Fibroids, also called uterine
fibroids, or leiomyomata, refers to a condition where women have
non-cancerous tumors or lumps in the uterus. Fibroids are not
associated with cancer and they rarely develop into cancer (less
than 0.1% of cases). If the fibroids grow large they can lead to
'compression syndrome' in which adjacent organs such as the bladder
and the bowel may be compressed, leading to frequency of urination
or constipation and bloating. Dr. Vasquez is a specialist in
managing fibroids; the most common tumor found in women and is the
most common indication for a hysterectomy in the United States.
Depending on the experience of the doctor, a myomectomy (the
surgical
removal of a
uterine fibroid
tumor)
can always be done regardless of the size, number or location of the
fibroids.
The first thing you have to know about fibroids is that they are
almost always benign. Approximately 40% of all women have fibroids.
Fibroids are the most common indication for hysterectomy in the
United States. But most women with fibroids need no surgery at all,
and those who do require surgery certainly do not need
hysterectomies.
Fibroids are tumors of the smooth muscle cells in the wall of the
uterus. The uterine wall is primarily composed of smooth muscle
cells (the myometrium). A uterine fibroid is thought to originate as
a mutation within one of these myometrial (smooth muscle) cells that
leads to the progressive loss of it own growth regulation. Each
fibroid tumor grows from a single progenitor cell (each tumor arises
from one single cell) and all the cells within a particular fibroid
contain the same abnormal DNA that favors growth. Different fibroid
tumor originate from different muscle cells, each with their own
genetic (DNA) abnormality so that each tumor may grow at its own
rate (some faster and some slower). Fibroid tumors are not malignant
(cancer) About 65% of uterine specimens removed during abdominal
hysterectomy contain fibroids (many are quite small) and about
15-20% of hysterectomies performed in the USA are for problems
involving fibroids.
Troublesome Fibroids
When
fibroids cause heavy bleeding or pain, interfere with pregnancy, or
are pressing on adjacent organs and interfering with their normal
function, surgery is the only treatment available.
Bleeding
When the endometrium breaks away form the inner wall of the uterus,
a network of corkscrew-shape arteries called the spiral arteries
open and begin to bleed. The separation of the endometrium from the
uterine wall releases a powerful hormone called prostaglandin, which
causes the smooth muscle of the uterus to contract and squeeze the
lining and blood out from the cavity and through the vagina. If you
look at the illustration to the left, which shows a submucous (or
intracavitary) fibroid bulging into the cavity of the uterus, you
can see that the
uterine musculature cannot contract in the area surrounding the
fibroid because the normal tissue has been pushed aside. She can
become severely anemic and often will feel weak, faint, and unable
to go about her usual activities.
Fibroids-Infertility
To
understand the obstacle fibroids present, you have to picture the
scenario that sets the stage for a successful pregnancy. A
fertilized egg cannot implant in a section of the uterine wall
occupied by a fibroid; if it tries to attach itself, it will be
rejected immediately and flow out with the next period. The fragile
embryo, attached to the uterine wall only by a delicate thread,
always loses this struggle to the tough fibroid rooted in the
uterine wall. If the embryo implants farther away from the fibroid
and establishes itself, it may have adequate blood supply but
eventually it too will have to compete for space with the rapidly
growing fibroids. Fibroids can interfere with pregnancy when they
are located near the fallopian tubes and obstruct the tubes so that
sperm cannot go up or the eggs come down. For many years
gynecologists believed that only submucous fibroids interfere with
pregnancy. However, a number of recent studies have demonstrated
that women who were previously unable to conceive also became
pregnant after intramural (being
within
the substance
of the walls
of the uterus) or subserous (situated
under
a serous membrane
that covers the uterus) fibroids were removed.
Fibroids-Pain
Several types of pain associated with fibroids
usually lead to surgery: (1) acute pain that occurs when a section
of a fibroid undergoes degeneration; (2) severe menstrual pain; (3)
pain from endometriosis, which is often associated with fibroids;
and (4) severe pressure, tugging, and pulling sensation.
Uterine Fibroid
Symptoms
Women who do experience
uterine fibroid symptoms may suffer from pelvic pain,
abnormal menstruation, and a variety of other conditions. Pregnancy
may be complicated, resulting in miscarriage, premature birth, and
other difficulties.
Uterine Fibroid
Symptoms Check List
-
Heavy menstrual bleeding
-
Abnormal menstruation
-
Pelvic pain
-
Constipation
-
Urinary problems
-
Hemorrhoids
-
Anemia
-
Weight gain
-
Miscarriages
-
Infertility
Abnormal Menstruation
and Menorrhagia
Fibroids can result in a number of abnormal menstruation symptoms.
