UTERINE FIBROIDS
Uterine fibroids (also known as leiomyomas) are the most common non-malignant tumor of a womans uterus. These are generally well-circumscribed masses that develop in the smooth muscle layer of the uterine wall. These masses occur in approximately 25% of all women in the U.S. and have been estimated to be present in one out of every five women over age 35. Usually fibroids are most common in women over age 30 and the masses will usually shrink after a woman goes through menopause. The fibroids begin to develop in the muscle layer of the uterus and can be from microscopic in size to huge enough to fill the pelvis or abdomen.
What factors lead to the development of fibroids?
The exact cause of fibroids has so far not been determined. Research is being done to try to determine if a genetic factor is present that could lead to their development. It is known that certain factors may increase the likelihood that women might develop fibroids:
- Estrogen It has been shown that fibroids are sensitive to the amount of estrogen that is being produced by the ovaries. This would explain why fibroids tend to decrease in size after menopause when estrogen levels decrease.
- Inherited pattern It has been known that women in certain family groups have a high tendency to developing fibroids. Often a woman will report to her physician that many of her relative have had fibroids, and she will need to watch for potential development of fibroids.
- Obesity It has been shown that estrogen is converted and made in fat cells and so women who are obese have a higher risk of developing fibroids.
- Women who have never been pregnant often have an increased risk of developing fibroids
- Early onset of period before age 10 seems to have an increased risk of fibroids probably due to longer exposure to estrogen production.
- Women of African heritage have an increased risk reported as high as 5-10 times higher than Caucasian women.
What are the signs and symptoms of fibroids?
Women do not always have symptoms when fibroids are present on the uterus. Even very large fibroids may not produce symptoms. The most common symptoms include:
- Irregular vaginal bleeding or an increase in the amount of blood loss with periods
- Pressure on the bladder which possibly cause frequent urination, an urgency to urinate, loss of urine, or sometimes difficulty to urinate
- Pressure on the rectum which can cause constipation
- Pressure on the pelvic muscles which may give a sensation of fullness or lower abdominal pain
- Increase in size of the abdomen with a change in the waist size
- A pelvic mass which may be discovered by your physician
- Infertility may occasionally result due to fibroids
What are the types of fibroids?
Fibroids have been described and distinguished based on the location of the fibroids in the uterus:
- Subserosal fibroids located just under the outer coating of the uterus
- Pedunculated fibroids attached to the uterus but hanging off the body of the uterus by a stalk
- Intramural fibroids located in the thick muscular layer of the wall
- Submucous fibroids located just beneath the lining of the uterus and may protrude into the cavity of the uterus
- Cervical fibroids located in the body of the cervix
The majority (approximately 95%) are subserosal or intramural in location with the remaining types making up the remainder of the cases of fibroids
How are fibroids diagnosed?
Fibroids are usually found on pelvic exam performed by your physician. Sometimes small fibroids may not be felt easily and may be seen on studies such as ultrasound, CT scan or MRI. They may also be found when a patient is undergoing surgical procedures such as exploratory laparotomy or laparoscopy.
What treatments are available for fibroids?
Over the years many types of treatments have been tried and some have been more successful than others. Medical therapies have been tried to either stabilize symptoms or attempt to shrink fibroids and may include birth control pills, progesterone, or medications that block the stimulation of the ovaries to produce hormones (such as Lupron). Recent studies have shown some improvement with a new preparation called Cytotec (RU-486) which is sometime used for induction of labor for pregnant women. Non surgical procedures are sometimes used such as uterine artery embolization (injection of an agent to block the flow of blood to the fibroids) and MRI directed high intensity ultrasound ablation (procedure only available in a few medical centers in the US). Surgical procedures are available which include removal of the fibroids with preservation of the uterus called a myomectomy or a hysterectomy which will remove the uterus along with the fibroids.
If you have symptoms, see you physician. Only your physician can diagnose whether fibroids are present and if they are present can direct in making a decision that is best for you.
More about Dr. Aulds
Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.
Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.
Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.
