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Every time I find nodes in the patient’s uterus during an ultrasound examination in my office and diagnose fibroids, I get similar questions:
“Doctor, is it not cancer?” or “Is it very bad? Is it very dangerous for me?”, “Why did it appear in me?”, “What are my next steps?”, “Natalia, I want to get rid of it urgently”.
Let me reassure you right away: uterine fibroids are a completely benign tumor that is unlikely to affect a woman’s quality of life. But sometimes it can cause threatening conditions. Read the article further and get answers and practical recommendations on what to do with fibroids and how to prevent its growth.
What is uterine fibroids
Uterine fibroids are one of the most common diseases, affecting approximately 70% of women during their reproductive life. They also called myomas, and there are several types of these tumors, depending on which layer of the uterus they are located in. The uterus has a muscular layer, a mucous membrane (endometrium) and an outer layer (serosa). If you have been diagnosed with this condition, remember that you are not alone, there are many women who have similar formations in the uterus.
Uterine fibroids develop from the muscle and fibrous tissue of the uterus. They are found inside the uterine epithelium and on its walls. Fibroids can be of different sizes – from very tiny, invisible to the eye, to the accumulation of tumors that can even affect the size of the uterus. There can also be several of them at the same time.
Most often they appear in women of childbearing age, mainly in their 30–40s. Most myomas do not require surgical treatment and “dissolve” after the start of menopause. But it is crucial to work with the risk factors for fibroids in order to avoid complications and surgical treatment.
I remember when a woman came to me with complaints of painful intercourse, during an ultrasound examination. Then I found a myomatous node, it was small, up to 5 cm, but it was located in such a way that there was severe pain during each friction. Unfortunately, in that case, laparoscopic removal of the node was the only solution.
Fibroids are more common in African-American women and appear earlier. Doctors do not yet understand the reasons for this. Some studies have found a genetic link, others – hormonal.
Causes
The exact causes of fibroids have not yet been identified. We know about the influence of estrogen and progesterone on the development of myomas. During pregnancy, when the level of these hormones increases, fibroids grow rapidly. Under the influence of anti-hormonal drugs, fibroids shrink. The same happens during menopause.
The appearance of myomas is also influenced by heredity. You have more chances of their formation if women from your family had fibroids.
In addition, researchers have found a role for genetic factors and cell characteristics in the growth of fibroids.
At the same time, there are certain risk factors that increase the likelihood of fibroids in the uterus. These include reproductive age and race – the percentage of African-American women who are diagnosed with fibroids is 80%. Among others:
Symptoms
Two-thirds of women have no or very few symptoms at all. However, in one third of women, the symptoms can be serious and complicate their life.
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Constipation
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Pelvic pain
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Painful sex
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Pain in the lower back
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Discomfort in the abdomen
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Heavy or prolonged periods
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Bleeding between periods
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Frequent urination or difficulty with it
Complications that fibroids can cause
The main complication for a non-pregnant woman is the development of infertility if fibroids deform the uterine cavity.
Fibroids may also seriously complicate pregnancy, especially when they grow under the influence of estrogen and progesterone hormones. Namely:
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Pain in the abdomen;
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Risk of premature delivery;
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Miscarriage, but this is quite rare;
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Higher risk of need for cesarean section – enlarged fibroids can block the exit from the uterus.
Myoma does not develop into cancer. The presence of fibroids does not increase the risk of cancer in the uterus.
How uterine fibroids are treated
Therapy depends on the symptoms, reproductive plans, age and location of fibroids.
Medication treatment
If there are no symptoms, or they are mild and do not interfere to your life, doctors usually suggest an observation strategy. Fibroids may not grow at all or even shrink, so you just need to visit your gynecologist regularly and be attentive to your body (as always).
When the signs of fibroids reduce the quality of life, in particular heavy bleeding and pain, symptom management is offered. These are painkillers and hormonal contraception. It can be oral pills or an intrauterine system that releases progesterone. The latter reduces the thickness of the uterine epithelium, so your periods become less heavy.
If you are planning a pregnancy, you may be prescribed non-hormonal medications to reduce bleeding and medications to restore iron levels in the blood.
At the same time, your doctor will suggest medications to shrink fibroids.
Non-surgical methods
Embolization of fibroids. The doctor will inject polyvinyl alcohol (PVA) into the arteries feeding the fibroids. It blocks the blood supply to the fibroids, so the fibroids shrink. This is not surgery, but you will probably have to spend a few nights in the hospital because of the complications. These may include nausea, vomiting and pain in the first few days after the procedure.
Endometrial ablation. Mostly prescribed for women with heavy bleeding, but the procedure is also used to remove small fibroids. It involves the removal of the uterine mucosa. Various ablation methods are used, including wire loop, laser, microwave, freezing or hot liquid, etc. Usually this procedure leads to complete amenorrhea, that is, it will be impossible to get pregnant. Ablation is performed under local or general anesthesia, but you can usually go home afterward. There may be bleeding for a few days. But this is for women who are no longer planning a pregnancy.
There are also relatively new, modern methods of non-surgical treatment of fibroids.
Procedures under the control of MRI. Directed laser or ultrasound energy is used to remove fibroids. The methods are still being studied, but 79.3% of women who underwent treatment reported significant improvement in symptoms. However, the effect of the procedures on the subsequent ability to become pregnant is still being studied.
Transcervical radiofrequency ablation under ultrasound guidance. Using a device with an ultrasound sensor at the end, which is inserted through the vagina into the uterus, the fibroids are heated. This causes it to shrink. More than 70% of patients had a reduction of myomas by at least 50% within 6 months after the procedure. The effect on the reproductive system is still being studied.
Surgery
If symptoms persist and other treatments do not have the desired effect, you may need surgery. You should discuss its type with your doctor and possibly more than one, weighing your reproductive plans and possible risks.
Myomectomy. Only fibroids are removed without touching the healthy uterine tissue. It is best for women who want to have children after myomas treatment or want to keep the uterus for other reasons. It is possible to become pregnant after myomectomy. Surgery options range from laparoscopy and hysteroscopy to an abdominal incision. It all depends on the type, size and location of the fibroids.
Hysterectomy. The most radical method that involves the removal of the uterus. After this operation, it is impossible to get pregnant.
Prevention
Although it is usually impossible to influence the occurrence of fibroids, but why not try. And this, as always, is a lifestyle adjustment. A healthy diet, reducing sugar intake, getting rid of bad habits and physical activity can reduce the chances of developing uterine myomas. And if it does appear, a healthy lifestyle helps to reduce symptoms and control the growth of these benign tumors.
Stay healthy always!
More about your health and body is in the courses: A girl becomes a woman, All about you. What it’s like to be a Woman, All about you 35+.
I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com.
Contact the Lior Medical Center for help if you feel any symptoms, or better – for routine examinations. This is the best way to identify the problem at an early stage and prevent complications.
