An extremely common condition in women, fibroids are benign growths in the uterus. While generally referred to as uterine fibroids, there are actually three different types of uterine fibroid: intramural fibroids;

suberosal fibroids, and submucosal fibroids. The different names refer to the various locations these fibroids may be found within the uterus. However, fibroid tumors are not only fund in the uterus. It is also possible to have ovarian fibroids and breast fibroids.

Uterine fibroids can lead to a number of symptoms, including pressure in the abdomen and heavy menstrual periods. In some cases, fibroids can even contribute to infertility issues. Although it is entirely possible to acheive pregnancy, about a quarter of women with fibroids will experience difficulties getting pregnant.

Diagnosing fibroids is not extremely difficult. Some can be felt during a routine pelvic exam while others may require the use of ultrasound, laparoscopy or even a hysteroscopy to determine the fibroids exact location. Treatment is available for the fibroids, although it may be recommended to just do nothing if the fibroids are not causing any problems. If your fibroids are interfering with your life in some way, medications can be prescribed to combat fibroid symptoms while surgery can be performed to remove the fibroids. However, the only way to permanently eradicate uterine fibroids is through a hysterectomy.

Because fibroids are in fact tumors, many women may be concerned about whether or not their fibroids will lead to cancer. While there is connection between the two, it is extremely rare for fibroids to develop into cancerous growths.

Fibroid Symptoms

Uterine fibroids are benign (non-cancerous) growths in the uterus made up of muscular and fibroid tissue. Fibroids, also known as uterine leiomyomata, may either grow as a single tumor or in clusters. A single fibroid may vary immensely in size from less than an inch, like a small apple seed, to eight inches across or more, like a large grapefruit.

On the basis of their location in the uterus, fibroids can be divided into three groups:

1. Subserosal Fibroids - These grow on the outer covering of the uterus.
2. Intramural fibroids- These grow within the muscular wall of the uterus.
3. Submucosal Fibroids - These grow just underneath the uterine lining.

Fibroid tumors of the uterus are very common, occurring in about 20% to 40% of women who are 35 years of age or older. African women are at a higher risk; as many as 50% of them have fibroids of significant size.

Some Typical Symptoms Of Fibroids

Studies have revealed that 30% to 50% of women who have uterine fibroids experience no symptoms and continue to carry out their day-to-day activities with ease, but in about 25% of women, fibroids tumors are quite symptomatic. In some women, the symptoms of uterine fibroids are so severe that they find it difficult to maintain a good quality of life.

A wide variety of symptoms can accompany fibroids. However, fibroids are not the only reason why a woman may experience some of these symptoms. Therefore, it is important to seek out a proper diagnosis from your doctor is you are bothered by any of these symptoms.

Heavy Menstrual Bleeding

Excessive or prolonged menstrual bleeding is one of the most common symptoms of fibroids. Often, women who have large or multiple fibroids encounter such problems as

• Finding it difficult to leave the house on the their menstrual flow is heaviest
• Quickly filling a sanitary towels, making it necessary to change sanitary towels frequently, even as often as every hour
• A long bleeding period.
• Passing blood clots

• All these instances indicate the presence of uterine fibroids.

  It is important to note that excessive or prolonged bleeding can result in a condition called anaemia, which is characterized by fatigue, headache and lightheadedness. Anemia requires the use of prescribed iron supplements to restore depleted iron levels.

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  Pelvic Pain and Pressure

  
  Over time, uterine fibroids may grow in size and start exerting pressure on the surrounding organs. This condition not only arouses a vague sense of discomfort, but also makes it difficult to lie face down or bend over.

  At times, severe pain is experienced in the pelvic region due to the presence of fibroids. Pelvic pain usually occurs when the fibroid tumor undergoes a process called degeneration. The pain is generally persistent and localized, and improves within two to four weeks.

  Acute pelvic pain also occurs when the stalk of a pedunculated subserosal or submucosal fibroids twists.

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Bladder and Rectal Problems

Growing fibroids can exert pressure on the bladder, thereby reducing its capacity or blocking the outflow of urine. This results in the frequent urge to urinate or, occasionally, a woman may find it difficult to urinate despite having a full bladder.

