What are Fibroids and How Common are they?
Fibroids are considered noncancerous tumors of the uterus, and are found in over 80% of women. Although 97% benign, there does exist a malignancy rate of approximately 1-3%.
Fibroid tumors are the most common uterine pathology and are the primary reason for approximately 80% of the hysterectomies in this country today. Also known as myomas, leiyomomas, fibromas, and fibromyomas, these tumors can have an extensive blood supply from within the uterus.
Fibroid Types
Fibroid tumors usually present in four different types:pedunculated, subserosal,, intramural, submucosal.
- Pedunculated fibroids are those extending from the uterus on a stalk.This type of tumor may be found within the endometrial cavity or extending outside the uterus into the pelvis. These are the most easily removed tumors, and often the surgical removal can be performed through laparoscopy or hysteroscopy. The symptoms include pain or pressure in a specific area, or bleeding depending on where the tumor is located.
- Subserosal are those fibroids located just beneath the outer layer of the uterus. These are the tumors that are most easily accessible and are often removed via a simple or laparoscopic myomectomy. If allowed to increase in size, symptoms can include pelvic pain, back pain, urinary frequency, constipation, bloating and indigestion.
- Intramural tumors are those located deep in the uterus in the main body of the organ. These are the most common and the most difficult to remove, and are responsible for the highest percentage of hysterectomies. These tumors can produce bleeding problems, abdominal pressure, and painful intercourse, in addition to all the symptoms listed above
- Finally, submucosal fibroids are those directly adjacent to the endometrial lining. These are the tumors primarily responsible for heavy menstrual bleeding. These tumors impinge on the endometrial cavity and can produce long heavy periods, cramps, clots, and cervical
- pressure.
What Causes Fibroids?
The true etiology of fibroid tumors is unknown. Research has shown significant genetic correlation, as well as a strong cultural component: fibroids are 4-6 times more likely in the African American populations, and yet are rarely seen in the Asian culture. With the introduction of hormones into our general food supply, the incidence of fibroid tumor disease is increasing across the general population regardless
of race or culture.
We do know that these tumors are directly responsive to estrogen and exhibit their most significant growth spurts just prior to the monthly menses.Women that have a documented estrogen dominance have a much higher rate of tumor
growth, which is also witnessed during pregnancy. Conversely, women in the menopausal phase of life, demonstrate a reduction in the growth of tumors, with some fibroids even shrinking slightly in size.
The Signs and Symptoms of Fibroid Tumors
Signs and symptoms of fibroids are dependent on the size, number and location of the tumors. Many patients complain of menstrual problems like heavy periods, with extended days of flow, cramps and clots.
However, many women have absolutely no symptoms at all. The following symptoms are known (but not limited)to be associated with fibroids and will increase in severity based on size and number of tumors:
- heavy bleeding or increased flow
- clotting
- cramps
- abdominal pressure
- irregular and painful periods
- bloating
- indigestion
- urinary frequency
- constipation
- painful intercourse
- back pain
- pressure in the legs
- PMS
- fatigue
Fibroid Tumor Treatments
For any long term relief, once symptommatic, most fibroids need to be surgically removed. Delaying removal of tumors usually allows the fibroids to grow in size and number. There are multiple treatments available from herbal supplements, birth control pills, IUDs, minimally invasive procedures like UAE to laparoscopic, Robotic and open surgeries.
The type of treatment recommended is often based on the size, number and location of the fibroids and the skill and philosophy of your physician. Please refer to our section on Types of Treatments for more indepth and comparative information and analysis.
Fertility & Fibroids:
Fertility outcomes with fibroids are dependent on the size, number and location of the tumors. In general, only -12% of fibroids are associated with primary infertilty so most women can have uncomplicated pregnancies with these tumors, and research has shown that if conception takes place only 10-15% of women will have complications with pregnancy.
Submucosal and intracavity tumors are an example of those that can produce complications and even pregnancy loss. Intracavity fibroids are in direct competition for space within the endometrial cavity with a developing fetus. This can create obstacles to development and miscarriage can occur. Submucosal tumors by nature of their location near the lining can also contribute to infertility by inhibiting implanation of the fertilitzed egg. Fundal fibroids are known to block fallopian tubes and are therefore a primary source of infertility by preventing conception.
No matter what type, the longer fibroid tumors are left untreated, the greater the chance of infertility.
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