Fibroatous Uterus: Definition, Causes, Symptoms, Diagnosis and Treatment

They are the most common benign tumors in women of childbearing age. They are made of muscle cells and other tissues that grow in and around the wall of the uterus.

The cause of fibroids is unknown. Risk factors include being African American or being overweight.

Many women with fibroids have no symptoms. If you have symptoms, they may include:

  • Strong or painful periods or bleeding between periods.
  • Feeling “full” in the lower abdomen.
  • Urinate often.
  • Pain during sex
  • Back pain.
  • Reproductive problems, such as infertility, multiple abortions or premature birth.

Your doctor may find fibroids during a gynecological exam or through imaging tests. Treatment includes medications that can slow or stop your growth or surgery.

If you do not have symptoms, you may not even need treatment. Many women with fibroids can get pregnant naturally. For those who can not, treatments for infertility can help.

From changes in lifestyle to medications and surgery, these are the most effective ways to prevent fibroids from growing and getting rid of them forever.

Causes of Fibroids

The exact cause of fibroids is not yet known, research finds two of the main factors that can trigger the growth of fibroids.

Genetic Factor

It is believed that one of the main causes is the genetic factor. If any member of your family has a history of uterine fibroids, you run the risk of developing them.

Factor Hormonal

Two of the hormones Estrogen and progesterone help stimulate the uterine lining during menstrual cycles. These hormones are also considered one of the factors that trigger the growth of fibroids.

Where are the Fibromas

Fibroids can appear anywhere in the uterus and are named because of their location. Cervical growths are rare. Most develop from the muscle or myometrium.

  • Serosal : develop on the outside of the uterus and affect the serous lining.
  • Pedunculados : they develop in stems outside the uterus.
  • Intramural : they develop inside the uterine muscle.
  • Submucosal : involve the endometrial lining.

How Common are Fibroids?

Eighty percent of all women have fibroids in the womb, and between 12 and 25% have problems such as severe bleeding and pain. It is the most common gynecological condition in women.

Increased Risk of Having Fibroids

African-American women have fibroids two or three times more than Caucasian or Hispanic women. In addition, African-American women are much more likely to grow up and cause problems than Caucasian women.

African-American women develop problems at an earlier age, and tumors grow faster, become larger, and cause more bleeding and anemia than women of other races.

Symptoms Can Cause Fibroids

The following is a list of common symptoms from higher to lower frequency:

  • Heavy bleeding and clots with the menstrual cycle that results in anemia (low blood count) and fatigue.
  • Severe pain with the menstrual cycle.
  • Frequent urination
  • Pain in the legs and back, pelvic pressure, swelling of the abdomen, pain with sexual intercourse.
  • Constipation.
  • Clots in the legs and pelvis.

Can Fibromas cause Infertility?

The growth of fibroids in the submucosa can cause infertility by avoiding implantation. Implantation occurs when the embryo (the combined egg and sperm) attaches to the endometrial lining, with the placenta developing and obtaining a blood supply from the uterine muscle.

Submucosal growths can prevent implantation and can cause problems with conception (the possibility of becoming pregnant) or can cause a miscarriage (loss of pregnancy).

Intramural fibromas (in the muscle) can also prevent conception. Tumors can also block the fallopian tubes , which results in difficulty getting pregnant.

Blockage of the tube will not allow the embryo to enter the uterine cavity, and will be implanted in the endometrial lining. Problems during pregnancy may include:

Detachment of the placenta : detachment of the placenta, which causes bleeding and loss of pregnancy.

Abnormal pregnancy growth : if the blood flow is compromised or if the growth is very large, it can prevent the baby from growing properly.

Preterm labor and birth : prevention of normal growth that leads to contractions and premature labor. Early labor can lead to premature delivery of the baby and possible developmental problems.

Does Growth Location Cause Different Types of Symptoms?

Yes. The location of fibroids is important to understand how fibroids cause problems.

Bleeding Abundant

Submucosal growths can cause severe bleeding, even if they are small, by increasing the area of ​​the lining and also increase menstrual flow and decrease the normal ability of the lining to stop bleeding.

Intramural fibroids that are larger or closer to the cavity will increase blood flow to the uterus and affect the normal systems that control bleeding in the uterus . These will also increase the size of the uterine cavity, thus increasing bleeding.

Bleeding and Pain

Fibroids that increase bleeding in the uterine cavity result in the formation of clots in the cavity. The pain is caused by the distention of the cavity and the passage of clots.

Many patients have very large blood clots and have extreme pain due to their menstrual cycle due to the formation of clots.

