UTERINE FIBROID

Uterine Fibroids are tumors or lumps made of muscle cells and other tissue that grow in the wall of the uterus (womb). They are also called leiomyomas or myomas. Fibroids are almost always benign (meaning not cancerous). They can grow as a single tumor, or there can be many of them. The size, shape, and location of fibroids can vary also. A single fibroid can be less than 1 inch in size or can grow to 8 inches across or more. They may be present within the uterus wall, inside the uterus, on its outer surface or attached to it by a stalk-like structure (see image below). Uterine fibroids can grow very slowly or enlarge quite rapidly.

Experts still do not know what causes uterine fibroids but they have been linked to the hormones estrogen and progesterone, which are produced by the ovaries. Fibroids usually develop during a woman's reproductive years (age of 16 to 50) when estrogen levels are at their highest. They tend to shrink when estrogen levels are low, such as after the menopause. It is also thought that fibroids occur more often in overweight or obese women because being overweight increases the level of estrogen in the body.

Uterine fibroids are common, appearing in up to 70% of women by age 50. Black women are three to five times at greater risk; they develop fibroids more often and at a younger age than women of other ethnic groups. Persons with a family history of fibroids are at increased risk, whereas women who have children appear to be at a lower risk.
 
SYMPTOMS

Most fibroids do not cause any symptoms, but some women with fibroids can have:

• Heavy (bleeding) or painful periods
• Pain or pressure in the pelvic region
• Enlargement of the lower abdomen
• Frequent urination (from fibroid pressing on the bladder)
• Pain during sex
• Lower back pain
• Reproductive problems, such as infertility, multiple miscarriages and early onset of labor during pregnancy

TREATMENT

The most common method used to diagnose fibroids is ultrasound. If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor may monitor you occasionally to see if they have grown. For women who have symptoms, treatment may depend on the woman’s age, the size of the fibroids and whether or not she wants to become pregnant.

MEDICATION

1. Over the counter pain medication such as Ibuprofen and Paracetamol can be use by women with mild abdominal pain.

2. Birth control drugs can be used to help control symptoms in women who experience moderate to severe pain and heavy menstrual bleeding. These may include:

• Low-dose birth control pills
• Progesterone-like injections (e.g., Depo-Provera®)
• An intrauterine device (IUD) called Mirena®, which contains a small amount of progesterone-like medication

3. Tranexamic acid, Mifepristone and Ulipristal acetate (Ella/Esmya) are also medication used to treat heavy menstrual bleeding in women with fibroids.

4. Gonadotropin-releasing hormone agonists (GnRHa) are drugs that stop the menstrual cycle and can shrink fibroids. They are sometimes used before surgery to reduce the risk of bleeding. Because GnRHa have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRHa agonist, her fibroids usually return to their previous size.
 

SURGERY

For women with moderate to severe symptoms, surgery may be the best form of treatment.

1. Myomectomy

Myomectomy is surgery to remove the fibroids from the wall of the uterus. It removes only the fibroids and leaves the healthy tissue of the uterus in place. It is best for women who still wish to have children after treatment or who wish to keep their uterus for other reasons. You can become pregnant after a myomectomy. The surgery can be performed in many ways; it can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. After myomectomy it is still possible for new fibroids to grow.

 
2. Hysterectomy

 Hysterectomy is a major surgical procedure in which the entire uterus is removed. This surgery is the only sure way to cure uterine fibroids. It is done when a woman's fibroids are large, if she has heavy bleeding, if she is near or past menopause, or if she does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional.

 
NON-SURGICAL TREATMENT

1. Endometrial Ablation is a procedure that destroys the lining of the uterus. It is used to treat women with small fibroids (less than 3 centimeters). It is not often recommended for women who want to have children.

 2. Uterine Artery Embolization (UAE) is a procedure where tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases. The effects of this procedure on fertility are uncertain.  

 Click the link below to learn more about fibroid treatment.
https://www.youtube.com/watch?v=eSJ-ztQ97Og  (you may skip to 16:52)

 
 Tip#1:

Maintain a healthy weight, because high levels of body fat are associated with elevated levels of estrogen.

Tip#2:

Exercise regularly, as this may lower your chances of uterine fibroids.

Tip#3:

Maintain a healthy diet. Eat a low-fat diet and try to minimize your consumption of red meat and poultry, which may build up fat in the body that could then be used to produce more estrogen. Try to occasionally replace meat with beans and legumes instead.

Tip#4:

Eat more cruciferous vegetables (these are green leafy vegetables such as arugula, broccoli, cabbage, cauliflower, collard greens, kale and turnip greens), and try not to over cook them. Cruciferous vegetables are rich in nutrients, including several carotenoids and vitamins, and they are a good source of fiber. They may also have a protective effect against fibroids. Studies show that these vegetables contain a group of substances (called glucosinolates), which may have anti-cancer effects as well.

Tip#5:

For more information about Fibroids and fertility, click the link below.
https://fertilityinstitute.com/2016/08/24/do-uterine-fibroids-affect-your-fertility-and-pregnancy/    

 
 I hope these tips on UTERINE FIBROID were helpful; Remember, YOUR HEALTH IS INVALUABLE.

 By Dr. J. Lawarna Matthew

 
Acknowledgement
The American College of Obstetrician and Gynecologists
The Fertility Institute
Visit https://www.acog.org/Patients/FAQs/Uterine-Fibroids for more information.