UTERINE FIBROIDS  
              

        Uterine fibroids are growths, or tumors, that develop in the muscular wall of the uterus.
      They may also be called myomas, leiomyomas, leiomyomata uteri, or simply fibroids.
      Fibroids are generally benign—that is, they are not cancerous (malignant). A woman may
      have just one fibroid, or many. Fibroids are the most common kind of growths of the uterus.
      Over 40% of women may develop fibroids during their lifetime.

      Uterine fibroids can range in size, for example from as small as a grape (less than 1 inch)
      to larger than a melon. They can appear:

• Beneath the outer surface of the uterus

• Totally within the wall of the uterus

• Inside the uterus

      Not much is known about the cause of fibroids, but evidence suggests that their
      growth is related to estrogen and possibly other hormones. In fact, increased levels
      of these hormones may speed up the growth rate of fibroids.

       Estrogen levels in the body may go up or down for a number of reasons. For
      example, estrogen levels rise and fall during the menstrual cycle. If you are
      pregnant or taking certain kinds of birth control pills, your estrogen level increases.
      When you enter menopause, your level decreases as your body stops producing
      estrogen. As a result, fibroids tend to be less of a problem at this stage of a
      woman's life.

      Even though the medical community is not completely certain what causes fibroids
      and why some women have them and others don’t, there do seem to be factors that
     may play a role.

    
    Signs and symptoms

      When signs and symptoms are present, the most common uterine fibroids symptoms
      include:

• Heavy menstrual bleeding

• Prolonged menstrual periods or bleeding between periods

• Pelvic pressure or pain

• Urinary incontinence or frequent urination

• Constipation

• Backache or leg pains

        Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of
      nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep
      into surrounding tissue, causing pain and fever. A fibroid that hangs by a stalk inside
      or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk
      and cutting off its blood supply.

       Fibroid location influences your signs and symptoms:

• Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are thought to be primarily responsible for prolonged, heavy menstrual bleeding.

• Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing constipation, or on your spinal nerves, causing backache.

      Causes

       Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium).
       A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass
       distinct from neighboring tissue.

       Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses
       that can distort and enlarge the uterus. They can be single or multiple, in extreme cases
       expanding the uterus so much that it reaches the rib cage.

       Doctors don't know the cause of uterine fibroids, but research and clinical experience
       point to several factors:

• Genetic alterations. Many fibroids contain alterations in genes that code for uterine muscle cells.

• Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and estrogen receptors than do normal uterine muscle cells.

• Other chemicals. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

        Risk factors

        There are few known risk factors for uterine fibroids, other than being a woman of
        reproductive age. Other factors include:

• Heredity. If your mother or sister had fibroids, you're at increased risk of also developing them.

• Race. Black women are more likely to have fibroids than are women of other racial groups. In addition, black women have fibroids at younger ages, and they're also likely to have more or larger fibroids.

      When to seek medical advice

       Make an appointment in our office if you have:

• Pelvic pain that doesn't go away

• Overly heavy or painful periods

• Spotting or bleeding between periods

• Pain with intercourse

• Difficulty emptying your bladder

• Difficulty moving your bowels

       Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain
       that comes on suddenly.

       Screening and diagnosis

      Uterine fibroids are frequently found incidentally during a routine pelvic exam.
      Your doctor may feel irregularities in the shape of your uterus through your abdomen,
      suggesting the presence of fibroids.

      Ultrasound

      If confirmation is needed, we may obtain an ultrasound — a painless exam that uses
     sound waves to obtain a picture of your uterus — to confirm the diagnosis and to map
     and measure fibroids. A doctor or technician moves the ultrasound device (transducer)
     over your abdomen (transabdominal) or places it inside your vagina (transvaginal) to
     obtain images of your uterus.

        Transvaginal ultrasound provides more detail because the probe is closer to the
         uterus.
        Transabdominal ultrasound visualizes a larger anatomic area. Sometimes, fibroids are  
        discovered during an ultrasound conducted for a different purpose, such as during a
        prenatal ultrasound.

     Other imaging tests

        If traditional ultrasound doesn't provide enough information, your doctor may order
        other imaging studies, such as:

• Hysterosonography. This ultrasound variation uses sterile saline to expand the uterine cavity, making it easier to obtain interior images of the uterus. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound.

