Fibroid Tumors of the Uterus - An Overview
Who is most likely to have uterine fibroids?
How are uterine fibroids diagnosed?
A. Fibroid tumors are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. They typically improve after menopause when the level of estrogen, the female hormone that circulates in the blood, decreases dramatically. However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.
Fibroids range in size from very tiny to the size of a cantaloupe or larger. In some cases they can cause the uterus to grow to the size of a five-month pregnancy or more. Fibroids may be located in various parts of the uterus. There are three primary types of uterine fibroids:
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Intramural
fibroids, which develop within the uterine wall and expand,
making the uterus feel larger than normal. These are the most common
fibroids. This can result in heavier menstrual flows and pelvic pain
or pressure.
Subserosal fibroids, which develop under the outside covering of the uterus and expand outward through the wall. They typically do not affect a woman's menstrual flow, but can become uncomfortable because of their size and the pressure they cause. Submucosal fibroids are deep within the uterus, just under the lining of the uterine cavity. These are the least common fibroids, but they often cause symptoms, including very heavy and prolonged periods. |
You might hear fibroids referred to by other names, including myoma, leiomyoma, leiomyomata and fibromyoma.
Q. What are typical symptoms?A. Depending on location, size and number of fibroids, they may cause:
- Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots. This often leads to anemia.
- Pelvic pain
- Pelvic pressure or heaviness
- Pain in the back or legs
- Pain during sexual intercourse
- Bladder pressure leading to a constant urge to urinate
- Pressure on the bowel, leading to constipation and bloating
- Abnormally enlarged abdomen
A. Uterine fibroids are very common. The number of women who have fibroids increases with age until menopause: about 20 percent of women in their 20s have fibroids, 30 percent in their 30s and 40 percent in their 40s. From 20 percent to 40 percent of women age 35 and older have uterine fibroids of a significant size.
African-American women are at a higher risk: as many as 50 percent have fibroids of a significant size. It is not known why, although genetic variability is thought to be a factor.
Fibroid tumors may start in women when they are in their 20s, however, most women do not begin to have symptoms until they are in their late 30s or 40s. Physicians are not able to predict if a fibroid will grow or cause symptoms.
Fibroids can dramatically increase in size during pregnancy. This is thought to occur because of the increase in estrogen levels during pregnancy. After pregnancy, the fibroids usually shrink back to their pre-pregnancy size.
Fibroids typically improve after menopause when the level of estrogen decreases dramatically. Fibroids can grow while a menopausal woman is taking estrogen supplements (hormone replacement therapy) or they may not be affected at all.
Q. How are uterine fibroids diagnosed? Fibroids are usually diagnosed during a gynecologic
internal examination. Your doctor will conduct a pelvic exam to
feel if your uterus is enlarged. The presence of fibroids is
most often confirmed by an abdominal ultrasound. Fibroids also
can be confirmed using magnetic resonance (MR) and computed
tomography (CT) imaging techniques. Ultrasound, MR and CT are
painless diagnostic tests. Appropriate treatment depends on
the size and location of the fibroids, as well as the severity
of symptoms.
Fibroids also can be confirmed using magnetic resonance (MR) imaging or computed tomography (CT). MR and CT also are painless diagnostic tests that can give accurate and clear information on the presence of fibroids.
Diagnostic hysteroscopy also is an option, particularly to evaluate the presence of submucosal fibroids. A long, thin probe-like instrument is passed through the vagina and cervix into the uterus, where the physician can check for growths and take samples of tissue. The lighted hysteroscope illuminates the uterus. This procedure, which can cause some discomfort, is generally performed by a gynecologist, and can be done without anesthesia or with a local anesthetic in an office.
Known medically as uterine artery embolization, this is a fundamentally new approach to the treatment of fibroids that blocks the arteries that supply blood to the fibroids. It is a minimally invasive procedure, which means it requires only a tiny nick in the skin, and is performed while the patient is conscious but sedated - drowsy and feeling no pain.
Fibroid embolization is usually done in a hospital by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures.
The interventional radiologist makes a small nick in the skin (less than one-quarter of an inch) at the crease at the top of the leg to access the femoral artery, and inserts a tiny tube (catheter) into the artery. Local anesthesia is used so the needle puncture is not painful.
An arteriogram (a series of images taken while radiographic dye is injected) is performed to provide a road map of the blood supply to the uterus and fibroids.
The interventional radiologist slowly injects tiny plastic (polyvinyl alcohol or PVA) or gelatin sponge particles the size of grains of sand into the vessels. The particles flow to the fibroids first, wedge in the vessels and cannot travel to other parts of the body. Over several minutes, the arteries are slowly blocked. The embolization is continued until there is nearly complete blockage of the blood flow in the vessel.
As a result of the restricted blood flow, the tumor (or tumors) begin to shrink.
Fibroid embolization usually requires a hospital stay of one night, although some women do go home the same day. About six to eight hours of bed rest is typical after the procedure. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to combat cramping, which is a common side effect. Fever also is an occasional side effect, and is usually treated with acetaminophen. Total recovery generally takes one to two weeks, but can take longer.
While embolization to treat uterine fibroids has been performed for more than six years, embolization of arteries in the uterus is not new. The procedure has been used successfully by interventional radiologists in uterine arteries for more than 20 years to treat heavy bleeding after childbirth. Today, fibroid embolization is being performed at hospitals and medical centers across the country, in Canada and around the world. As of the end of 1998, about 1,500 to 2,000 fibroid embolization procedures had been done world-wide.
In some cases, a transvaginal ultrasound may be necessary. The radiologist inserts an ultrasound probe into the vagina so the inside of the uterus can be seen even more clearly than with the abdominal procedure. There is generally little if any discomfort associated with this procedure.
The interventional radiologist steers the catheter through the artery to the uterus using X-ray imaging (fluoroscopy) to guide the catheter's progress. The catheter is moved into the uterine artery at a point where it divides into the multiple vessels supplying blood to the fibroids.
The procedure is then repeated on the other side so the blood supply is blocked in both the right and left uterine arteries. Some physicians block both uterine arteries from a single puncture site, while others puncture the femoral artery at the top of both legs. After the embolization, another arteriogram is performed to confirm the results. The skin puncture where the catheter was inserted is cleaned and covered with a bandage.