Periods may be longer and more frequent than normal, and tumor
pressure can result in severe cramping. Menorrhagia, or heavy
prolonged menstrual flow, is also possible. Women with menorrhagia
may pass blood clots, and may develop anemia (decreased red blood
cells and hemoglobin).
Fibroids-Unusual
Bleeding
In
addition to heavier menstrual bleeding, women may also experience
bleeding outside of menstruation. Like menorrhagia, this unscheduled
bleeding can result in anemia. In rare occurrences, blood loss can
be life threatening.
Fibroids-Pelvic
Pain and Dyspareunia
Pressure
from tumor growth can result in dull, aching pelvic pain. This
sensation is sometimes reported as pain, or as a feeling of pressure
in the abdomen. Pain may also be experienced during sexual
intercourse, a condition known as dyspareunia.
Occasionally, the stem of a pedunculated fibroid may twist, blocking
the blood vessels in the fibroid in much the same way a kink in a
garden hose prevents water flow. This results in sharp, severe pain.
In this circumstance, hospitalization and surgical removal of the
growth will be required.
Fibroids-Bladder
and Bowel Problems
The
pressure of a growing tumor can cause bladder and bowel problems.
Women may find it difficult to urinate, or conversely, experience
urgent and frequent urination. The need to urinate may force women
to get up several times a night resulting in sleep deprivation.
Constipation, hemorrhoids, and difficult bowel movements may all
occur as the fibroid puts pressure on the bowels.
Fibroids-Miscarriages
and Pregnancy Complications
Most
women with fibroids have normal pregnancies. However, the
possibility of a miscarriage is higher if fibroids are present. The
increased blood flow to the uterus during pregnancy can cause
fibroid growth. If the tumor blocks the uterine passage, a C-section
may be required. Large growths also increase the chance of premature
delivery, and greater blood loss during delivery. Occasionally, a
growth may block the uterus so completely that it causes
infertility.
Weight Gain
Benign
uterine growths can grow to large sizes without producing symptoms.
This may only be detectable as gradual weight gain and distention of
the abdomen, as if the woman was pregnant. As cancerous tumors can
also cause this type of distention, it is important to consult your
doctor if you experience sudden, inexplicable weight gain.
What
is the treatment for uterine fibroids?
If
you have fibroids, but do not have any symptoms, you may not need
any treatment. But we will check periodically to see if they have
grown.
Fibroids-Medications
If you have fibroids and have mild symptoms, we might
only suggest pain medication. Non-steroidal anti-inflammatory drugs
or other painkillers can be used for mild pain. If pain becomes
worse, we can prescribe a stronger painkiller.
Other drugs used to
treat fibroids are called gonadotropin releasing hormone agonists (GnRHa),
progestogens and progesterone blockers.
These drugs can decrease the size of the fibroids. Anti-
progesterone agents, such as a drug called mifepristone, also can
stop or slow the growth of fibroids. These drugs offer relief from
the symptoms of fibroids; however, once you stop the therapy, the
fibroids often grow back.
Fibroids-Surgery:
MYOMECTOMY
If you have fibroids with moderate or severe
symptoms, surgery may be the best way to treat them. Here are the
options:
Any
woman with fibroids can have the tumors removed, her uterus
reconstructed, and all her organs preserved. There is no such thing
as an impossible myomectomy. In this section Dr. Vasquez describes
the surgical approaches to myomectomy. Very frequently fibroids can
be removed through non-invasive surgery using either a laparoscope
(a long thin tube equipped with a tiny viewing device that is
inserted through a small incision near the belly button) or a
hysteroscope (an instrument similar to the laparoscope that is
inserted into the uterine cavity through the vagina). Whatever
approach is contemplated, prior to surgery we need to know as much
as possible about the size and location of the fibroids.
-
Myomectomy
- a surgery to remove fibroids
without taking out the healthy tissue of the uterus. There are
many ways Dr. Vasquez can perform this procedure in view of his
experience, the technological advances including fine fiber optics
and new surgical devices allowing for the safe resection of the
fibroids minimizing blood loss. The type, size, and location of
the fibroids will determine what type of procedure will be done.
Talk with Dr. Vasquez about the different types of this surgery
when you come for an office visit.
-
Hysteroscopic myomectomy
–
involves a special instrument called a
hysteroscope.
This technique is primarily useful for women with bleeding or
recurrent miscarriages as there is usually little change in the
size of the uterus with this approach.
-
Laparoscopic myomectomy
involves a different instrument called a
laparoscope.
In general, myomectomy diminishes menorrhagia (prolonged and/or
profuse menstrual flow) in roughly 80-90% of patients presenting
with this symptom.
-
Myolysis
– 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.
-
Cryomyolysis
involves using a freezing probe at the time of
laparoscopy
to
destroy the blood vessels feeding the fibroids.
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