Benign Tumour of Uterus Uterine fibroids

Myomas ,Liomyomous

Definition

Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium) and fibrous tiussue.

It is the most common tumour in the women.

A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue.whorle-like appearance with blood vessele at the prephery of tumour ,poor blood supply inside it

Risk factors

other than being a woman of reproductive age Other factors include:

Heredity. mother or sister had fibroids ,

Race. Black women are more likely to have fibroids than are women of other racial groups & fibroids at younger ages, and they're also likely to have more or larger fibroids

obese women are at higher risk of fibroids, other studies have not shown a link.

a lower risk of fibroids

take oral contraceptives

athletic women may have,

pregnancy and giving birth may have a protective effect ,

but results remain unclear.

CausesFibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.several factors:Genetic alterations. Many fibroids contain alterations in genes that code for uterine muscle cells .

Hormones. It isa hormone(estrogen) dependent tumourFibroids contain more estrogen and estrogen receptors than do normal uterine muscle cells .

Other chemicals. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Sign& SymptomsA symptomaticHeavy menstrual bleeding Prolonged menstrual periods or bleeding between periods

•Pelvic pressure or pain •Urinary incontinence or frequent urination

•Constipation •Backache or leg pains

•Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and fever. A fibroid that hangs by a stalk inside or outside the uterus (pedunculated fibroid) can trigger pain by twisting twisting on its stalk and cutting off its blood supply.

•:

Fibroid location influences signs and symptoms

Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are thought to be primarily responsible for prolonged, heavy menstrual bleeding.

Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) press on bladder, causing urinary symptoms. If fibroids bulge from the back of uterus, they occasionally can press on rectum, causing constipation spinal

nerves, causing backache .

Complications of fibroids;

1-Degenerations;hylain .necrosis, red degeneration ( pregnancy, menopause) ,calcifications

2-Sarcomatous changes;<0.05%3-Rare:Parasitic changes; as attachment to

omentum bowel l to gain blood supply, metastasis through blood vessels to vessel

wall, Polycythmia associated with broud ligament

fibroid

Affect of pregnancy on fibroid

Subinvolution

ascending infection

torsion

Affect of Fibroid on Pregnancy

•Infertility Abortion

•PUC• preterm labor

• Abruptio placentae•abnormal Lie & position

• ,increase rate of operative delivery

• PPH (uterine atony).

•Red Degeneration• 2nd trimester & menopause as abdominal pain fever ,tachycardia

luococytosis tender abdomen ,there is no indication for myomectomy during pregnancy (uncontrolled bleeding)

•treated by rest IVF ,Opiat analgesia

Screening and diagnosis

Uterine fibroids are frequently found incidentally during a routine pelvic exam. you may feel irregularities in the shape of your uterus throughy abdomen, Suggesting the presence of fibroids.

Ultrasound

•Sometimes, fibroids are discovered during an ultrasound conducted for a different purpose, such as during a prenatal ultrasoundIf confirmation is needed to map and measure fibroids (transabdominal) or inside (transvaginal) to obtain images.

•Transvaginal ultrasound provides more detail because the probe is closer to the uterus. Transabdominal ultrasound visualizes a larger

anatomic area..

Hysterosonography

This ultrasound variation uses sterile saline to expand the uterine cavity, making it easier to obtain interior images of the uterus. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound

Hysterosalpingography

. if infertility is a concern fallopian tubes are open .

Hysteroscopy

the walls of uterus and the openings of fallopian tubes .

Others

Imaging techniques that may occasionally be necessary include computerized tomography

(CT) and magnetic resonance imaging (MRI) .

Other tests abnormal vaginal bleeding, a complete blood count (CBC) to determine if iron deficiency anemia because of chronic blood loss. blood tests to rule out bleeding disorders and to determine the levels of reproductive hormones produced by ovaries.

TREATMENT

There's no single best approach to uterine fibroid treatment

A -Watchful waiting no signs or symptoms, watchful waiting (expectant management) could be the best course.

They usually grow slowly and tend to shrink after menopause when levels of reproductive hormones drop

B-Medications

Medications for uterine fibroids target hormones that regulate your menstrual

cycle ,

treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:

Gonadotropin-releasing hormone (Gn-RH) ago

Medications called Gn-RH agonists (Lupron, Synarel, others) act at the same sites that Gn-RH does. But when taken as therapy, a Gn-RH agonist produces the

opposite effect to that of your natural hormone .Estrogen and progesterone levels fall, menstruation stops, fibroids shrink and anemia often improves. , less blood

loss during surgery, and shorter operations .However, side effects; the shrunken, softened fibroids that result can be more difficult to detect and remove,. hot flash,osteoproses,costy,recurrance

*Androgens.

Danazol, a synthetic drug similar to testosterone, has been shown to shrink fibroid tumors, reduce uterine size, stop menstruation and correct anemia. However, occasional unpleasant side effects such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.

medications. Oral contraceptives or progestins

can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, are effective for heavy vaginal bleeding unrelated to fibroids, but they don't reduce bleeding caused by fibroids.

C-Surgery

Three surgical approaches

This operation remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends ability to bear children -!Hysterectomy

2_Myomectomy

surgeon removes the fibroids, leaving the uterus in place. If want to bear children, this option. With myomectomy, as opposed to a hysterectomy, there is a risk of fibroid recurrence.

#Patient who need myomectomy they should signed for hysterectomy which may needed at same time as emergency.

#Stormy postoperative period as fever abdominal pain, systemic reaction to collected blood in cavity of removed myoma

There are several ways a myomectomy can be done:

a-Abdominal myomectomy

. If you have multiple fibroids, very large or very deep fibroids.

•

b-Laparoscopic myomectomy

. If the fibroids are small and few in number

c-Hysteroscopic myomectomy

. This if the fibroids (submucosal) (hysteroscopy) is passed through vagina and cervix and into uterus

D-Myolysis

Variations of myomectomy — in which uterine fibroids are destroyed without actually removing

them — include :1-Myolysis. In this laparoscopic procedure, an

electric current destroys the fibroids and shrinks the blood vessels that feed them .

2-Cryomyolysis. In a procedure similar to myolysis, cryomyolysis uses liquid nitrogen to freeze the fibroids.

The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.

3-Uterine artery embolization

Small particles injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink.. Advantages over surgery include:No incision Shorter recovery time

Complications may occur if the blood supply to your ovaries or other organs is compromised.

4-Focused ultrasound surgery

MRI-guided focused ultrasound surgery (FUS), approved by the Food and Drug Administration in October 2004, is a newer treatment option for women with fibroids. Unlike other fibroid treatment options, FUS is noninvasive and preserves uterus.This procedure is performed crafted MRI scanner they locate and destroy (ablate) fibroids inside uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. Initial results with this technology are promising, but its long-term effectiveness is not yet known.