Fibroid

What are uterine fibroids?

• Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas.
• The number, size, shape, and location of fibroids can vary greatly.
• They may be inside the uterus(submucus), on its outer surface (subserosal)or within its wall(intramural), or attached to it by a stem-like structure(pedunculated)..

Who get fibroids?

Fibroids are common,with around 1 in 3 women developing them at some point in their life. They most often occur in women aged 30 to 50., but they can occur at any age. Fibroids occur more often in African American women than in white women.

Why fibroids develop?

The exact cause of fibroids is unknown,but they have been linked to the hormone oestrogen( female reproductive hormone produced by the ovaries) Fibroids usually develop during a woman's reproductive years (from around the age of 16 to 50) when oestrogen levels are at their highest.They tend to shrink when oestrogen levels are low, such as after the menopause when a woman's monthly periods stop.

What are symptoms of fibroids?

Many women are unaware they have fibroids because they do not have any symptoms.Women who do have symptoms (around 1 in 3) may experience:

• changes in menstruation—heavier bleeding, longer or more frequent menstrual periods or period pain
• pain—heavy and aching in the abdomen/lower back and/or during sex
• pressure—frequent or difficult urination
• constipation or difficult bowel movements
• abdominal cramps.
• Infertility(the inability to become pregnant) may occur in cases where a woman has large fibroids.

Fibroids can sometimes prevent a fertilised egg attaching itself to the lining of the womb, or prevent sperm reaching the egg, but this is rare.If you have a submucosal fibroid (a fibroid that grows from the muscle wall into the cavity of your womb), it may block a fallopian tube, making it harder for you to become pregnant.

What complication can occur with fibroid?

• Fibroids that are attached to the uterus by a stem may twist. This can cause pain, nausea or fever.
• Infertility (the inability to become pregnant) may occur in cases where a woman has large fibroids.Fibroids can sometimes prevent a fertilised egg attaching itself to the lining of the womb, or prevent sperm reaching the egg, but this is rare.If you have a submucosal fibroid (a fibroid that grows from the muscle wall into the cavity of your womb), it may block a fallopian tube, making it harder for you to become pregnant.Problems during pregnancy
• If fibroids are present during pregnancy, it can sometimes lead to

Miscarriage ,tummy (abdominal) pain during pregnancy ,risk of premature labour,problems with the development of the baby.

Labour- A fibroid can also interfere with labor and birth if it blocks the passage to the birth canal. If such a case, delivery by a Caesarean section is necessary. Fibroids may increase your risk of bleeding heavily after birth and can increase the time it takes for your womb to return to its normal size.

• Just as fibroids can affect pregnancy, pregnancy can affect fibroids. It is thought that fibroids grow during pregnancy because of higher levels of oestrogen

How are fibroids diagnosed?

• during a routine pelvic exam.
• Ultrasonography 
• Hysteroscopy 
• Hysterosalpingography  (special X-ray test)
• Sonohysterography ( test in which fluid is put into the uterus through the cervix. Ultrasonography is then used to show the inside of the uterus).
• magnetic resonance imaging(MRI) and computed tomography scans(CT), may rarely needed.

When is treatment necessary for fibroids?

Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal the need for treatment:

• Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
• Bleeding between periods
• Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
• Rapid increase in growth of the fibroid
• Infertility
• Pelvic pain

Can medication be used to treat fibroids?

Medications may reduce the heavy bleeding and painful periods that fibroids sometimes cause.

• Birth control pills and other types of hormonal birth control methods—These drugs often are used to control heavy bleeding and painful periods.
• Gonadotropin-releasing hormone (GnRH) agonists—These drugs stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
• Progestin–releasing intrauterine device (IUD)—This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.

What types of surgery may be done to treat fibroids?

• Myomectomy : is the surgical removal of fibroids while leaving the uterus in place. It can be done open This surgery can be done by making a cut on the tummy(abdomen) which is usually a bikini scar, or by the new method of keyhole, buttonhole (laparoscopic) surgery.Type of surgery depends on size,site and number of fibroids. Nowadays, even large fibroids are being removed by the laparoscopic route due to the availability of a new machine called a morcellator, which reduces the tumor to small pieces. Because a woman keeps her uterus, she may still be able to have children. In general approximately 50% Of women of women with infertility and fibroid become pregnant after myomectomy.Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.
• Hysterectomy: is the removal of the uterus.It is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.
• Magnetic resonance imaging-guided ultrasound surgery:In this new approach, ultrasound waves are used to destroy fibroids. The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging. Whether this approach provides long-term relief is currently being studied.