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FIBROIDS

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Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of broids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one broid or many of varying sizes. A broid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.
Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.

WHAT ARE THE SYMPTOMS OF FIBROIDS?

Some of the causes of abnormal bleeding include the following:

  • Changes in menstruation
  • Longer, more frequent, or heavy menstrual periods —Menstrual pain (cramps)
  • Vaginal bleeding at times other than menstruation —Anemia (from blood loss)
  • Pain
  • In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
  • Miscarriage
  • Ectopic pregnancy
  • During sex
  • Pressure
  • Difficulty urinating or frequent urination
  • Constipation, rectal pain, or difficult bowel movements
  • Abdominal cramps
  • Enlarged uterus and abdomen
  • Miscarriages
  • Infertility

 

WHEN IS IT NECESSARY TO GET TREATMENT?

  • Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
  • Bleeding between periods
  • Uncertainty whether the growth is a broid or another type of tumor, such as an ovarian tumor
  • Rapid increase in growth of the broid
  • Infertility
  • Pelvic pain
  • Birth control pills and other types of hormonal birth control methods—These drugs often are used to control heavy bleeding and painful periods.
  • Gonadotropin-releasing hormone (GnRH) agonists—These drugs stop the menstrual cycle and can shrink broids. They sometimes are used before surgery to reduce the risk of bleeding. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her broids usually return to their previous size.
  • Progestin–releasing intrauterine device —This option is for women with broids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the broids themselves.
  • Myomectomy is the surgical removal of broids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new broids may develop. If they do, more surgery may be needed.
  • Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the broids are very large. A woman is no longer able to have children after having a hysterectomy.
  • Hysteroscopy—This technique is used to remove broids that protrude into the cavity of the uterus. A resectoscope is inserted through the hysteroscope. The resectoscope destroys broids with electricity or a laser beam. Although it cannot remove broids deep in the walls of the uterus, it often can control the bleeding these broids cause. Hysteroscopy often can be performed as an outpatient procedure (you do not have to stay overnight in the hospital).
  • Endometrial ablation—This procedure destroys the lining of the uterus. It is used to treat women with small broids (less than 3 centimeters). There are several ways to perform endometrial ablation.
  • Uterine artery embolization (UAE)—In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood ow to the broid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases.
  • Magnetic resonance imaging-guided ultrasound surgery—In this new approach, ultrasound waves are used to destroy broids. The waves are directed at the broids through the skin with the help of magnetic resonance imaging. Studies show that women have improved symptoms up to 1 year after having the procedure. Whether this approach provides long-term relief is currently being studied.