Pain and Pressure

The larger intramural and serous tumors increase pain with the menstrual cycle and may also “degenerate” or lose their blood supply, causing severe pain.

Subserosal growths can also take up space and push against other structures such as the spine and pelvis, causing pelvic pain and pressure and pain in the back.

Pedunculated fibroids often lose their blood supply and degenerate. These can also twist, causing very severe pain.

Frequent Urination

Intramural and subserosal fibroids can increase the size of the uterus, which can put pressure on the bladder. The bladder can not be filled to capacity and empties more frequently.

The growths in the posterior part of the uterus cause this problem frequently by pushing the uterus to the front and compressing the bladder, and it can also cause back pain.

Constipation

Constipation is a less common symptom, which is the result of large fibroids in the back of the uterus that can block or block the rectum, causing an accumulation of stool and constipation.

Many patients have alternating episodes of constipation and diarrhea. This is the result of growths that block the passage of stool, which then “settle” in the rectum. The function of the rectum is to absorb water from the stool.

The longer the stool is sitting, the more water is absorbed, and the result is hard stools that do not pass, causing constipation. Diarrhea occurs when the pressure in the rectum builds up to a point that exceeds the blockage. The result is the passage of loose stools beyond the point of blockage, causing diarrhea .

Pain in the Sexual Relationship

Pain with sexual intercourse, also caused dysmenorrhea, can occur from the fibroids in the front or upper part of the uterus. This is an unusual symptom, but it can happen.

The most common causes of dysmenorrhea include endometriosis and scar tissue in the pelvis.

Less Common Symptoms

Clots in the pelvis and legs. Very large fibroids that press on the sides of the pelvis can block the large veins that drain the blood from the legs.

This results in a slow movement of blood in the veins, also called “stasis”, which produces clots. The clots cause swelling in the legs, and they can also cause the clots to fall off and enter the lungs.

This is called a pulmonary embolism (clot) and can be life-threatening.

Obstruction of the ureters : very large fibroids that press on the side of the pelvis can also cause partial blockage of urine from the ureters. The ureters are the tubes that allow urine to flow from the kidney to the bladder in the pelvis.

This can cause hydronephrosis (hydro = water, nephrosis = kidney) or swelling of the kidney due to the accumulation of urine in the kidney. Usually, this is mild and does not compromise kidney function.

In more severe cases, back pain and loss of function in the kidney may occur over time.

Prolapse of cervical fibroids : the passage of fibroids from the cervix or cavity can cause hemorrhage, pain and infection. In general, these are rare and are treated with vaginal excision.

Diagnosis

Ultrasound is a simple, economical and very effective method to diagnose the size, number and location of fibroids, and the patient tolerates it very well.

Usually, MRI is not needed, but it can provide more information about the specific location of the growths and rule out adenomyosis.

CT scans are not useful and should not be done. Pelvic exams may be useful, but they have a very limited ability to identify size, number and location.

Pelvic exams can also confuse pelvic masses with fibroids, and have significant limitations in patients with previous surgery, other gynecological conditions such as endometriosis, and in heavier patients.

Pelvic exams can also be painful both during and after exams.

Ultrasound or Sonogram

Ultrasounds are easy to perform with a minimum of pain. Abdominal ultrasounds examine fibroids of the abdomen, while transvaginal ultrasounds examine fibroids through the vagina.

Transvaginal ultrasounds are very effective since the ultrasound device is placed directly into the uterus through the vagina.

Ultrasounds can easily see the number, location and size of fibroids. They are cost effective and should be used to follow growths that increase in size or cause symptoms.

Saline ultrasounds use saline, or salt water, in the uterine cavity at the time of ultrasound.

This increases the ability of the sonogram to evaluate fibroids in or near the uterine cavity, and helps to see other structures in the cavity that can be overlooked by regular ultrasound, such as growths in the cavity.

Magnetic resonance

Magnetic resonance imaging or magnetic resonance imaging is a costly technique to obtain images of fibroids. Although it is more sensitive than an ultrasound, it is not necessary for most patients with fibroids.

Indications for a Magnetic Resonance:

Adenomyosis : Magnetic resonance imaging is useful to identify adenomyosis. Adenomyosis occurs when the endometrial lining of the uterus grows in the muscle. Patients with this condition have hemorrhages in the muscle with each menstrual cycle, which can cause severe pain and heavy bleeding.

Extensive adenomyosis may result in the formation of an “adenomyoma,” or collection of adenomyosis, which is sometimes detected by ultrasound as a fibroid. The adenomomas should not be removed, since the removal of an adenomyoma also causes the removal of a portion of the muscle of the uterus.

