Uterine fibroids – The most common symptoms that something is wrong. Causes and methods of treating fibroids

Uterine fibroids are benign tumors that develop in the muscle tissue of the uterus or in the fallopian tubes, cervix, or tissues near the womb. Often appearing in childbearing age. Myomas can range in size from very small, undetectable by the human eye, to huge, which can distort and enlarge the uterus. It is possible to have one or more fibroids Many women have uterine fibroids at some point in their lives. However, you may not know you have them because they often don’t cause any symptoms. A doctor may accidentally detect fibroids during a pelvic examination or prenatal ultrasound.

1. Myomas are usually benign changes, not cancerous
2. Genetic and hormonal factors are among the most common causes of fibroids
3. Myomas may be asymptomatic. What should worry you? Heavy periods, pain during intercourse, pressure in the pelvis, constipation, a bloated abdomen
4. You can find more such stories on the TvoiLokony home page

What are uterine fibroids?

Uterine fibroids, or uterine fibroids, are growths consisting of the muscles and connective tissue of the uterine wall. The fibroids are usually not cancerous (benign). The uterus itself is a pear-shaped organ located in the pelvis. It is the place where the baby grows and develops during pregnancy. A normal, properly developed uterus will be the size of a lemon.

Myomas can grow as a single nodule or in clusters. The myoma clusters can be from 1 mm to more than 20 cm in diameter (although they can be even larger). The bumps can even reach the size of a watermelon. Moreover, uterine fibroids can develop in the uterine wall, in the main cavity of the organ, or even on the outer surface. Myomas can vary in size, number and location in and on the uterus.

It is worth adding that uterine fibroids, depending on the woman, can cause different symptoms. Therefore, the treatment plan will depend on the individual case.

Where do uterine fibroids grow?

Where uterine fibroids grow, how big they are and how many there are will determine what type of treatment is best for you or whether treatment will be required at all.

Depending on where the myoma is formed, it will have a different name. This is how the following are distinguished:

1. submucosal fibroids. In this case, the fibroids grow in the space (cavity) in which the baby grows during pregnancy.
2. intramural fibroids. These fibroids are embedded in the wall of the uterus itself.
3. subserous fibroids. This time, located outside the uterus, these fibroids are tightly connected to the outer wall of the uterus.
4. pedunculated fibroids. The least common type. These fibroids are also located outside the uterus. However, pedicled fibroids are connected to the uterus by a thin stem. When describing them, it is often mentioned that they resemble mushrooms in that they have a stem and then a much wider top.

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The reasons for the formation of uterine fibroids

The exact causes of uterine fibroids are unknown, however research and clinical experience show the following factors.

1. Genetic changes. Many fibroids contain changes in their genes that differ from those in the normal muscle cells of the uterus.
2. Hormones. Estrogen and progesterone, two hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of uterine fibroids. Myomas contain more estrogen and progesterone receptors than normal uterine muscle cells. Uterine fibroids tend to shrink after the menopause due to a decrease in hormone production.
3. Other growth factors. Substances that help the body to maintain tissue, such as insulin-like growth factor, can affect the growth of uterine fibroids.
4. Extracellular matrix (ECM). The extracellular matrix is ​​the material that causes cells to stick together like mortar between bricks. ECM increases in fibroids and makes them fibrous. The extracellular matrix also stores growth factors and causes biological changes in the cells themselves.

Doctors believe that uterine fibroids develop from a stem cell in the smooth muscle tissue of the uterus (Latin. myometrium). A single cell divides many times, eventually forming a compact, rubbery mass that is separate from nearby tissue.

The growth patterns of uterine fibroids vary, they may grow slowly or quickly, or they may remain the same size. Some fibroids go through spikes in growth, and some may contract on their own. Moreover, many fibroids that were present during pregnancy shrink or disappear after pregnancy as the uterus returns to its normal size.

Uterine fibroids risk factors.

There are several known risk factors for uterine fibroids other than being a woman of childbearing age.

1. Race. Although all women of childbearing age can develop fibroids, black women are more likely to have fibroids than women of other racial groups. In addition, black women often develop fibroids at a younger age and are likely to have more or more fibroids as well as more severe symptoms.
2. Heredity. If a patient’s mother or sister has had fibroids, she is at increased risk of developing them.
3. Other factors. The beginning of the period at an early age; obesity; vitamin D deficiency; a diet richer in red meat and poorer in green vegetables, fruits and dairy products; Drinking alcohol, including beer, seems to increase the risk of developing fibroids.