Uterine fibroids may also press against the rectum, causing problems such as difficulty and pain with bowel movements and a feeling of rectal fullness. In some extreme cases, fibroids may induce the development of hemorrhoids.

Lower Back Pain

Although lower back pain is very common, sometimes fibroids, particularly largesubserosal fibroids on the back surface of the uterus, may be responsible for it. Lower back pain occurs when fibroids press against muscles and nerves in the lower back region.

Pain or Discomfort During Sexual Intercourse

Intramural fibroids located in the cervix region are usually responsible for pain or discomfort during intercourse. Sometimes pain may occur only in specific positions or during certain times of the menstrual cycle.

Fibroids And Infertility.

Normally, it is believed that fibroid tumors do not have any effect on fertility and pregnancy, but studies have revealed that in about 3% of women, infertility is caused by uterine fibroids. Mainly large, multiple and pedunculated or stalked uterine fibroids are the real culprits.

Enlarged subserosal uterine fibroids may induce infertility in two ways:

• By compressing the fallopian tubes and blocking the passage of sperm and egg.
• By distorting the pelvic anatomy to such an extent that it becomes difficult for the fallopian tube to capture an egg at the time of ovulation.

Large or multiple intramural and submucosal fibroids are also not far behind when it comes to inducing infertility. These tumors of the uterus can cause infertility in a myriad of ways.

• They may block the fallopian tube, thereby preventing sperm from fertilizing the egg.
• They may increase the size of the uterine cavity, which increases the distance that sperm have to travel.
• Both intramural and submucosal fibroids may have a severe impact on the uterus’ ability to contract, which in turn can interfere with sperm migration and ovum transport.
• Multiple and large submucosal fibroid as well as intramural fibroid tumors can distort the entire anatomy of the uterus. In such a situation, even if the sperm is able to fertilize the egg, the chances of that egg implanting are drastically reduced.

Treatments for Uterine Fibroids

Uterine fibroids are benign tumors on the muscular wall of the uterus. Also called uterine leiomyomas or simply myomas, fibroids grow from the muscle cells of the uterus. They may either protrude from the inside to form submucosal fibroids, or appear on the outside covering of the uterus to form subserosal fibroids. When these fibroid tumors are contained within the muscular walls, they are called intramural fibroids.

Generally, treatment is not necessary if the fibroids are asymptomatic, but women who suffer from significant symptoms must immediately consult a doctor to get their fibroids treated. Fibroids can be treated either through medical treatment or via surgical treatments methods.

Why Use Medicines for Fibroids?

Medical treatments alleviate the symptoms of uterine fibroids temporarily. Medications may shrink the fibroids to a certain extent, but they do not eliminate them. Moreover, they are associated with side effects, which are often difficult to tolerate.

Medical treatment of fibroids is a good option for those women who are experiencing heavy menstrual bleeding, but women who are suffering from pressure symptoms caused by large fibroids may not benefit from any medicines currently available.

Researches are underway to develop new drugs that will be able to treat fibroids themselves, not just their symptoms. Until then, tried and tested medications are the only options available to lessen severe symptoms of fibroids.

Gonadotropin-Releasing Hormone (GnRH) Agonists

GnRH agonists are the foundation of medical treatment for fibroids. GnRH agonists, such as Lupron and Synarel, block the production of the female hormone estrogen, which results in temporarily stopping heavy bleeding as well as shrinking the fibroids.

GnRH medication is administered only under specific circumstances. For instance, a woman who is experiencing profuse menstrual bleeding and is suffering from profound anaemia is an ideal candidate for GnRH medication. It is likely that she will need blood transfusions during the surgery for removal of fibroids, but if she uses lupron for two to three months before the surgery to make her periods temporarily stop, along with an iron supplement, the anaemia will improve and the need for a blood transfusion will be reduced.

GnRH agonist is not a permanent treatment for uterine fibroids because the fibroids will grow back to their original size and, often larger, the moment the medication is discontinued. Moreover, GnRH agonists are associated with a number of unpleasant menopausal symptoms such as hot flashes, vaginal dryness, and bone loss.

