All patients must first be evaluated with ultrasound or MRI to make sure the fibroids will respond well to this treatment. Doctors called interventional radiologists perform UFE.

The best candidates for UFE are women who:

    have fibroid tumors that are causing heavy bleeding
    have fibroid tumors that are causing pain or pressing on the bladder or rectum
    don’t want to have a hysterectomy
    don’t want to have more children



Sometimes after UFE, the particles that are put into the fibroids to cut off their blood supply have traveled to the ovaries. In a few women, the ovaries then stop working for a short time or permanently.

Although researchers know that UFE may affect how ovaries function, they are unsure of how exactly UFE affects fertility. If you want to have children in the future, you should talk with your doctors about the small, but definite risk of UFE causing you to go into early menopause.

Too few women have gotten pregnant after UFE for researchers to know if there is an increased risk of pregnancy complications.

Focused Ultrasound Ablation or FUAFocused Ultrasound Ablation is a medical device that uses magnetic resonance image guided focused ultrasound to target and destroy uterine fibroids.

The device is intended to treat women who have completed child bearing or do not intend to become pregnant. FUA is non-invasive surgery. It spares the uterus and is an alternative to myomectomy, hysterectomy, watchful waiting, hormone therapy, or uterine fibroid embolization.

FUA combines two systems – a magnetic resonance imaging (MRI) machine to visualize patient anatomy, map the volume of fibroid tissue to be treated, and monitor the temperature of the uterine tissue after heating, and a focused ultrasound beam that heats and destroys the fibroid tissue using high frequency, high-energy sound waves.

The treatment requires repeated targeting and heating of fibroid tissue while the patient lies inside the MRI machine. The procedure can last as long as three hours.

This device can be used to treat some – but not all – fibroids. Fibroids close to sensitive organs such as the bowel or bladder and those outside the image area cannot be treated.