Uterine fibroids are benign tumors that originate in the uterus (womb). It is also called an Uterina myoma.
• It is unknown why women develop uterine fibroids.
• Most women with uterine fibroids have no symptoms. However, fibroids can cause many symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. These are the most commonly abnormal bleeding, pain, and pressure.
• Uterine fibroids are diagnosed by pelvic exam and by ultrasound.
• If treatment for uterine fibroids is necessary, several options are available. They include surgery (hysterectomy, myomectomy, cryosurgery), MRI-guided high-intensity focused ultrasound (MRgFUS or HIFU), and uterine artery embolization (UAE).
• Pharmaceutical treatments: mifepristone (RU-486), danazol (Danocrine), raloxifene (Evista), GnRH analogs (Lupron and others), and low-dose formulations of oral contraceptives.
Why is a hysterectomy performed?
The most common reason hysterectomy is performed for uterine fibroids. Other common reasons are:
• abnormal uterine bleeding (vaginal bleeding),
• cervical dysplasia (pre-cancerous conditions of the cervix),
• endometriosis, and uterine prolapse (including pelvic relaxation).
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, huge 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 outer 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.
• Pedunculated fibroids grow on a stalk of tissue known as a pedicle (like a mushroom), extending either inside the cavity of the uterus or outside the uterus from its outer surface.
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 several symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. Large fibroids can cause:
• 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.
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, irregularities in the vascular (blood vessel) system, and tissue response to injury have all been suggested to play a role in the development of fibroids.
Family history is a crucial factor since there is often a history of fibroids developing in women of the same family. Race also appears to play a role. Women of African descent are two to three times more likely to develop fibroids than women of other races. Women of African ancestry also develop fibroids at a younger age. They may have symptoms from fibroids in their 20s, in contrast to Caucasian women with fibroids, in whom symptoms typically occur during the 30s and 40s. 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) before 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. During the first trimester of pregnancy, about a third of fibroids will enlarge and then shrink after birth. In general, fibroids tend to shrink after menopause, but postmenopausal hormone therapy may cause symptoms to persist.
Overall, these tumors are relatively common and occur in about 70% to 80% of all women by the time they reach age 50.
Uterine fibroids can be as small as a few millimeters (less than an inch) in diameter. They can also be huge (grapefruit-sized or larger).
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