ARE UTERINE FIBROIDS SERIOUS?

Uterine fibroids are benign tumors that originate in the uterus (womb).

It is not known exactly why women develop uterine fibroids. Most women with uterine fibroids have no symptoms. However, fibroids can cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. These are most commonly abnormal bleeding, pain and pressure.

Uterine Fibroids are diagnosed by pelvic exam and by ultrasound.

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WHAT ARE UTERINE FIBROIDS? WHAT DO THEY LOOK LIKE

Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. Uterine fibroids are usually round. In most cases, fibroids do not cause pain or other symptoms. However, exceptionally large fibroids may cause pressure on the bladder or other organs, leading to specific symptoms (see: What are the symptoms of uterine fibroids?)

Uterine fibroids are often described based upon their location within the uterus.

• Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle.
• Submucosal (submucous) fibroids are located inside the uterine cavity beneath the inner lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus.
• Intramural fibroids are located within the muscular wall of the uterus.
• Pedunculated fibroids grow on a stalk of tissue known as a pedical (like a mushroom), extending either inside the cavity of the uterus or outside the uterus from its outer surface.

 

WHAT ARE THE SYMPTOMS OF UTERINE FIBROIDS? DO THEY CAUSE PAIN?

Most of the time, uterine fibroids do not cause symptoms or problems, and a woman with a fibroid is usually unaware of its presence.

However, abnormal uterine bleeding is the most common symptom of a fibroid. If the tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause heavy periods, painful periods, prolonged periods or spotting between menses. Women with excessive bleeding due to fibroids may develop iron deficiency anemia. Uterine fibroids that are degenerating can sometimes cause severe, localized pain.

Fibroids can also cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. Large fibroids can cause:

• pressure,
• pelvic pain, including pain during sex,
• pressure on the bladder with frequent or even obstructed urination, and
• pressure on the rectum with painful or difficult defecation.

While fibroids do not interfere with ovulation, some studies suggest that they may impair fertility and lead to poorer pregnancy outcomes. In particular, submucosal fibroids that deform the inner uterine cavity are most strongly associated with decreases in fertility. Occasionally, fibroids are the cause of recurrent miscarriages. If they are not treated in these cases, the woman may not be able to sustain a pregnancy.

 

WHAT CAUSES UTERINE FIBROIDS TO GROW? HOW BIG CAN THEY GET?

We do not know exactly why women develop these tumors. Genetic abnormalities, alterations in growth factor (proteins formed in the body that direct the rate and extent of cell proliferation) expression, abnormalities in the vascular (blood vessel) system, and tissue response to injury have all been suggested to play a role in the development of fibroids.

Early pregnancy decreases the likelihood that fibroids will develop. Fibroids have not been observed in girls who have not reached puberty, but adolescent girls may rarely develop fibroids. Other factors that researchers have associated with an increased risk of developing fibroids include having the first menstrual period (menarche) prior to age 10, consumption of alcohol (particularly beer), uterine infections, and elevated blood pressure(hypertension).

Estrogen tends to stimulate the growth of fibroids in many cases. Uterine fibroids can be as small as a few millimeters (less than an inch) in diameter. They can also be very large (grapefruit-sized or larger).

Another risk of leaving these tumors alone is that they sometimes grow to a size that eventually cause significant symptoms, thus requiring removal. If fibroids grow large enough, the surgery to remove them can become more difficult and risky.

WHAT TESTS DIAGNOSE UTERINE FIBROIDS?

Uterine fibroids are diagnosed by pelvic exam and even more commonly by ultrasound. Often, a pelvic mass cannot be determined to be a fibroid on pelvic exam alone, and ultrasound is very helpful in differentiating it from other conditions such as ovarian tumors. MRI and CT scans can also play a role in diagnosing fibroids, but ultrasound is the simplest, cheapest, and best technique for imaging the pelvis. Occasionally, when trying to determine if a fibroid is present in the uterine cavity (endometrial cavity), a hysterosonogram (HSG) is done. In this procedure, an ultrasound exam is done while contrast fluid is injected into the uterus through the cervix. The fluid within the endometrial cavity can help outline any masses that are inside, such as submucosal fibroids.

 

WHAT ARE THE RISKS OF UTERINE FIBROIDS DURING PREGNANCY?

Some studies have shown an increased risk of pregnancy complications in the presence of fibroids, such as first trimester bleeding, breech presentation, placental abruption, and problems during labor. Fibroids have also been associated with an increased risk of cesarean delivery. The size of the fibroid and its precise location within the uterus are important factors in determining whether a fibroid causes obstetric complications.

 

 

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