Uterine fibroids are benign tumors, which grow from the muscle layers of the uterus. They are often asymptomatic.
Estrogen receptors on uterine fibroids cause fibroids to be larger in reproductive years and shrink after a woman passes through menopause.
Fibroids are named according to where they are found. There are four types:
Intramural fibroids are found in the wall of the womb and are the most common type of fibroids.
Subserosal fibroids are found growing outside the wall of the womb and can become very large.
Submucosal fibroids are found in the muscle beneath the inner lining of the womb wall.
Cervical fibroids are found in the wall of the cervix (neck of the womb).
In very rare cases, malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the uterus.
Symptoms
The symptoms depend on the size, location, number, and the pathological findings. Fibroids, particularly when small, may be entirely asymptomatic. Generally, symptoms relate to the location of the lesion and its size.
abnormal gynecological hemorrhage
heavy or painful periods
abdominal discomfort or bloating
back ache
urinary frequency or retention
infertility
pain during intercourse
During pregnancy they may cause miscarriage, bleeding, preterm labor or interference with the position of the fetus.
Diagnosis
Diagnosis is usually accomplished by bimanual examination, better yet by ultrasound. MRI can be used to definite the depiction of the size and location of the fibroids within the uterus.
Treatment
The presence of fibroids does not mean that they need to be treated; it is expectantly depending on the symptoms and presence of related conditions. The presence of uterine fibroids can cause problems which can be solved by:
Surgical Therapy: Surgical removal of a uterine fibroid usually takes place via hysterectomy or myomectomy, in which only the fibroid is removed. It is possible to remove multiple fibroids during a myomectomy. Although a myomectomy cannot prevent the recurrence of fibroids at a later date, such surgery is increasingly recommended, especially in the case of women who have not completed bearing children or who express an explicit desire to retain the uterus.
These procedures can be performed via Laparoscopy or Laparotomy.
Medical therapy: First line treatment may involve oral contraceptive pills, either combination pills or progestin-only, in an effort to manage symptoms. If unsuccessful, further medical therapy involves the use of medication to reduce estrogens in an attempt to create a medical menopause-like situation, with the use of GnRH Analogs.
A new method is the “High intensity focused ultrasound”, which is a non-invasive intervention (requiring no incision) that uses high intensity focused ultrasound waves to ablate (destroy) tissue in combination with Magnetic Resonance Imaging (MRI), which guides and monitors the treatment.
Malignancy
Very few lesions are or become malignant. Signs that a fibroid may be malignant are rapid growth or growth after menopause.