Uterine Fibroids

 

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Uterine fibroids are non-cancerous tumors which can also be called fibromyomas, leiomyomas or myomas, They are growth of muscle within the uterine wall.  The size of a fibroid can range from a small seed to larger than a grapefruit before they're discovered. There can be multiple fibroids or one single growth and can be located on the surface of the uterus, in the wall of the uterus, or in the uterine cavity.

Fibroids are made of muscle cells and other tissues that grow within and around the muscular wall of the uterus.  They are also composed of extracellular matrix (i.e., collagen, proteoglycan, fibronectin).

Uterine fibroids are the most common, non-cancerous tumors in women of childbearing age causing symptoms in approximately 25% of women. 

The cause of uterine fibroids is unknown, however, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.

Prevalence of Fibroids in Black women

Uterine fibroids occur more often in black women than in any other ethnic group. The fibroids tend to occur at earlier ages and grow to larger sizes in black women than they do in non-black women.  70% to 80% of black women will develop benign uterine fibroid tumors by their late forties, according to the National Institute of Environmental Health Sciences.  Recent medical research suggests that at least 1 in 3 black women will have clinically recognized fibroids.  Uterine fibroids constitute a major public health issue for black women in the United States (Wise, 2005). The reason as to why black women are more at risk for fibroids is sstill unknown. 

Fibroids are often described by their location in the uterus

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  • Myometrial -- in the muscle wall of the uterus

  • Submucosal -- just under the surface of the uterine lining

  • Subserosal -- just under the outside covering of the uterus

  • Pendunculated -- occurring on a long stalk on the outside of the uterus or inside the cavity of the uterous

Fibroids are highly dependent on the hormone estrogen, so the size may increase during pregnancy when estrogen levels are higher. Fibroids tend to shrink after menopause when estrogen levels drop.

What are the symptoms of Fibroids?

While not cancerous, uterine fibroids can cause problems that affect a women’s overall health.  Depending on the size, location and number of fibroids, common symptoms can include:

  • Pelvic pain and pressure

  • Excessive bleeding, including prolonged periods and passage of clots, which can lead to severe anemia

  • Abdominal swelling

  • Pressure on the bladder, leading to frequent urination

  • Pressure on the bowel, leading to constipation and bloating

  • Multiple miscarriages or early labor

  • Infertility--- Research from 2006 indicates that incidence ofinfertility is higher in African American women than in Caucasian women, and that infertility among black women has steadily been increasing, whereas it is decreasing among white women (Chandra, and Stephen 2006).

Treatments Available for fibroids

Treatment depends on several things, including:

  • Age

  • General health

  • Severity of symptoms

  • Type of fibroids

  • Whether a woman is pregnant

  • If she wants children in the future

Uterine Artery Embolization:  Uterine artery embolization (UAE), also called uterine fibroid embolization (UFE) is an endovascular procedure. It is done through the arterial system. It is non-surgical and minimally invasive. It does not require general anesthesia- the groin is numbed and the patient is sedated, but still conscious enough to respond to a question. This is a new, non-surgical uterine fibroid treatment. It is safer than uterine fibroid treatments that require surgery and a highly effective alternative for some women who strongly desire to avoid hysterectomy.  

Hormone Therapy: GnRH agonists are drugs that block estrogen production, starving uterine fibroids of estrogen and causing them to shrink.

Endometrial Ablation and Resection: A gynecologist places a scope through the cervix into the uterine cavity to burn and scrape the lining of the uterus. The procedure also is used to burn and cut out uterine fibroid tumors that can be reached through the scope. The removal of the lining (endometrial ablation) stops bleeding, but not all uterine fibroid tumors can be removed with this technique. Like a hysterectomy, this fibroid treatment causes permanent infertility. A heated balloon may also be used.

Magnetic Resonance-guided Focused Ultrasound (MRgFUS): A magnetic resonance-guided focused ultrasound (MRgFUS) — a minimally invasive procedure. It uses high-energy ultrasound waves to generate heat at a specific point to destroy uterine fibroid tissue and relieve symptoms. The MR scanner allows the Interventional Radiologist to see where the fibroid is and what has been treated and to monitor temperature changes inside the body. Only a small spot is treated at a time and the process is repeated, usually about 50 times per session, until the fibroid is destroyed. The technology is limited to symptomatic women not interested in childbearing who have only a few fibroids. Large fibroids and multiple smaller fibroids are difficult to treat. One caution is that, because this is a new technology, the long-term effects are not yet clear.

Hysterectomy:  Uterine fibroids can be treated with surgery, including hysterectomy, which removes the entire uterus, and myomectomy, which removes the fibroids but leaves the uterus. Both are major surgeries that require 4 days in the hospital and a 6-week recovery period. Myomectomy can preserve fertility, but carries the additional risk of recurrence, since most women have multiple fibroids and it is impossible to cut them all out.

Myolysis or Cryomyolysis: These are uterine fibroid treatments in which uterine fibroids are burned or frozen via laparoscopic surgery.


For more information about uterine fibroids, please contact the following organizations:

- Office on Women’s HealthPhone: 800-994-9662 (TDD: 888-220-5446) - American College of Obstetricians and Gynecologists Phone: 202-638-5577 - Center for Uterine Fibroids Phone: 800-722-5520

References/sources:

- Centers for Disease Control and Prevention — United States Cancer Statistics - National Institutes of Health - Chandra, A. Stephen E. H. (2006).  Declining estimates of infertility in the United States: Fertile Sterile. Vol. 86:516–23. - Wise, A. Lauren et al. 2007. Perceptions of racial discrimination and risk of uterine leiomyomata. Journal of Epidemiology. Vol. 18;47-757.