Uterine fibroids are common non-cancerous (benign) growths of the uterus. They are also referred to as fibroids, leiomyoma, leiomyomata, myoma and fibromyoma. They can range in size from a grape to watermelon, and can mimic pregnant uterus.
Although fibroids are very common, for most women, they do not cause symptoms or cause only minor symptoms. It is common for a woman to have multiple fibroids and it may be difficult to understand which fibroid is causing your symptoms.
Bulky symptoms are due to large size of the fibroid and include abnormally enlarged abdomen, pelvic pain/pressure, back pain, leg pain, pain during sexual intercourse. Pressure on urinary bladder may cause frequent urge to urinate or urinary incontinence. Pressure on the bowel may cause constipation and bloating.
Bleeding symptoms include heavy prolonged periods, passage of clots and breakthrough bleeding. Excessive bleeding can lead to anemia.
Fibroids are hormonally sensitive so symptoms are likely to be cyclical, like menstruation.
As estrogen levels tend to increase prior to the onset of menopause, this may cause the size of many uterine fibroids to increase along with the symptoms. During menopause, the levels of estrogen decrease dramatically, causing fibroids to shrink. However, women taking hormone replacement therapy (HRT) during menopause may not experience any symptom relief because the estrogen contained in this regime may cause fibroid tumors to enlarge and symptoms to return.
Fibroids can dramatically increase in size during pregnancy. This is thought to occur because of the increase in estrogen levels during pregnancy. After pregnancy, the fibroids usually shrink back to their pre-pregnancy size.
Approximately 20-40 percent of women 35 years and older have fibroid tumors. Fibroids are more common among women of African-American descent. Some statistics indicate that up to 80 percent of African-American women will develop uterine fibroids. The majority of uterine fibroids are diagnosed and treated in women between the ages of 35 and 54. However, fibroids can and do occur in women under the age of 35, even as young as the early 20s.
Uterine fibroids are the most frequent reason why premenopausal women get hysterectomies and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, one-third is due to fibroids.
Types of Fibroids
The wall of the uterus is made of three layers. Fibroids can be categorized according to their location within uterine wall.
- Subserosal Fibroids typically develop on the outer uterine wall. This type of fibroid tumor can continue to grow outward increasing in size. The growth of a subserosal fibroid tumor will put additional pressure on the surrounding organs. They typically do not affect a woman's menstrual flow, but can cause pelvic pain, back pain and generalized pressure. The subserosal fibroid can develop a stalk or stem-like base, making it difficult to distinguish from an ovarian mass. These are called pedunculated. The correct diagnosis can be made with either an ultrasound or magnetic resonance (MR) exam.
Intramural Fibroids develop within the lining of the uterus and expand inward, increasing the size of the uterus, and making it feel larger than normal in a gynecologic internal exam. These are the most common fibroids. Intramural fibroids can result in heavier menstrual bleeding and pelvic pain, back pain or the generalized pressure that many women experience. They can also cause bulk symptoms.
- Submucosal Fibroids are just under the lining of the uterus. These are the least common fibroids, but they tend to cause the most problems. Even a very small submucosal fibroid can cause heavy bleeding - gushing, very heavy and prolonged periods. Large submucosal fibroid tumors may increase the size of the uterus cavity, and can block the fallopian tubes which can cause complications with fertility.
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