Embolization : MRI is usually indicated when considering embolization procedures. Magnetic resonance imaging will help determine the planning for embolization and the possible success of the procedure.

Hysteroscopy

Hysteroscopy is used to evaluate the uterine cavity. There are better and less expensive options. Saline ultrasounds can provide similar information.

Office hysteroscopy has become more popular among gynecologists as a procedure that is easily performed in the office.

The growths identified in an office visit can not usually be eliminated, and most patients will require a work visit to receive treatment.

The result is a second surgical procedure for the patient and two billable procedures for the surgeon. For this reason, office hysteroscopy is not routinely recommended for evaluation of fibroids in the uterine cavity.

HSG

HSG, or hystero (uterus) salpingo (tubes) gram, is an evaluation of the uterine cavity and tubes, using a contrast medium that passes through the cervix that is radiopaque.

Opaque radio means that the dye can be seen with fluoroscopy, a radiological test that shows the dye that passes through the uterus and the tubes. It is mainly used to ensure that the fallopian tubes are open.

Although it can identify fibroids, polyps or scars in the cavity, it is not usually used to diagnose fibroids.

Treatment for the Fibromatosus Uterus

Years ago, the elimination of the entire uterus was the only way to take care of uterine fibroids. Nowadays, there are many options for the treatment of uterine fibroids. If you have fibroids, take some time to decide which is the best uterine fibroid treatment for you.

The overgrowth of benign and non-cancerous muscle cells in the uterus are not malignant, so there is no need to panic. Your options are based on your symptoms of uterine fibroids.

Not all people with fibroids have symptoms, and if they do, it usually depends on how big the fibroids are, how many there are, and where they are located. Signs of uterine fibroids include heavy bleeding, pelvic pressure, having to urinate a lot, back pain and constipation or diarrhea.

When deciding on a fibroid treatment option, you and your doctor will also consider “the desire for future fertility,” unlike hysterectomies, many other uterine fibroid treatments allow you to get pregnant later.

If you have uterine fibroids but do not have any symptoms or only minor symptoms, doing nothing while being alert to any changes is an option. If the fibroids are not causing any problems, and they are not dramatically enlarged, they can be monitored. You do not necessarily need to intervene.

This is usually the strategy when a woman approaches menopause or after menopause. Estrogen causes fibroids to grow; Often, as estrogen naturally decreases, so do fibroids.

Watchful waiting is also an option if you want to get pregnant and the fibroid does not seem to interfere with the pregnancy. From the point of view of pregnancy, some fibroids are very problematic, others are not.

The specialists can help you decide if this option is safe and effective for you.

Changes in Diet and Lifestyle

Because we do not really understand what causes the formation of fibroids, it is difficult to say what to do to prevent them, we know that fibroids are sensitive to hormones, especially estrogen, and that changes in lifestyle that affect production of hormones can alleviate some symptoms.

In fact, diet and exercise may be the two main things you can do at home to treat uterine fibroids. Estrogen affects fibroids, and fat cells produce estrogen, therefore, reducing some excess body fat could improve fibroid symptoms.

While there are no major studies on diet or foods that can reduce fibroids, there is some anecdotal evidence, she adds, that women who follow a plant-based diet have improved symptoms of fibroids.

Exercise can also help relieve some symptoms of uterine fibroids, but there are no known ways to get rid of fibroids naturally.

If staying alert and changes in lifestyle are not options for you, doctors can switch to hormonal medications to control symptoms and even reduce fibroids.

Several of these medications, such as leuprolide (Lupron), are agonists of the gonadotropin-releasing hormone (GnRH).

They work by blocking the production of hormones. This causes the fibroids to shrink, which relieves the symptoms of uterine fibroids, such as heavy bleeding, pelvic pain, or the need to urinate at all times.

The reduction of bleeding is especially important to reduce a woman’s risk of anemia.

But stopping the production of hormones means that you can also end up with menopause symptoms like hot flashes. Some doctors prescribe “secondary” medications (low doses of hormones) to counteract that effect without reducing the functioning of the GnRH agonist.

GnRH agonists, available in pills, nasal sprays and injection forms, are generally used for a short period of time. They can be useful to reduce the size of a fibroid before surgery, for example. Fibroids will grow again after these medications stop.

Hormone Medications

Hormonal contraceptives are another option to treat the symptoms of uterine fibroids. They will not necessarily reduce the size of uterine fibroids, but they can regulate periods or reduce heavy bleeding.

