WHAT IS FIBROID?

A fibroid is a noncancerous tumor composed of muscle and fibrous tissue. It is located in the uterus.

• Fibroids can cause pain, abnormal vaginal bleeding, constipation, repeated miscarriages, and an urge to urinate frequently or urgently.
• Doctors do a pelvic examination and usually ultrasonography to confirm the diagnosis.
• Treatment is necessary only if fibroids cause problems.

Fibroids are also called leiomyomas or myomas.

Fibroids in the uterus are the most common noncancerous tumor of the female reproductive tract. By age 45, about 70% of women develop at least one fibroid. Many fibroids are small and cause no symptoms. But about one fourth of white women and one half of black women eventually develop fibroids that cause symptoms. Fibroids are more common among women who are overweight.

CAUSES

What causes fibroids to grow in the uterus is unknown. High levels of estrogen and possibly progesterone (female hormones) seem to stimulate their growth. Fibroids may become larger during pregnancy (when levels of these hormones increase), and fibroids tend to shrink after menopause (when levels decrease drastically).

If fibroids grow too large, they may not be able to get enough blood. As a result, they begin to degenerate and cause pain.

Fibroids may be microscopic or as large as a basketball.

Fibroids may grow in different parts of the uterus, usually in the wall (which has three layers):

• Under the outer surface of the uterus (subserosal fibroids)
• In the wall of the uterus (intramural fibroids)
• Under the inside layer (lining or endometrium) of the uterus (submucosal fibroids)

Subserosal fibroids are the most common type.

Some fibroids grow from a stalk (called pedunculated fibroids). Some submucosal fibroids extend into the interior of the uterus (called intracavitary fibroids). Fibroids that grow in the wall or just under the endometrium can distort the shape of the interior of the uterus.

Often, women have more than one fibroid.

Very rarely, fibroids become cancerous.

WHERE FIBROIDS GROW

SYMPTOMS

Symptoms depend on

• The number of fibroids
• Their size
• Their location in the uterus

Many fibroids do not cause symptoms. The larger the fibroid, the more likely it is to cause symptoms. Fibroids, particularly those just under the lining, commonly make menstrual bleeding heavier or last longer than usual. Anemia may result from the loss of blood.

Large fibroids may cause pain, pressure, or a feeling of heaviness in the pelvic area during or between menstrual periods. Fibroids may press on the bladder, making a woman need to urinate more frequently or more urgently. They may press on the rectum, causing discomfort and constipation. They may interfere with how organs function, for example, by blocking the urinary tract and thus the flow of urine out of the body. Large fibroids may cause the abdomen to enlarge.

A fibroid growing on a stalk may twist, cutting off its blood supply, and cause severe pain.

Fibroids that are growing or degenerating can cause pressure or pain. Pain due to degenerating fibroids can last as long as they continue to degenerate.

Fibroids that cause no symptoms before pregnancy may cause problems during pregnancy. Problems include

• Miscarriage
• Early (preterm) labor
• Abnormal positioning (presentation) of the babybefore delivery
• Excessive blood loss after delivery(postpartum hemorrhage)

Fibroids can cause infertility by blocking the fallopian tubes or by distorting the shape of the uterus, making attachment to the lining of the uterus (implantation) of a fertilized egg difficult or impossible.

Fewer than 1% of fibroids become cancerous.

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