Uterine fibroids
Definition:
Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.
In general, uterine fibroids seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain or profuse menstrual bleeding.
Symptoms:
In women who have symptoms, the most common symptoms of uterine fibroids include:
Fibroid location influences your signs and symptoms:
See your doctor if you have:
Causes:
Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue. The growth patterns of uterine fibroids vary — some fibroids may continue to grow slowly; other fibroids may remain the same size or even shrink on their own over time.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:
Complications:
Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek medical care right away. You may need surgery.
Pregnancy and fibroids
Fibroids usually don't interfere with conception and pregnancy. However, it's possible that fibroids could distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo, and in these cases, doctors often recommend removing these fibroids before attempting pregnancy.
In other cases, treatment for fibroids during pregnancy isn't necessary. A common complication of fibroids during pregnancy is localized pain, typically between the first and second trimesters. This is usually easily treated with pain relievers. But if you have fibroids and you've experienced repeated pregnancy losses, your doctor may recommend removing one or more fibroids to improve your chances of carrying a baby to term, especially if no other causes of miscarriage can be found and if your fibroids distort the shape of your uterine cavity.
Treatments and drugs:
There's no single best approach to uterine fibroid treatment. Many treatment options exist.
Watchful waiting
Many women with uterine fibroids experience no signs or symptoms. If that's the case for you, watchful waiting (expectant management) could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause when levels of reproductive hormones drop.
Medications
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you also elect to have your ovaries removed, it brings on menopause and the question of whether you'll take hormone replacement therapy. Most women with uterine fibroids can choose to keep their ovaries.
Myomectomy
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. With myomectomy, there's a risk of fibroid recurrence.
Myomectomy options include:
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus.
This procedure is performed while you're inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. One or two treatment sessions are done in an on- and off-again fashion, sometimes spanning several hours.
Because it's a newer technology, researchers are learning more about the long-term safety and effectiveness of FUS. Research continues, but so far data collected show that FUS for uterine fibroids is safe and very effective.
Other minimally invasive procedures for fibroids
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
Definition:
Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.
In general, uterine fibroids seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain or profuse menstrual bleeding.
Symptoms:
In women who have symptoms, the most common symptoms of uterine fibroids include:
- Heavy menstrual bleeding
- Prolonged menstrual periods — seven days or more of menstrual bleeding
- Pelvic pressure or pain
- Frequent urination
- Difficulty emptying your bladder
- Constipation
- Backache or leg pains
Fibroid location influences your signs and symptoms:
- Submucosal fibroids. Fibroids that grow into the
inner cavity of the uterus (submucosal fibroids) are thought to be
primarily responsible for prolonged, heavy menstrual bleeding and are a
problem for women attempting pregnancy.
- Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing constipation, or on your spinal nerves, causing backache.
See your doctor if you have:
- Pelvic pain that doesn't go away
- Overly heavy or painful periods
- Spotting or bleeding between periods
- Pain with intercourse
- Difficulty emptying your bladder
- Difficulty moving your bowels
Causes:
Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue. The growth patterns of uterine fibroids vary — some fibroids may continue to grow slowly; other fibroids may remain the same size or even shrink on their own over time.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:
- Genetic alterations. Many fibroids contain alterations in genes that are different from those in normal 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 do normal uterine muscle cells.
- Other chemicals. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.
Complications:
Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek medical care right away. You may need surgery.
Pregnancy and fibroids
Fibroids usually don't interfere with conception and pregnancy. However, it's possible that fibroids could distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo, and in these cases, doctors often recommend removing these fibroids before attempting pregnancy.
In other cases, treatment for fibroids during pregnancy isn't necessary. A common complication of fibroids during pregnancy is localized pain, typically between the first and second trimesters. This is usually easily treated with pain relievers. But if you have fibroids and you've experienced repeated pregnancy losses, your doctor may recommend removing one or more fibroids to improve your chances of carrying a baby to term, especially if no other causes of miscarriage can be found and if your fibroids distort the shape of your uterine cavity.
Treatments and drugs:
There's no single best approach to uterine fibroid treatment. Many treatment options exist.
Watchful waiting
Many women with uterine fibroids experience no signs or symptoms. If that's the case for you, watchful waiting (expectant management) could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause when levels of reproductive hormones drop.
Medications
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:
- Gonadotropin-releasing hormone (GnRH) agonists.
Medications called GnRH agonists (Lupron, Synarel, others) treat
fibroids by causing your natural estrogen and progesterone levels to
decrease, putting you into a temporary postmenopausal state. As a
result, menstruation stops, fibroids shrink and anemia often improves.
Your doctor may prescribe a GnRH agonist to shrink the size of your
fibroids before a planned surgery. Many women have significant hot
flashes while using GnRH agonists.
- Progestin-releasing intrauterine device (IUD). A
progestin-releasing IUD can relieve heavy bleeding and pain caused by
fibroids. A progestin-releasing IUD provides symptom relief only and
doesn't shrink fibroids or make them disappear.
- Androgens. Danazol, a synthetic drug similar to
testosterone, may effectively stop menstruation, correct anemia and even
shrink fibroid tumors and reduce uterine size. However, this drug is
rarely used to treat fibroids. Unpleasant side effects, such as weight
gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches,
unwanted hair growth and a deeper voice, make many women reluctant to
take this drug.
- Other medications. Oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids.
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you also elect to have your ovaries removed, it brings on menopause and the question of whether you'll take hormone replacement therapy. Most women with uterine fibroids can choose to keep their ovaries.
Myomectomy
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. With myomectomy, there's a risk of fibroid recurrence.
Myomectomy options include:
- Abdominal myomectomy. If you have multiple
fibroids, very large fibroids or very deep fibroids, your doctor may use
an open abdominal surgical procedure to remove the fibroids.
- Laparoscopic or robotic myomectomy. If the fibroids
are small and few in number, you and your doctor may opt for a
laparoscopic procedure, which uses slender instruments inserted through
small incisions in your abdomen to remove the fibroids from your uterus.
Your doctor views your abdominal area on a remote monitor via a small
camera attached to one of the instruments. Use of a surgical robot now
allows for removal of more fibroids or larger fibroids.
- Hysteroscopic myomectomy. This procedure may be an
option if the fibroids are contained
inside the uterus (submucosal). A long, slender instrument (hysteroscope) is passed through your vagina and cervix and into your uterus. Your doctor can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus.
This procedure is performed while you're inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. One or two treatment sessions are done in an on- and off-again fashion, sometimes spanning several hours.
Because it's a newer technology, researchers are learning more about the long-term safety and effectiveness of FUS. Research continues, but so far data collected show that FUS for uterine fibroids is safe and very effective.
Other minimally invasive procedures for fibroids
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
- Myolysis. In this laparoscopic procedure, an
electric current or laser destroys the fibroids and shrinks the blood
vessels that feed them. A similar procedure called cryomyolysis freezes
the fibroids. The safety, effectiveness and associated risk of fibroid
recurrence of myolysis and cryomyolysis have yet to be determined.
- Endometrial ablation. This treatment, performed
with a specialized instrument inserted into your uterus, uses heat,
microwave energy, hot water or electric current to destroy the lining of
your uterus, either ending menstruation or reducing your menstrual
flow. Endometrial ablation is effective in stopping abnormal bleeding,
but doesn't affect fibroids outside the interior lining of the uterus.
- Uterine artery embolization. Small particles (embolic agents) injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique, performed by an interventional radiologist, is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include no incision and a shorter recovery time. Complications may occur if the blood supply to your ovaries or other organs is compromised.
Facebook
0 komentar:
Posting Komentar