Fibroids 101

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Fibroids are growths of tissue that are usually found in the wall of the uterus, or womb. They are made of a mixture of muscle tissue from the uterus and threadlike fibers of connective tissue.

Although they are called tumors, fibroids are not cancerous. Fibroids usually shrink after menopause. New fibroids do not develop before puberty or after menopause.

Fibroids are very common. They occur in 2 or 3 out of every 10 women over age 35. They occur most often in women between ages 30 and 50, although women in their 20s sometimes have them.

It is common to have more than one fibroid. Some women may have as many as a hundred. Fibroids can be as small as a pinpoint or as large as a basketball. They are usually round or oval in shape, like a ball or an egg. Their texture is firm, like an unripe peach.

Medical names for a fibroid are leiomyoma, myoma, and fibromyoma.

Fibroids can grow in different parts of the uterus. They are named according to which part of the uterus they are found

fibroid1Fibroids that grow inside the wall of the uterus are called intramural fibroids. They are the most common type of fibroid.
Fibroids that grow outward from the wall of the uterus into the abdominal cavity are called subserous or subserosal fibroids. Fibroids that grow inward from the uterine wall, taking up space within the cavity of the uterus, are called submucous or submucosal fibroids. A fibroid that is attached to the uterus by a thin stalk is called a pedunculated fibroid.

  • Fibroids are very common. They occur in 2 or 3 out of every 10 women over age 35.
  • It is common to have more than one fibroid. Some women may have as many as a hundred.
  • Fibroids occur most often in women between ages 30 and 50, although women in their 20s sometimes have them.
  • Three out of every 10 hysterectomies in the United States are performed because of fibroids.

A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumor cell and starts to grow and multiply. Heredity may be a factor. It is thought that a muscle cell in the uterus may be “programmed” from birth to develop into a fibroid sometime-perhaps many years-after puberty (the start of menstrual periods).

After puberty, the ovaries produce more hormones, especially estrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.

  • For many women, fibroids cause no problems. More than half of women with fibroids do not know they have them until their doctor tells them so.The most common problems caused by fibroids are:
    Heavy or long menstrual periods. Periods may last more than seven days and menstrual flow may be very heavy. Some women find they need to change sanitary napkins or tampons so often that they cannot function normally during their period. Heavy menstrual flow can sometimes lead to anemia.
  • Pressure on other organs. Large fibroids may press on organs in the pelvis.
    • If fibroids press on the bladder, a woman may feel the urge to urinate frequently. She may pass only small amounts of urine and she may feel as though she has not completely emptied her bladder.
    • If fibroids press on the bowel, she may feel constipated or full after eating only a small amount of food.
    • If fibroids press on one or both ureters (the tubes connecting the kidneys to the bladder), they may partially block the flow of urine. A woman may not be aware of this because it often isn’t painful. Over time, however, this kind of blockage can lead to kidney infections or other serious kidney damage.
  • Pain in the pelvis. The pressure of large fibroids on other organs may cause pain in the pelvis. Sometimes, if fibroids do not get the blood flow they need to sustain themselves, they degenerate or die. This may cause severe pain lasting for days or weeks. fibroid3Pain may also occur if the stalk of a fibroid twists, cutting off blood supply to the fibroid. Rarely, a fibroid may become infected and cause pain.

Fibroids can occur in any woman of reproductive age. African American women are three times as likely as Caucasian women to have fibroids. It is not known how common fibroids are in women of other races and ethnic backgrounds.

Many women learn they have fibroids when their doctor performs a routine pelvic exam. A uterus that is enlarged or irregular in shape is a sign that a woman may have fibroids. Certain tests help the doctor to be sure of the diagnosis.

  • Ultrasound. During this test, sound waves too high-pitched to be heard travel from a handheld instrument that is placed gently on the abdomen or in the vagina. The sound waves “bounce” off of internal organs and return to the instrument. This creates a picture of the internal organs that can be seen on a screen. If there are fibroids in the uterus, they can be seen in the picture. The doctor can measure the fibroids and can also see if anything else is causing enlargement of the uterus.

An ultrasound exam usually takes 15 to 30 minutes. The test does not use X-rays and has no known risks. It is safe to do an ultrasound test on a woman who is pregnant. (The handheld instrument is placed on the abdomen of a pregnant woman.) A woman may feel some discomfort because she needs to have a full bladder during the test.

  • Magnetic resonance imaging (MRI). This test uses powerful magnets to create a picture of the internal organs. It does not use X-rays, and it is not necessary to have a full bladder. The test takes 30 to 45 minutes. MRI tests are not done routinely because they are much more expensive than ultrasound tests. It is safe to do an MRI test on a woman who is pregnant.

