An in depth discussion of Uterine Fibroids
Fibroids or leiomyomas(myomas) are the commonest non-cancerous tumors of the uterus. Nearly 50-60% of women in child bearing ages are estimated to have fibroids. However many women do not have any complaints because of these fibroids. However fibroids are one of the commonest indications for hysterectomy.
Fibroids are actually tumors of the smooth muscle of the uterus. These grow under the influence of estrogens and progesterone. Hence fibroids are not seen in the post menopausal population.
Growth and location are the main factors that determine if a fibroid leads to symptoms and problems. A small lesion can be symptomatic if located within the uterine cavity while a large lesion on the outside of the uterus may go unnoticed. Different locations are classified as follows:
Intramural Fibroids are located within the wall of the uterus and are the most common type; unless large, they may be asymptomatic. Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity.
Subserosal fibroids are located underneath the mucosal (peritoneal) surface of the uterus and can become very large. They can also grow out in a papillary manner to become pedunculated fibroids. These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma.
Submucosal fibroids are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesion in this location may lead to bleeding and infertility. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix.
Cervical fibroids are located in the wall of the cervix (neck of the uterus).
The symptoms of fibroid relate to their location and size. A large intra mural fibroid may not cause any problems, but a small sub mucosal fibroid can cause lot of problems. The most common symptoms caused by fibroids include pain, irregular menstrual bleeding, heavy menstrual bleeding, inter-menstrual bleeding, recurrent abortions (sub mucous fibroid), and infertility. Women may also complain of painful urination and defecation along with urinary retention.
The pain of fibroid is typically dull dragging type of pain but may also present as a sharp pain localised to lower abdomen and vagina. The pain may at times radiate to lower back and legs.
The most common symptom associated with fibroids is menstrual irregularities. Most commonly women have heavy and prolonged bleeding. Women may also develop inter –menstrual bleeding and bleeding after sexual intercourse (cervix fibroids).
Fibroids, especially sub mucosal fibroids may also cause infertility and recurrent abortions in frequently.
The diagnosis of fibroids is made by demonstration of these masses on ultra sound. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam. The location can be determined and dimensions of the lesion measured.
Most fibroids do not need treatment. Asymptomatic fibroids detected incidentally can be managed conservatively with serial ultrasound scans to study the evolution of these fibroids. Most of them will shrink after menopause, so by expectant management we can minimise the hazards of surgery.
Treatment for symptomatic fibroids is surgical in nature. The surgical procedures most commonly used are Hysterectomy and Myomectomy.
During hysterectomy the entire uterus along with its supporting tissues is removed. This is generally reserved for those women who have completed their families and are symptoms due to fibroids.
Myomectomy is reserved for small to medium isolated fibroids in a child bearing age women who wants to retain her reproductive functions.
To summarise, fibroids are a benign tumor of the uterus. It rarely causes symptoms, but when it does cause symptoms the management of choice remains removal of the fibroid surgically either by a hysterectomy or myomectomy.
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