Uterine fibroids facts

• Uterine fibroids are benign tumors that originate in the uterus (womb).
• It is not known exactly why women develop uterine fibroids.
• Most women with uterine fibroids have no symptoms. However, fibroids can cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. These are most commonly abnormal bleeding, pain and pressure.
• Uterine fibroids are diagnosed by pelvic exam and by ultrasound.
• If treatment for uterine fibroids is required, both surgical and medical treatment options are available.

What are uterine fibroids?

Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are much denser than normal myometrium. Uterine fibroids are usually round.

Uterine fibroids are often described based upon their location within the uterus. Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle. Submucosal (submucous) fibroids are located inside the uterine cavity beneath the inner lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:

• Genetic changes. Many fibroids contain changes in genes that differ from those in typical uterine muscle cells.

• Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids.

  Fibroids contain more estrogen and progesterone receptors than typical uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.

• Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.
• Extracellular matrix (ECM). ECM is the material that makes cells stick together, like mortar between bricks. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes biologic changes in the cells themselves.

Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue.

The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own.

Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to its usual size.

For the most part, uterine fibroids that do not cause a problem for the woman can be left untreated. In some cases, even fibroids that are not causing symptoms require removal or at least close observation. Rapid growth is a reason to watch more carefully, since a rare cancerous form of fibroid (referred to as a leiomyosarcoma) can be a fast-growing tumor, and it cannot be differentiated from a benign fibroid by ultrasound, MRI , or other imaging studies. However, this type of tumor occurs in less than 1% of uterine fibroids.

Another risk of leaving these tumors alone is that they sometimes grow to a size that eventually cause significant symptoms, thus requiring removal. If fibroids grow large enough, the surgery to remove them can become more difficult and risky.

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Factors that can have an impact on fibroid development include:

• Race. Although all women of reproductive age could develop fibroids, women are more likely to have fibroids than are women of other racial groups. In addition, women have fibroids at younger ages, and they're also likely to have more or larger fibroids, along with more-severe symptoms.
• Heredity. If your mother or sister had fibroids, you're at increased risk of developing them.
• Other factors. Starting your period at an early age; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

There is no cure for uterine fibroids, but there are treatment options available.

• There are many factors that can contribute to the development of uterine fibroids, including age, genetics, and lifestyle choices. However, there is no known cure for uterine fibroids.
• The first step is getting an accurate diagnosis from your doctor. After that, you'll want to talk about your treatment options with them and get a prescription for the medication that works best for you.
• Treatment options include surgery, radiation therapy and/or hormone therapy (estrogen). Surgery can be performed in several ways depending on your individual situation and needs.
• Radiation therapy is also an option that may be used alone or in conjunction with other treatments such as surgery or hormone therapy (estrogen). Hormone therapy may help to shrink your fibroids so that they become less noticeable or painful.
• There are a number of medications that can be used in the treatment of uterine fibroids. Some of these medications are used to shrink the tumors, while others are used to control the symptoms caused by the tumors.

The following medications may be prescribed for uterine fibroids:

• Dilation and curettage (D&C): A D&C is a procedure that removes tissue from inside your uterus. Your doctor may recommend this procedure if you have heavy bleeding or pain during your periods or when having sex. The cells that are taken out during a D&C are examined under a microscope to see if they're cancerous or not.
• Hysteroscopy: This procedure allows your doctor to look inside your uterus using an instrument called a hysteroscope. If a growth is found during hysteroscopy, it can be removed by surgery or medication.

Symptoms
Heavy or painful periods,Irregular bleeding or spotting between periods,Pain in the lower abdomen (in the pelvis) or back,Pain during intercourse or penetration of the vagina by a tampon
Conditions
Tumors that grow in a woman's womb (uterus)
Drugs
Birth control pills, Hormone replacement therapy, Progestin-only contraceptives, Depo-Provera injections, The Mirena intrauterine device (IUD)Claritin (loratadine),Aerius (desloratadine),Flonase (fluticasone propionate),Xyzal (levocetirizine dihydrochloride)