Uterine fibroids ( myomata uteri) is one of the most common bening tumors in women. Incide is more common in african american women than in the caucassian women. They become more commonly after the latter half of the reproductive years, however in african american women is not uncommon to see these fibroids well below 30 year of age. The growth of fibroids is associated with estrogen in the body and is demostrated by the fact that after menopause fibroids shrink in size and further growth is not seen. In rare occasions though, the growth of fibroids after menopause can be associated with postmenopausal estrogen secretion either in the ovary or some other place, and this is never normal. These fibroids grow inside the muscle of the uterus, called myometrium and they are composed of smooth muscle and fibrous tissue. As they enlarge, they can grow either internally or externally causing different symptoms.
Fibroids can be categorized as follows: a) submucous b) subserous c ) intracavitary d) pedunculated. All these terms refer to the position where fibroids can be located inside the uterine cavity or outside, as in the case of peduculated fibroids. Pedunculated fibroids, can even be confused with ovarian cysts because of their location.
Although rare, fibroids can become malignant, as is the case for sarcomatours degeneration of fibroids. Fortunately, this is very rare. Another rare conditions about fibroids, is called ” intravenous leomyomatosis” where a fibroid can extend into the veins of the organs adjacent to the uterus ( ligaments and tissue around the uterus) .
Before talking and discussing what symptoms fibroids can cause, let me first say that there are fibroids that do not cause symptoms at all. They are found sometimes on a regular well woman exam, and they are better left undisturbed. Incidence of malignancy for one of these fibroids, its less than 0.3%. This is less risky than the actual surgery for removal of fibroids or removing the uterus ( hysterectomy).
Small fibroids only need to be observed from time to time, as they may stay the same size for years to come. When there are issues of infertility, fibroids that are associated with this condition, are the ones that are occluding the fallopian tubes or if they are submucous, which means that it is inside the uterine cavity. However, if large tumors are found in an asymtomatic patient, that does not want to have any more children, its better to remove them.
Signs and symptoms of fibroids
1) Abnormal uterine bleeding: This is the most common symptoms of all. Large fibroids can increase the size of the uterus and give menorrhagia ( excessive uterine bleeding)
2) Pelvic Pressure: Most of the time the bladder is the organ most affected by this symptoms. Patient sometimes complaint of excessive urination or feeling of urinary retention. Constipation might be other symptom, as fibroid can compress the bowel, however this is not as common.
3) Pain: This is one of the most common reasons to seek medical therapy. These tumors can undergo a process called necrosis ( dying of tissue) and cause severe pain. In the case of pedunculated fibroids, they can twist and give rise to acute severe abdominal or pelvic pain.
4) Abdominal distortion: If your abdomen becomes distorted because the effect on a large fibroid, you might consider therapy, as this may cause pain. Fiborids this size can be more challenging to remove, so do not wait until this happens.
5) Rapid growth of fibroids: Most of the time fibroids are slow growing bening tumors, however if you and your clinician notices rapid enlargement consider surigcal therapy since this may be a sign of malignant transformation. If you are menopausal, this rapid enlargement should alarm more, since like we discussed before, fibroids after menopause are supposed to decrease in size, not enlarge.
There is a tudy in the Journal of Women’s Health that revealed that 800 mg daily of EGCG or Green Tea Extract can reduced the size of uterine fibroids (bening masses of the uterine cavity) symptoms, bleeding and even anemia. These are good news because patients often do not want either surgery fot symptomatic fibroids or even hormonal management of this condition. However this was a small study of only 33 patients. As with any other medication, there might be side effects to excess green tea extract like insomnia, anxiety and blood thining.
Surgical alternatives and other medical therapies are available for management of fibroids. One thing to keep in mind though, that if you choose to have surgical removal of the fibroids or surgical removal of the uterus, discuss with you OBGYN if you need to remove your ovaries as well, since they are not related to your problem ( if you only have a fibroid uterusof course and nothing else) Most of the time, a problem in the uterus is not related to ovarian pathologies. Talk to your OBGYN about if you are a candidate to remove or not to remove the ovaries at the time of surgical therapy for fibroids.
Pink Women’s Center is a board certified OBGYN group located in Katy Tx and west Houston Texas. We care for normal and high risk pregnancies, gynecologic and menopausal problems, including abnormal vaginal bleeding, abnormal pap smear, stress incontinence, osteoporosis, sexual dysfunction, fibroids, endometriosis and much more. We are a certified menopause OBGYN group, the only one in Houston Texas.
If you think you have fibroids ( pelvic pain, uterine cramps, excessive bleeding during your period, urinary frequency) contact us to have a complete gynecologic examination.
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