Also check: The most common genetic diseases. How are they made?

Uterine fibroids – symptoms

Uterine fibroids do not cause any symptoms in many women. However, when symptoms are present, they are related to the location, size and number of uterine fibroids.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

1. profuse menstrual bleeding;
2. bleeding between periods;
3. menstrual periods longer than a week;
4. pressure or pain in the pelvis;
5. feeling of fullness in the lower abdomen / flatulence;
6. frequent urination;
7. difficulty emptying the bladder;
8. constipation;
9. back or leg pain;
10. pain during sex;
11. chronic vaginal discharge;
12. increased abdominal bloating, making the abdomen look pregnant.

Symptoms of uterine fibroids usually stabilize or resolve after the menopause as hormone levels in the body decline.

Rarely, a uterine myoma can cause severe pain as it overgrows the blood supply and begins to die.

Also read: Abdominal bloating is not the result of diet alone. What diseases can herald?

Uterine fibroids – diagnosis

Often, uterine fibroids are first detected during a regular examination with a doctor. They are palpable during pelvic examination and also diagnosed during a gynecological examination or during prenatal examinations. Quite often, a description of severe bleeding and other related symptoms may prompt a physician to consider uterine fibroids as part of the diagnosis. There are several tests that can be done to confirm the presence of uterine fibroids as well as to determine their size and location.

1. Ultrasound examination. This examination consists in creating an image of internal organs using sound waves. Depending on the size of the uterus, ultrasound can be performed either transvaginally or transabdominally.
2. Magnetic resonance imaging (MRI). The study creates detailed images of your internal organs using magnets and radio waves.
3. Computed tomography (CT). The study uses X-ray images to give a detailed picture of your internal organs from several angles.
4. Hysteroscopy. In this study, the doctor inserts a small, illuminated telescope called a hysteroscope through the cervix into the uterus. The doctor then injects saline into the uterus, widening the uterine cavity and allowing the doctor to examine the walls of the uterus and the openings of the fallopian tubes.
5. Hysterosalpingography (HSG). Detailed X-ray where contrast is first injected and then x-rays of the uterus are taken. This is more common in women who are also undergoing a fertility assessment.
6. Sonohysterography (SHG). The test involves placing a small catheter transvaginally and injecting saline into the uterine cavity. This extra fluid helps to create a clearer picture of the uterus than with a standard ultrasound.
7. Laparoscopy. During the examination, the doctor makes a small incision in the lower abdomen. Then, a thin and flexible tube with a camera at the end is inserted through this incision to closely examine the patient’s internal organs.

If a woman has abnormal menstrual bleeding, her doctor may order other tests to investigate possible causes. These may include a complete blood count to determine if you are anemic due to chronic blood loss and other blood tests to check for a bleeding disorder or thyroid problem.

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Uterine fibroids – treatment

Treatment for uterine fibroids can vary depending on their size, number and location, as well as the symptoms they cause. If a woman does not experience any symptoms of uterine fibroids, she may not need treatment. Small fibroids can often be left to fend for themselves. It should be emphasized that some women never experience any symptoms or problems with uterine fibroids.

Your doctor may recommend periodic pelvic examinations and ultrasound, depending on the size or symptoms of the fibroids. Treatment is usually needed if you experience symptoms of fibroids, including anemia due to excessive bleeding, moderate to severe pain, infertility problems, or problems with the urinary tract and gut.

The treatment plan will depend on several factors, including:

1. the amount of uterine fibroids;
2. the size of uterine fibroids;
3. the location of uterine fibroids;
4. symptoms associated with uterine fibroids;
5. the patient’s willingness to become pregnant;
6. the patient’s desire to preserve the uterus.

If you want to have children in the future, some treatment options may not be suitable for you. Check with your healthcare provider about your thoughts on having children and your goals for the future as you discuss treatment options.

Uterine fibroids – drug treatment

Pharmacological treatment of uterine fibroids includes both drugs and supplements, as well as indirect measures – such as hormonal contraception.

