Also known as Uterine Fibroids or leiomyomata are tumours of the uterus. They are a benign tumour, which grow in the muscle layer of the uterus. These vary is size and location and may affect 25% of women during their reproductive lives. The growth of fibroids is associated with high oestrogen levels and as oestrogen levels decline, the fibroids tend to regress. Oestrogen levels decline naturally after menopause and drug treatments used are based on these facts.
Location
The location of the fibroid determines the name given to that type of fibroid. An Intra-uterine Fibroid is located within the uterine cavity and can be referred to as sub-mucosal as they are situated below or within the endometrial lining. A Myometrial Fibroid or Intramural Fibroid is situated in the muscle wall of the uterus. An Extra-uterine Fibroid or Sub-serosal Fibroid is located outside of the uterus.
Type
Fibroids may be single or multiple. They can be discrete, fibrous and encapsulated tumours, which are spherical in shape. Pedunculated tumours are attached by a long stalk. There is a danger with the pedunculate tumour of the stalk twisting and cutting off the blood supply to the tumour, this can be dangerous and may need an emergency operation, however, this is rare. The Pedunculate form can either be sub-serosal or submucosal, growing from either the inner or outer wall of the uterus.
Symptoms
Heavy menstrual bleeding is the common symptom and the associated anemia due to the blood loss. Also the size of the fibroid, which can be quite large, may be noticeable with abdominal enlargement. Urinary frequency, constipation, abdominal pain, back pain, pain during intercourse (dysparennia), infertility and miscarriage are some of the various optional symptoms that are associated with the size and location of the fibroid(s).
Diagnosis
In many cases fibroids can be detected without invasive surgery. In some cases they can be felt, while others are discovered during an ultrasound scan or during a magnetic resonance imaging (MRI) scan. However, in some cases, when the ovaries cannot be clearly seen, a laparscopy procedure may be necessary to establish that the pelvic mass is a fibroid and not ovarian cysts or cancer.
Medical Treatments
If the fibroid is small and the symptoms manageable then the situation is likely to be observed and not treated. They can be surgically removed by either a hysteroscopic resection (for a submucosal fibroid), or by a myomectomy (leaves the uterus intact and may allow future pregnancy), or by a hysterectomy (total removal of the uterous and fibroids). Some fibroids are too difficult to remove without a hysterectomy or if heavy bleeding occurs during the myomectomy a hysterectomy may have to be performed. There is also Uterine Fibroid Embolisation (UFE), which rather than remove the fibroid which blocks or reduces the blood flow to the fibroid and allows the uterus to remain intact. The long term effect of this treatment is not known.
Drug treatments may be used to shrink the fibroids and the most favoured now are the gonadotropin-releasing hormone (GnRH) agonist, which are designed to reduce oestrogen levels and fooling the body into menopause. This brings with it the symptoms of menopause and the risk of osteoporosis.
Nutritional Approach
The nutritional approach is also to reduce the oestrogen levels but works on two levels. Firstly by ensuring that the body has the vitamins, minerals and fibre needed for the body to transform and excrete the excess oestrogen. Secondly by reducing the intake of those foods that may increase the oestrogen levels or that may contain xeno-oestrogenic properties. Other treatments will address the bodies iron levels, be aimed to reduce the menstrual flow, as well as ensuring the digestive system is working and to boost the immune system.
This will work along side and compliment any medical treatment that is being undertaken.