Androgens

Medical treatment of fibroids based on the administration of androgens is also quite effective. Androgens, also called male hormones, are produced both in men’s and women’s bodies, but they perform different functions.

In women, ovaries, fat cells, and adrenal glands produce androgens, which are primarily converted into the female hormone estrogen. When given as medical therapy, androgens can relieve fibroid symptoms, but this therapy is usually accompanied with numerous unwanted side effects.

Danazol, an androgenic steroid, works quite well on the symptoms of fibroids. It reduces the production of reproductive hormones in the brain and ovaries, disrupts the menstrual cycle and raises testosterone levels in the blood. In this way, it helps to shrink fibroid tumors, stop menstruation, correct anaemia and reduce the uterine size. But these benefits are coupled with unpleasant side effects, such as weight gain, acne, headache, unwanted hair growth and a deeper voice. For this reason, androgen therapy is not widely used.

Intrauterine Devices (IUD)

Typically,IUDS  are used to prevent pregnancy, but they also provide some non-contraceptive benefits. A new IUD called Levonorgestrel Intrauterine System (IUS) releases 20 mcg of levonorgestrel directly into the uterus. Due to this hormonal feature, IUS yields non-contraceptive benefits, such as a reduction in menstrual blood loss and pain, as well as offering protection against the growth of fibroids.

Oral Contraceptive Pills

Uterine fibroids induce heavy menstrual bleeding, and combined oral contraceptive pills containing oestrogen and progesterone, along with birth control pills containing only progesterone, can help to reduce bleeding as well as regulate the menstrual cycle. However, birth control pills do not have any effect on fibroids, that is, they neither reduce them nor do they cause them to grow faster.

Non-Steroidal Anti Inflammatory Drugs

NSAIDs, such as Aspirin, and Nurofen, are typically given to alleviate pain, inflammation and prostaglandin levels, but they do not provide any help in curing or shrinking the fibroids.

Novel medical therapies, including progesterone-receptor modulators and somatostatin analogues, are being tested as possible future medicinal treatments. It is hoped that, in the future, medicinal treatments for uterine fibroids will be just as effective as the current surgical treatments.

Surgical Fibroid Treatment

Uterine fibroids are very common amongst women of childbearing age. In fact, between 50% and 80% of all women will develop at least one fibroid at some point during their lives. For most women, fibroids are not a huge problem, and cause relatively few symptoms. However, for some women uterine fibroids are associated with painful and distressing symptoms, including heavy menstrual periods, abdominal cramping, and even infertility. If your uterine fibroids are causing you particularly painful symptoms, you may want to consider having them surgically removed. While  medicinal treatments are available, these often just treat the symptoms associated with fibroids. For permanent relief, there are a number of effective surgical treatments available for uterine fibroids.

Traditional Surgical Treatments

There are a few surgical treatments that are traditionally used to remove uterine fibroids. These traditional techniques tend to be the most effective, but also require longer recovery time and more painful side effects.

Myomectomy

Myomectomy involves the surgical removal of uterine fibroids without the removal of the uterus. It is performed in hospital under general anesthetic. Though myomectomy is often successful, fibroids that have been removed can grow back in the future.

Myomectomy can be performed several different ways depending upon the size, number and location of the fibroids in the uterus. There are basically three type of myomectomy:

• Abdominal Myomectomy: A major surgical procedure in which the fibroids on the muscular wall of the uterus are removed through an incision in the lower abdomen.
• Laparoscopic Myomectomy: An effective surgical procedure to remove pedunculated subserosal fibroids. Complications may include injuries to the internal organs and bleeding. Moreover, the uterus is usually left weaker after surgery. Therefore, abdominal myomectomy is a better proposition for women who are planning on becoming pregnant in the future.
• Hysteroscopic Myomectomy: Only
• submucosal fibroids can be removed through this procedure, during which a laparoscope is inserted into your uterus that will guide your surgeon while a resectoscope shaves parts of the fibroids off of your uterus.

