Description
# Uterine fibroids are benign smooth muscle tumors known as leiomyoma.
# About 20% of women develop uterine fibroids by age 40.
# They develop within the wall of the uterus as nodules of smooth muscle cells and fibrous connective tissue. The uterus becomes large and irregular in shape. It is an extremely common disease. There can be one or many fibroid tumors on the uterus.
# It is the second most common indication for major surgery in women after cesarean section.
# It can develop as a single nodule or many fibroid tumors that may range in size from 1 mm to more than 20 cm (8 inches) in diameter. They can grow within the uterine wall and may protrude toward the outer uterine surface and the pelvic cavity.
Causes
# The etiology is not clear. Most likely, they develop from uterine smooth muscle cells.
Symptoms
# Many women do not have any symptoms.
# Heavy, prolonged, unusual monthly menstrual bleeding is the most common symptom.
# An increase in menstrual cramps and pelvic pain
# Pain in the back, flank, or legs, as the fibroids press on nerves that supply the pelvis and legs
# Pain during sexual intercourse
# Pressure on the urinary system, increased frequency of urination
# Pressure on the bowel, leading to constipation and bloating
# Abnormally enlarged (distended) abdomen
Diagnosis
# Pelvic exam
# Ultrasound
# MRI
# If necessary, a hysteroscopy (in which a camera is used to look into the uterus) or hysterography (in which a dye is injected into the uterus and x-rays are taken) can be done.
Similar conditions
# Pregnancy
# Leiomyosarcoma
# Ovarian cancer
# Adenomyosis
Treatment
# No treatment is necessary, just follow-up every 6 months, if the woman does not have symptoms.
# If the fibroid's blood supply is cut off, then the woman will have a lot of pain. This is an emergency and needs immediate medical attention.
# If bleeding is heavy, medroxyprogesterone or estrogen can help decrease the bleeding.
# If the woman is severely anemic (low blood count), this needs to be treated before any surgery is attempted. Surgical removal of the fibroid is required if the uterus is getting bigger very quickly, if it is causing symptoms, or bleeding is excessive.
# The smaller the fibroids, the less risky the surgery. Therefore, when possible, women are given medicines such as Leuprolide or Nafarelin for 2 to 3 months before surgery to shrink the fibroids.
# Surgery to remove either the individual fibroids or the entire uterus is the main treatment.
# If a woman desires pregnancy, the fibroids can be surgically removed and the uterus is left intact.
# If a woman does not desire pregnancy, the entire uterus is removed. This can be done through the stomach (abdominal hysterectomy), through the vagina (vaginal hysterectomy), or by laparoscopy-assisted vaginal hysterectomy (a camera-assisted surgery).
# Women can still become pregnant if the uterus is left in place, but they may have to have a C-section.
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