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Uterine Fibroids

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UTERINE FIBROIDS (MYOMAS) What are fibroids? A fibroid, also called myoma, or leiomyoma, is a benign (non-cancerous) tumor arising from the smooth muscle of the uterus. Because a fibroid consists of smooth muscle tissue as well as fibrous tissue, the preferred term is myoma. It is the most common pelvic tumor, occurring in 70% of women. It is extremely rare that it turns malignant (cancerous). Myomas are usually multiple, but each one starts from a single muscle cell. Although they are most often seen in the uterus, they may also grow in the cervix and the fallopian tubes. Uterine myomas are classified according to location: Intramural Myomas within the muscle wall of the uterus Subserosal The myoma extends to the outer wall of the uterus. Pedunculated A subserosal myoma can grow on a stalk from the outer wall. Submucosal The myoma grows into the uterine cavity. Myomas start as small as a pea but can grow to fill the pelvis and they are often small and asymptomatic. Symptomatic fibroids occur in 25% of white women and 50% of black women. Their growth is variable and not predictable.

Fibroid locations

The names of fibroids reflect their orientation to the uterine wall. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus, and pedunculated fibroids hang from a stalk inside or outside the uterus. http://www.mayoclinic.com/health/medical/IM01586 What causes myomas? The cause is unknown as yet. It is usually an inherited condition. For some reason, it is more common in black women. Risk factors include: Race Obesity and overweight Myomas are estrogen-dependent tumors. Growth is associated with exposure to circulating estrogen, the main female hormone. Thus, maximum growth is during the reproductive years, when a woman produces high concentrations of estrogen regularly. There is a growth spurt in the decade before menopause.

They can grow in pregnancy, not just because of high estrogen, but because of increased blood flow to the - uterus. Predictably, they decrease in size after menopause, or other conditions of low estrogen.

Risk factorsThere are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors include:

Heredity. If your mother or sister had fibroids, you're at increased risk of also developing them. Race. Black women are more likely to have fibroids than are women of other racial groups. In addition, black women have fibroids at younger ages, and they're also likely to have more or larger fibroids.

Areas of research Research examining other potential risk factors continues in these areas:

Obesity. Some studies have suggested that obese women are at higher risk of fibroids, but other studies have not shown a link. Oral contraceptives. So far, strong data exist showing that women who take oral contraceptives have a lower risk of fibroids. This is generally true for all women, except those who start oral contraceptives between ages 13 and 16. Pregnancy and childbirth. Researchers have also looked at whether pregnancy and giving birth may have a protective effect, and so far pregnancy and childbirth seem to have a protective effect.

http://www.mayoclinic.com/health/uterine-fibroids/DS00078/DSECTION=risk-factors How do I know I have myomas? Most myomas produce no symptoms. Therefore, most women learn about it when they are examined by a gynecologist manually or through ultrasound. When symptoms occur, they usually correlate with The location of the myomas Their size Any degeneration in the myomas The most common signs of symptomatic myomas are:

Menstrual changes heavy bleeding, more frequent periods, cramping Pain in the abdomen and lower back, and during sex Pressure symptoms such as Frequent urination, or difficulty in urinating Constipation, rectal pain, or difficult bowel movement Back to Top Do I need treatment for myomas? Symptomatic myomas require medical attention. If you have no symptoms, but are seeking fertility care, your infertility specialist will tell you whether treatment of the myoma is necessary before to proceed to fertility treatment. Not all myomas necessarily interfere with fertility. Back to Top Signs and Symptoms of Myomas The most common signs of symptomatic myomas, all requiring medical attention, are: Menstrual changes heavy bleeding, more frequent periods, cramping Pain in the abdomen and lower back, and during sex Pressure symptoms such as - Frequent urination, or difficulty in urinating - Constipation, rectal pain, or difficult bowel movement If the myoma(s) grow big enough, your belly will grow. Doctors often describe the size of a myomatous uterus in terms of comparison to a pregnant uterus. Example: A 6-week uterus or a 12-week uterus. Excessive menstrual bleeding is often the only symptom. This is due to several factors: Increased blood supply to the myomas also brings increased blood supply to the uterine lining (endometrium) which is shed at menses. Fibroids usually increase the size of the uterine cavity, therefore , there is an increased surface area of the lining. Bleeding could also be aggravated by endometritis (inflammation of the lining) which is frequently observed in the endometrial tissue overlying submucosal tumors. Degeneration of the myoma Degeneration results because of infection or when the myoma loses its blood supply. The