1. Over-the-counter pain relievers. These drugs can be used to manage discomfort and pain caused by fibroids. Such drugs include acetaminophen and ibuprofen.
2. Iron supplements. If you are anemia due to excessive bleeding, your doctor may also suggest taking an iron supplement.
3. Contraception. Contraception can also be used to relieve the symptoms of fibroids, especially heavy bleeding during and between periods and menstrual cramps. Contraception can be used to control heavy menstrual bleeding. There are many pregnancy prevention options you can use, including oral birth control pills, vaginal contraception, injections, and IUDs.
4. Gonadotrophin releasing hormone (GnRH) agonists. These drugs can be taken with a nasal spray or injection, and they work by contracting the fibroids. They are sometimes used to shrink the uterine fibroids before surgery to facilitate removal. However, it should be added that these drugs are temporary and if you stop taking them, uterine fibroids may come back.
5. Oral treatment. Elagolix is ​​a medicine indicated for the treatment of severe uterine bleeding in premenopausal women with symptomatic uterine fibroids. Can be used up to 24 months. Another agent used in oral therapy is tranexamic acid. It is an oral antifibrinolytic drug that is indicated for the treatment of periodic heavy menstrual bleeding in women with uterine fibroids.

It is important to talk to your doctor about any medications you are taking. You should always consult your doctor before starting a new medication to discuss any possible complications.

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Uterine fibroids – surgical treatment

There are several factors to consider when talking about different types of fibroids removal surgery. Not only the size, location and number of fibroids can affect the type of surgery, but also the patient’s attitude towards having children in the future. Some surgical procedures allow the uterus to be preserved, which of course allows you to become pregnant later, while other options can either damage the uterus or remove it.

Myomectomy – involves the removal of uterine fibroids without damaging the uterus. There are several types of myomectomy. The type of surgery will depend on the location of the fibroids, their size and the number of fibroids. Types of myomectomy surgery to remove fibroids can include:

1. Hysteroscopy. The procedure involves the insertion of a thin, flexible tube-like instrument (telescope) through the vagina and cervix into the uterus. No incisions are made during this procedure. During the procedure, the doctor will use a device to cut off the fibroids.
2. Laparoscopy. Unlike hysteroscopy, this procedure involves placing several small incisions into the abdomen.
3. Laparotomy. During this procedure, an incision is made in the abdomen and the fibroids are removed through that one larger incision.

If the patient does not plan to become pregnant in the future, she will be able to undergo other surgical procedures. While these treatments may prove to be more effective, unfortunately they usually prevent future pregnancies. Surgeries to remove fibroids may include:

1. Hysterectomy. During this procedure, the uterus is removed. After the uterus is completely removed, the fibroids cannot return and symptoms should go away. If the uterus is removed and the ovaries remain in place, the patient will not enter the menopause after the procedure. A hysterectomy may be recommended if a woman experiences very heavy bleeding from fibroids or if her fibroids are large in size. When recommended, the most minimally invasive procedure for performing hysteroscopy is indicated. Minimally invasive procedures include transvaginal, laparoscopic, or robotic access.
2. Embolization of uterine fibroids. This procedure is performed by a radiologist who works with the patient’s gynecologist. A small catheter is placed in the uterine or radial artery and the small particles are used to block blood flow from the uterine artery to the fibroids. The loss of blood flow reduces the fibroids, thereby improving the symptoms resulting from their presence.
3. Nerve ablation with radio frequency current (RFA). A safe and effective method of treating women with symptomatic uterine fibroids. In this procedure, the radio frequency energy destroys the uterine fibroids and constricts the blood vessels that nourish them. This can be done during laparoscopic or transcervical surgery. The specialist makes two small incisions in the abdomen to insert the laparoscope with the camera on the end. Using the laparoscopic apparatus and the laparoscopic ultrasound tool, the doctor locates the fibroids for treatment. After locating the myoma, the doctor uses a specialized device to arrange several small needles through the myoma. The needles heat up the myoma tissue, destroying it. Destroyed myoma immediately changes its consistency, e.g. from hard like a golf ball to soft like foam. Over the next three to 12 months, the myoma continues to shrink, relieving symptoms.

