Fibroids

What are Fibroids (Leiomyoma)?

Fibroids are non-cancerous (benign) tumors, commonly seen in women of childbearing age. Fibroids are composed of muscle cells and other tissues. They develop in and around the wall of the uterus or womb. Uterine fibroids are usually round or semi-round in shape. . Fibroids are extremely common, affecting 40-80% of women in the U.S

Based on their location within the uterus, uterine fibroids can be classified as:

Subserosal: Located beneath the serosa (the membrane covering the outer surface of the uterus). Some may be peduculated fibroids that develop on a stalk attached to the outer wall of the uterus.

Submucosal : Located all or partially inside the uterine cavity below the inside layer of the uterus. Some of these may be completely intracavity fibroids, located completely within the uterine cavity.

Intramural: Located within the muscular wall of the uterus

Causes

The exact cause for the development of fibroids remains unknown, but some of the proposed causes include:

Genetics
Alterations in expression of growth factor (a protein involved in rate and extent of cell proliferation)
Abnormalities in the vascular system
Tissue response to injury
Hormonal imbalance

Symptoms

The majority of women with uterine fibroids may have no symptoms, in which case fibroids do not require treatment. However, symptoms often associated with the presence of fibroids include:

Heavy menstrual bleeding
Prolonged menstrual periods
Pelvic pressure or pain
Frequent urination
Constipation
Backache or leg pain
Difficulty in emptying your bladder
Infertility
Pregnancy complications (pregnancy loss, preterm labor, placental problems, need for cesarean section)

Diagnosis

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. Other imaging techniques such an MRI scan may also be employed.

Treatment

Treatment of fibroids can vary significantly based on your symptoms or desire for fertility or pregnancy. Options may include:

Hormones (birth control pills, progesterone intrauterine device or injection)
Hysteroscopic myomectomy: Removal of fibroids with surgery performed inside the uterus
Uterine artery embolization: blockage of the arteries supplying the fibroid with tiny beads
Ablation procedures to cause tissue breakdown of the fibroid
Myomectomy: fibroid removal
Hysterectomy: removal of uterus

Your doctor can help you decide which is the safest, most effective treatment option to meet your unique physical and personal needs. If you and your doctor ultimately decide surgery is the best option, myomectomy (removal of fibroids) or hysterectomy (removal of uterus including the fibroids) will be discussed.

Risks during Pregnancy

Some studies indicate that the presence of uterine fibroids during pregnancy increases the risk of complications such as the first trimester bleeding, breech presentation, placental abruption, increased chance of caesarean section and problems during labor.