This could be the pill or an intrauterine progestin-releasing device, as long as the location of the fibroids does not interfere with the safe insertion of one.

Androgens, the so-called male hormones, such as danazol (a synthetic drug that mimics testosterone), can stop periods and reduce fibroids. However, this treatment can also lead to weight gain, decreased voice and unwanted hair.

Non-Hormone Medications

Non-hormonal options include tranexamic acid (Lysteda), which can relieve bleeding if taken on the days when the period is intense.

And while they will not do anything to reduce the size of fibroids, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help relieve fibroid pain. For the most part, medical therapy tends to be more of a temporizing measure.

Focused Ultrasound Guided by Magnetic Resonance

In this non-surgical procedure, doctors use a magnetic resonance imaging system to locate their uterine fibroids and then remove them with high-frequency ultrasound. It is considered to be a permanent procedure to eliminate or decrease the size of fibroids.

The actual procedure is painless and non-invasive. It is done inside a magnetic resonance machine and, usually, you can go home the same day.

So far, focused ultrasound guided by magnetic resonance to treat uterine fibroids seems safe, but it is still relatively new. Researchers are still collecting long-term data, but it seems safe to use them if you still want to get pregnant.

Uterine Artery Embolization

Also called uterine fibroid embolization, this procedure deprives the fibroids of their vital blood, literally. Embolization can block the blood supply to fibroids, they shrink and die.

Your doctor will inject tiny particles into the arteries that supply blood to the fibroids. The particles establish a barricade for any blood that tries to reach the uterine fibroid.

Uterine artery embolization can be performed as an inpatient or outpatient.

In general, embolization is an option for women whose uterine fibroids are causing heavy bleeding or pain or whose fibroids press on the bladder or rectum, but it is not for you if you plan on becoming pregnant.

Studies are now under way to evaluate whether it is safe or not to have this procedure and to become pregnant, it is believed that it weakens the walls of the uterus, she says, putting it at risk of complications during pregnancy.

Endometrial ablation

Endometrial ablation is a type of minor surgery that not only destroys a fibroid but destroys the entire lining of the uterus (called the endometrium). It is usually an abundant hemorrhage, but it only works in some uterine fibroids.

Endometrial ablation does not treat all fibroids, only those that are toward the inner portion of the uterus. Endometrial ablation is usually done on an outpatient basis, even in your doctor’s office.

An instrument is inserted through the vagina and into the uterus, where it uses heat, electrical currents, or microwave energy to destroy fibroids and uterine tissue. It is unlikely that women can get pregnant after endometrial ablation.

Myomectomy

Unlike endometrial ablation, myomectomy is an option for women who still want to become pregnant and can be used to care for intracavitary fibroids or those that enter the uterine cavity.

Myomectomy is surgery to remove fibroids from the uterus, and keeps the uterus intact.

There are several different ways to perform a myomectomy: hysteroscopic, laparoscopic, abdominal or robotic.

Some involve inserting an instrument through the vagina and the cervix into the uterus to destroy or eliminate the fibroids. Others involve making small incisions in the uterine and abdominal walls to do the job.

The procedures are minimally invasive and are considered permanent. Fibroids do not grow back, however, in some cases, it is not the end of fibroids completely. Theoretically, there could be very small ones that will grow over time, but were not detected at the time of surgery.

Sometimes, myomectomy is accompanied by morcellation, a procedure that breaks fibroids into smaller pieces before they are removed.

It is recommended against this practice, especially for women who are near or at menopause, in case there is an undiagnosed cancerous tumor. If a cancerous tumor breaks into small pieces, it could spread.

Hysterectomy

A hysterectomy, or surgery to remove the uterus, used to be the only treatment for uterine fibroids. Fibroids remain the most common reason for a hysterectomy, and the procedure remains the only way to be 100% sure that fibroids will not return.

Nowadays, it is usually reserved for women with very large uterine fibroids and very severe hemorrhages that are approaching or postmenopausal. However, it may be the preferred treatment method in some patients.

If a woman has a family history of ovarian cancer or endometrial cancer, she may not be the best person to undergo a uterine preservation procedure.

Doctors may choose to remove only the uterus, part of the uterus, or also the ovaries and fallopian tubes. Removing the uterus means you can not have children. Removing the ovaries means that you will go to menopause.

There are different ways to perform a hysterectomy, doctors can insert an instrument and remove the uterus through the vagina, make small incisions in the abdomen or make important cuts in the abdomen, as well as a cesarean section.

This is considered major surgery and can have serious complications.