A Uterine Fibroid is a leiomyoma (benign (non-cancerous) tumor from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus. Fibroids are the most common benign tumors in females and typically found during the middle and later reproductive years. While most fibroids are asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency.
Signs and Symptoms
Fibroids, particularly when small, may be entirely asymptomatic. Symptoms depend on the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache, urinary frequency or retention, and in some cases, infertility. There may also be pain during intercourse, depending on the location of the fibroid. During pregnancy they may be the cause of miscarriage, bleeding, premature labor, or interference with the position of the foetus.
Location and Classification
Intramural fibroids are located within the wall of the uterus and are the most common type; unless large, they may be asymptomatic. Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity.
Subserosal fibroids are located underneath the mucosal (peritoneal) surface of the uterus and can become very large. They can also grow out in a papillary manner to become pedunculated fibroids. These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma.
Submucosal fibroids are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesion in this location may lead to bleeding and infertility. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix.
Cervical fibroids are located in the wall of the cervix (neck of the uterus). Rarely fibroids are found in the supporting structures (round ligament, broad ligament, or uterosacral ligament) of the uterus that also contain smooth muscle tissue.
Fibroids may be single or multiple. Most fibroids start in an intramural location that is the layer of the muscle of the uterus. With further growth, some lesions may develop towards the outside of the uterus or towards the internal cavity. Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes.
Extra uterine fibroids of uterine origin, metastatic fibroids.
Fibroids of uterine origin located in other parts of the body, sometimes also called parasitic myomas have been historically extremely rare, but are now diagnosed with increasing frequency. They may be related or identical to metastasizing leiomyoma.
Symptomatic uterine fibroids can be treated by:
medication to control symptoms
medication aimed at shrinking tumours
ultrasound fibroid destruction
myomectomy or radio frequency ablation
uterine artery embolization
Some sort of surgery is the only definitive treatment for fibroids.
Hysteroscopic resection of fibroids may be needed for women with fibroids growing inside the uterine cavity. In this procedure, a small camera and instruments are inserted through the cervix into the uterus to remove the fibroid tumors.
A myomectomy is a surgical procedure to remove just the fibroids. It is frequently the chosen treatment for premenopausal women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids have. The disadvantage of a myomectomy is that there are often “seedling” fibroids which are so small that they cannot be seen and removed, and these may grow again after 5-10 years and the patient may require another surgery at that time. Still it could give the patient her time to have a baby and that is the reason myomectomies are carried out even at the risk that the patient may need a another surgery after some time. If you have had a myomectomy and later get pregnant you will usually be advised to undergo a caesarean section for your delivery as the contractions of a normal delivery may cause the stitches in your uterus to come apart.
A myomectomy may be carried out via an open surgical technique, laparoscopic technique or a hysteroscopic technique depending on the number, size and location of the fibroids.
If a patient has finished her child bearing and is of an age where she does not want any more children then a hysterectomy is usually the best option as then there is absolutely no chance of recurrence of the problem.
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