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.