• Hysterosalpingography. This technique uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. In addition to revealing fibroids, it can help your doctor determine if your fallopian tubes are open.

• Hysteroscopy. Your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. The tube releases a gas or liquid to expand your uterus, allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes. A hysteroscopy can be performed in your doctor's office.

      Imaging techniques that may occasionally be necessary include computerized
      tomography (CT) and magnetic resonance imaging (MRI).

      Other tests

        If you're experiencing abnormal vaginal bleeding, your doctor may want to conduct other
        tests to investigate potential causes. He or she may order a complete blood count (CBC)
        to determine if you have iron deficiency anemia because of chronic blood loss. Your
       doctor may also order blood tests to rule out bleeding disorders and to determine the
       levels of reproductive hormones produced by your ovaries.

      Complications

       Although uterine fibroids usually aren't dangerous, they can cause discomfort and may
       lead to complications such as anemia from heavy blood loss. In rare instances, fibroid
       tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this
       stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek
       medical care right away. You may need surgery.

      Pregnancy and fibroids

      Because uterine fibroids typically develop during the childbearing years, women
      with fibroids are often concerned about their chances of a successful pregnancy.

       Fibroids usually don't interfere with conception and pregnancy, but they can occasionally
       affect fertility. They may distort or block your fallopian tubes, or interfere with the
       passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may
       prevent implantation and growth of an embryo.

            Research indicates that pregnant women with fibroids are at slightly increased
       risk of miscarriage, premature labor and delivery, abnormal fetal position, and
       separation of the placenta from the uterine wall. But not all studies confirm these
         associations. Furthermore, complications vary based on the number, size and
       location of fibroids. Multiple fibroids and large submucosal fibroids that distort the
       uterine cavity are the type most likely to cause problems. A more common
       complication of fibroids in pregnancy is localized pain, typically between the
       first and second trimesters. This is usually easily treated with pain relievers.

        In most cases, fibroids don't interfere with pregnancy and treatment isn't necessary.
        It was once believed that fibroids grew faster during pregnancy, but multiple studies
        suggest otherwise. Most fibroids remain stable in size, although some increase or
        decrease slightly, usually in the first trimester.

        If you have fibroids and you've experienced repeated pregnancy losses, your doctor
        may recommend removing one or more fibroids to improve your chances of carrying
        a baby to term, especially if no other causes of miscarriage can be found and your
        fibroids distort the shape of your uterine cavity.

        Doctors usually don't remove fibroids in conjunction with a Caesarean section because   
        of the high risk of excessive bleeding.

      Treatment         

       Watchful waiting

            If you're like most women with uterine fibroids, you have no signs or symptoms.
       In your case, watchful waiting (expectant management) could be the best course.
       Fibroids aren't cancerous. in most instances.  They rarely interfere with pregnancy.
       They usually grow slowly and tend to shrink after menopause when levels of
        reproductive hormones drop. This is the best treatment option for a large majority
       of women with uterine fibroids.

      Medications

        Medications for uterine fibroids target hormones that regulate your menstrual cycle,
        treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't
        eliminate fibroids, but may shrink them. Medications include:

·         Gonadotropin-releasing hormone (Gn-RH) agonists. To trigger a new menstrual cycle, a control center in your brain called the hypothalamus manufactures gonadotropin-releasing hormone (Gn-RH). The substance travels to your
pituitary gland, a tiny gland also located at the base of your brain, and sets
in motion events that stimulate your ovaries to produce estrogen and progesterone.

Medications called Gn-RH agonists (Lupron, Synarel, others) act at the same sites that Gn-RH does. But when taken as therapy, a Gn-RH agonist produces the opposite effect to that of your natural hormone. Estrogen and progesterone levels fall, menstruation stops, fibroids shrink and anemia often improves.

·         Androgens. Your ovaries and your adrenal glands, located above your kidneys, produce androgens, the so-called male hormones. Given as medical therapy, androgens can relieve fibroid symptoms. 

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                               KENNETH GOODRICH, M.D.  -  OBSTETRICIAN- GYNECOLOGIST  
     
                       Certified by the American Board of Obstetrics and Gynecology

  Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women,  Chronic Vaginal  Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
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