There is also a high frequency focused ultrasound beam (FUS or HIFU) procedure under the control of magnetic resonance imaging (MRgFUS) that can be used to treat fibroids. The procedure is performed with the patient inside the MRI machine, which allows the doctor to have a clear view of the fibroids. Ultrasound is then used to send targeted sound waves to the fibroids, which destroys it.

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Uterine fibroids and morcellation

Morcellation, the process of breaking up fibroids into smaller pieces, can increase the risk of cancer spreading if a previously undiagnosed tumor mass is morcellated during a myomectomy. There are several ways to reduce this risk, such as assessing risk factors before surgery, morcelling the myoma in the sac, or widening the incision to avoid morcellation.

All myomectomes carry a risk of developing into undiagnosed cancer, but younger premenopausal women generally have a lower risk of undiagnosed cancer than older women.

In addition, complications from open surgery are more common than the risk of undiagnosed cancer spreading into myoma during a minimally invasive procedure.

Also read: The body sends out five warning signs. It could be cancer

Uterine fibroids – complications

Although uterine fibroids are usually not dangerous, they can cause discomfort and lead to complications such as a drop in red blood cells (anemia), which in turn causes fatigue from severe blood loss. Rarely, a transfusion is needed due to blood loss.

Uterine fibroids and pregnancy

The fibroids do not usually prevent you from getting pregnant. However, it is possible that uterine fibroids, especially submucosal fibroids, may cause infertility or pregnancy loss. Myomas can also increase the risk of certain pregnancy complications, such as placental abruption, fetal growth retardation, and premature birth. In very rare cases, there is a higher risk of delivery by caesarean section.

Simply treating uterine fibroids with procedures such as a hysterectomy will not allow you to become pregnant in the future. In addition, radiofrequency ablation (RFA) of nerves may not be the best options if you are trying to optimize future fertility. If you wish to maintain your ability to become pregnant, please discuss the risks and benefits of different treatments with your doctor. Before deciding on a fibroid treatment plan, a complete fertility evaluation is recommended if you are actively trying to become pregnant.

Uterine fibroids – prevention

Currently, little is known about the prevention of uterine fibroids. Moreover, it may not be possible to prevent uterine fibroids, and it is worth adding that only a small percentage of these tumors require treatment.

It seems like a good idea for preventing uterine fibroids is to make healthy lifestyle choices, such as maintaining a healthy weight and eating fruits and vegetables.

Some studies also suggest that the use of hormonal contraceptives may be associated with a lower risk of fibroids.

Uterine fibroids – frequently asked questions

Are there any risks associated with treating uterine fibroids?

As with all treatments, treatments for uterine fibroids may be associated with certain risks. For example, medications you are taking can have side effects. It is important to check with your doctor before starting a new medication about medicines you can take for other conditions and about your complete medical history. If you experience side effects after starting a new medication, contact your doctor as soon as possible.

In addition, you should be aware that surgical treatment also carries some risks. Operations, for example, expose the patient to infections or bleeding. There may be an additional risk of myoma removal surgery from future pregnancies. Certain surgical options can prevent future pregnancies. A myiomectomy is a procedure that only removes the fibroids, which allows for future pregnancies. However, women who have had a myomectomy may need a cesarean delivery.

Can uterine fibroids change over time?

Uterine fibroids can change size suddenly or evenly over a long period of time. This is for a variety of reasons although it is usually due to the amount of hormones in your body. When hormone levels are high, uterine fibroids may increase in size. This can happen at certain times in life, for example during pregnancy, when a woman’s body releases large amounts of hormones to help the baby’s development.

If you know you have fibroids before pregnancy, please consult your doctor. You may need to be monitored to see how the myoma grows throughout your pregnancy.

Muscles can also shrink when hormone levels drop. This often happens after the menopause. After the menopause, the amount of hormones in a woman’s body is much less. Often, symptoms also disappear after the menopause.

Can uterine fibroids cause anemia?

Anemia is when the body does not have enough healthy red blood cells to carry oxygen to the organs. This results in general fatigue and weakness.

Some women may also experience an intense craving for ice, starch or dirt. This is called pica, and it is a mental disorder associated with anemia.

Anemia can occur in women who have frequent or heavy periods. Myomas can cause heavy periods or even bleeding between periods. Certain treatments, such as oral iron supplementation or intravenous iron infusion (in severe anemia), may improve the patient’s condition. If there are symptoms of anemia, please consult your doctor.