Who Should Have a Myomectomy?
Women with smaller uterine fibroids are the best candidates for myomectomy. Myomectomy is also appropriate for those women who would like to get pregnant in the future. However, myomectomy cannot guarantee fertility and only 50% of those undergoing the procedure experience a future pregnancy.

How is a Myomectomy Performed?
During a myomectomy, the surgeon makes a horizontal or transverse incision across your pelvic line. After opening the outer, muscular layer of the uterus, any visible fibroids are removed. The uterus is then repaired using sutures. Myomectomy can also be performed using laparascopic techniques. This requires four small incisions on either side of the abdomen. A small camera is then inserted into the uterus in order to guide the removal of the fibroids. The fibroids are cut into small pieces and removed through the abdominal incisions.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization is a procedure used to shrink the size of uterine fibroids and reduce the severity of symptoms. It involves no surgical incisions and can be performed under local or general anesthesia.

Who Should Get Uterine Fibroid Embolization?
Uterine fibroid embolization is particularly suited to women who have large, symptom-producing uterine fibroids. Embolization helps to shrink the fibroids and reduce the pain and bleeding that they can cause. Women with pedunculated fibroids should not undergo uterine embolization, as this can cause the fibroids to detach from the uterus and float around in the abdominal cavity.

How is Uterine Fibroid Embolization Performed?
Uterine fibroid embolization is a relatively non-invasive procedure. A catheter is guided through an incision made in your groin, and into the blood vessels that supply your uterus. Small plastic particles are then pushed through the catheter. These work to block the blood vessels, causing the fibroids to shrink and die. Recovery from the procedure takes about one week

Hysterectomy

A hysterectomy enables the surgeon to remove your uterine fibroids by removing your entire uterus. This is a permanent way of removing your fibroids, however, you will be unable to get pregnant or bear children after a hysterectomy. Hysterectomy procedures may also involve the removal of the fallopian tubes, ovaries, and cervix. Hysterectomy is the most common treatment used for uterine fibroid removal, and accounts for 30% of all fibroid treatments.

There are three different approaches to hysterectomy:

• Vaginal Hysterectomy: An incision is made in the vagina to remove the uterus. Although this procedure leaves no scars on the skin, there may be complications such as bleeding, infection or injury to intestines and bladder.
• Abdominal Hysterectomy: The uterus is removed through an incision in the lower abdomen. Complications are the same as in the case of vaginal hysterectomy.
• Laparoscopic Hysterectomy: The uterus is removed through four incisions on the abdomen. A small scar remains on the skin and complications and injuries to internal organs and bleeding may occur.

Who Should Get a Hysterectomy?
Hysterectomy is only recommended for those women who have a very enlarged uterus due to the growth of their uterine fibroids. Hysterectomy is generally suggested once the uterus grows to the size that it would be after 12 weeks of pregnancy. Hysterectomy is also performed when uterine fibroids appear to be cancerous.

How is a Hysterectomy Performed?
Abdominal hysterectomies are performed in hospital under general anesthetic. An incision is made in your abdomen and a surgeon removes your entire uterus. If your fibroids are smaller, than you may have a vaginal hysterectomy, in which the uterus is removed through an incision in the vagina. Recovery from a hysterectomy generally takes about six to eight weeks.

Deciding on Surgery

A number of factors are considered while selecting the most appropriate surgical procedure to deal with fibroids. One of the most critical questions that requires a lot of consideration is whether surgical treatment of fibroids will affect the a woman’s fertility.

Studies have revealed that hysterectomy provides excellent relief from the symptoms of fibroids. Yet, completely removing the uterus will mean that pregnancy is no longer a possibility. Therefore, women who wish to become pregnant in the future will need to opt for myomectomy.

With myomectomy, the relief is short-term and the risk of recurrence of fibroids is quite high. Moreover, between 11% to 26% of women require a second surgery after their initial surgical procedure. In addition, abdominal and laparoscopic myomectomy carry varying degrees of risk for uterine rupture during pregnancy or labour. Despite these disadvantages, myomectomy makes future childbearing possible.

A number of new treatments, such as thermoablative techniques with magnetic resonance imaging-guided therapy (which includes percutaneous laser ablation, cryomyomlysis and focused ultrasound treatment), are being investigated.