muscle cells and connective tissues are replaced by fat, cysts, calcification, and/or granular, hyaline or mucoid material characteristic of necrotic (dying) cells. This often leads to excessive menstrual bleeding. Excessive bleeding can lead to anemia, usually manifested in fatigue, headaches and lightheadedness. It can also affect your quality of life, if the bleeding interferes with your regular activities. Pain as a symptom is infrequent. It is usually associated with: Twisting(tortion) of a fibroid stalk Cervical dilatation, if a myoma protrudes through the lower uterine segment Carneous degeneration, often associated with pregnancy. Adenomyosis (presence of endometrial glands in the uterine muscle) is usually associated with myomas, and may also cause pain. Myomas can cause acute severe pain, due to torsion of the stalk or degeneration. In such cases, the pain will be localized to the specific area that is affected. This can usually improve with pain relievers and go away after two-three weeks. Obviously, if the pain is unbearable, it is best to see a doctor right away. Chronic pelvic pain, which is mild but persistent, can also occur. Again, this is generally localized to a specific area. Low back pain may be experienced, when the fibroids can press against the nerves of the lower back. Pain or discomfort during sexual intercourse (dyspareunia) may also be experienced. This may be associated only with certain positions, or with the beginning or middle (around ovulation) of your menstrual cycle. In any case, the doctor must rule out other possible causes of pain that may not be due to the myomas. For example; Acute pelvic inflammatory disease (PID) Endometriosis An ectopic pregnancy A ruptured ovarian cyst A "big belly" when you are not pregnant or particularly overweight can be a sign. Some patients find it difficult to bend over or exercise because of this. Most will feel a continuous sense of heaviness or discomfort in the lower abdominal region.

Pressure symptoms are more bothersome. As myomas grow, pressure is exerted on adjacent pelvic organs, especially the bladder and the rectum. Pressure on the bladder can cause: Frequent urination, because the bladder cannot hold as much as it can; or Inability to urinate despite a full bladder, because the pressure blocks the passage for urine. Pressure on the rectum can result in: Constipation Difficulty or pain during bowel movement A sense of fullness in the rectum Sometimes, hemorrhoids Back to Top Possible complications from myomas: Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek medical care right away. You may need surgery. Pregnancy and fibroids Because uterine fibroids typically develop during the childbearing years, women with fibroids are often concerned about their chances of a successful pregnancy. Fibroids usually don't interfere with conception and pregnancy. However, they can rarely distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo. Research indicates that pregnant women with fibroids are at slightly increased risk of miscarriage, premature labor and delivery, abnormal fetal position, and separation of the placenta from the uterine wall. But not all studies confirm these associations. Furthermore, complications vary based on the number, size and location of fibroids. Multiple fibroids and large submucosal fibroids that distort the uterine cavity are the type most likely to cause problems. A more common complication of fibroids in pregnancy is localized pain, typically between the first and second trimesters. This is usually easily treated with pain relievers. outflow

In most cases, fibroids don't interfere with pregnancy, and treatment isn't necessary. It was once believed that fibroids grew faster during pregnancy, but multiple studies suggest otherwise. Most fibroids remain stable in size, although some may increase or decrease slightly, usually in the first trimester. If you have fibroids and you've experienced repeated pregnancy losse

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