The doctor may decide to order an MRI:

  • if the ovaries are difficult to see during the ultrasound test
  • if the doctor wants to see the structure of the fibroids in more detail
  • CT scan. If MRI is unavailable, the doctor may request a CT scan of the pelvis. CT stands for computerized tomography. A CT scan uses X-rays. It is more expensive than an ultrasound test and may not provide any more information than the ultrasound test did. For these reasons, it is rare for a doctor to order a CT scan for suspected fibroids. A woman cannot have a CT scan if she is pregnant.
  • Hysteroscopy. This test allows the doctor to look directly into the cavity of the uterus. The doctor may decide to do a hysteroscopy if a woman is having heavy bleeding, is having trouble becoming pregnant, or if fibroids are suspected of causing other fertility problems (for example, a miscarriage). A woman cannot have a hysteroscopy if she is pregnant.

What happens during a hysteroscopy?

A thin telescope called a hysteroscope is gently inserted through the cervix and into the uterus. Enlarging the opening of the cervix to insert the hysteroscope can cause cramping and mild bleeding. Doctors generally advise women to take a mild pain medication before and, if necessary, after the procedure.

A hysteroscopy may be done in a doctor’s office (with local or no anesthesia) or in an operating room (with local or general anesthesia).

  • Uterine X-ray. This test is another option for diagnosing fibroids in women who are having bleeding or fertility problems. A woman cannot have a uterine X-ray if she is pregnant.

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What happens during a uterine X-ray?

An instrument is gently inserted into the opening of the cervix. Dye is injected, filling the uterus. The doctor can see the shape of the uterine cavity and can take X-ray pictures of the uterus and fallopian tubes. The doctor can see if the tubes are blocked because the dye will not pass through them.

This test may cause cramping. Doctors generally advise women to take a mild pain medication an hour or so before the test, which is done in a radiology suite (with local or no anesthesia). The dye is harmless (unless a woman has an allergy to iodine or shellfish) and it is quickly removed from the body.

Medical names for this test are hysterosalpingogram (or HSG) and uterotubogram.

  • Endometrial biopsy. In this test, a small piece of the lining of the uterus (the endometrium) is removed and examined under a microscope. The doctor may suggest an endometrial biopsy if a woman is having heavy or lengthy periods. The purpose of the test is to rule out other causes for the bleeding, such as infection, a polyp, or cancer.

What happens during an endometrial biopsy?

A thin tube is gently passed through the cervix to obtain a piece of tissue from the lining of the uterus. This takes only a few minutes. The test may cause cramping. It can usually be performed in a doctor’s office with local or no anesthesia.

  • Dilatation and curettage (D&C). This test is another way to obtain a small (or somewhat larger) piece of the lining of the uterus. It might be done instead of an endometrial biopsy if more tissue is needed or if an endometrial biopsy cannot be done.

What happens during a D&C?

The opening of the cervix is gently enlarged (dilated) by inserting metal probes of increasing thickness. Then, a scraping instrument is passed through the enlarged opening of the cervix to obtain a piece of tissue from the lining of the uterus. A D&C is performed in an operating room. Local or general anesthesia may be used.

The doctor also needs to rule out other problems that can cause the same symptoms as fibroids. For example, an imbalance of hormones may cause heavy periods. A bladder infection can cause a frequent need to urinate.
If fibroids are not causing problems, regular checkups may be the only management they need. This is called watchful waiting. The doctor examines a woman two or three times a year to see if the fibroids are growing and if they are beginning to cause problems. If the doctor cannot feel the woman’s ovaries during a pelvic exam, ultrasound should be performed once a year.

Here is a summary of the important facts and information related to fibroids.

  • Fibroids are growths of tissue that are usually found in the wall of the uterus. They can be as small as a pinpoint or as large as a basketball.
  • Although they are called tumors, fibroids are not cancerous.
  • More than half of women with fibroids do not know they have them until their doctor tells them so.
  • The most common problems caused by fibroids are heavy or long menstrual periods, pressure on other organs, and pain in the pelvis. For many women, however, fibroids cause no problems.
  • In most women, fibroids do not lead to cancer.
  • If fibroids are not causing problems, regular checkups may be the only management they need.
  • Surgery is the standard treatment for fibroids that are causing problems. The two kinds of surgery most commonly performed are hysterectomy (removal of the uterus) or myomectomy (removal of fibroids without removing the uterus).
  • Several new procedures offer alternatives to hysterectomy or myomectomy, especially for the removal of smaller fibroids. In some cases, fibroids may also be treated with medication.
  • Fibroids usually shrink after menopause.
  • New fibroids do not develop before puberty or after menopause

Here are some reliable sources that can provide more information on fibroids.

American College of Obstetricians and Gynecologists
409 12th St., SW
Washington, D.C.20024-2188
Phone: 202-638-5577

Online: http://www.acog.com

ACOG is a professional association for obstetricians and gynecologists. Its resource center offers information for health care consumers on obstetric and gynecological health conditions.

Read more: http://ehealthmd.com/content/fibroids-additional-sources-information#ixzz35yH5RPXG

http://ehealthmd.com/content/fibroids-putting-it-all-together#ixzz35yGsksUZ
http://ehealthmd.com/content/what-causes-fibroids#ixzz35y9eS9uZ

Compiled by Beverly A VanTull from articles by: Guy Slowik from http://ehealthmd.com/content/what-causes-fibroids#axzz35y9YvR3W

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