Fibroids are soft benign tumors that originate from the muscular wall of the uterus. They are commonly called uterine myomas or ovarian cysts and are described according to their location inside the uterus.
Incidence and Symptoms
Fibroids are very common and almost 4 out of 5 women develop the condition early in life. Asymptomatic fibroids are detected during routine scans and they are frequently found in women in the 30-to-40 age group. However, about 1 percent of women start showing active symptoms. Symptoms of fibroids are usually detected when patients complain of heavy and abnormal uterine bleeding, requiring treatments. As the tumors are located near the thick uterine muscular area, they have a very good supply of blood. During menstruation, the tumors bleed more, resulting in symptoms such as cramps, heavy bleeding or painful periods, spotting between periods, and pain during intercourse. As the fibroids are essentially solid lumps of muscle, they exert pressure on the rectum and urinary bladder, causing constipation and frequent urination. Women may also complain of symptoms such as leg cramps, pelvic fullness and bloating, backache, lower abdominal swelling, and fertility problems.
Based upon their location within the uterus, uterine fibroids are distinguished as follows:
- Subserosal fibroids are located beneath the lining membrane outside the uterus. These are usually located on the outside uterine surface.
- Submucosal (submucous) fibroids are inside the uterine cavity beneath the lining of the uterus.
- Intramural fibroids appear within the uterine muscular wall.
Women with no symptoms and no problems in fertility and conception may opt to leave the fibroids or ovarian cysts, with no treatments necessary. During menopause, fibroids or ovarian cysts usually shrink in size and symptoms lessen. Fibroids tend to shrink after menopause, but if hormone therapy treatments are taken after menopause, symptoms can continue. If treatments are necessary, they are usually in the form of medications and surgery.
- Medications: GnRHA or gonadotropin-released hormone agonist are the most popular treatments for fibroids. These reduce normal estrogen production and force fibroids to decrease in size. Other supportive medication include Tranexamic acid can reduce menstrual blood flow, anti-inflammatory drugs can reduce body pain, and contraceptive pills to decrease monthly bleeding.
- Surgery: The surgeon may choose to remove the entire uterus (hysterectomy). He may recommend a myomectomy in which only the fibroids are removed from the uterine wall. Other treatments include endometrial ablation in which the entire lining of the uterus and the attached fibroids are removed. Keyhole surgeries and treatments like uterine artery embolization are also popular, in which the fibroid is essentially starved to death. Two of the most recent techniques for fibroid removal include magnetic-resonance-guided percutaneous laser ablation and magnetic-resonance-guided focused ultrasound surgery. However, surgeons are not very sure about the risk versus benefit rate of these procedures.
Detection of Symptoms and Preventive Treatments are Key
A biannual uterine check is advised for all women over the age of 30. If you were sexually active at an early age, start regular checkups earlier. If you do have symptoms of bleeding, a detected uterine condition, or ovarian cysts, your gynecologist can detect uterine cysts early during regular evaluations and start treatments immediately.
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