By Marilyn Olson
Herald-News

Joliet -- Though usually harmless, uterine fibroids can disrupt a woman's life, causing everything from abnormal bleeding to infertility.  But there are treatment options available.

"Uterine fibroids are abnormal masses of smooth muscle tissue in and around the uterus," says Dr. Marek Piekos of Reproductive Health Specialists of Joliet.  "These growths originate in the muscle cells of the uterus and usually occur in masses, though sometimes there may only be one fibroid."

Their more scientific name is myomas, or leiomyomas, and it is estimated that they occur in one of every four or five women.  They are more prevalent in black women than white women and usually develop when women are in their 30's or 40's.  Black women are three times more likely to have uterine fibroids than white women.  Often their size diminishes after menopause.

"Often uterine fibroids don't cause any problems and are asymptomatic," Dr. Piekos says.  "But they may cause excessive bleeding, pain, pressure in the lower abdomen, infertility, miscarriage, and premature delivery of infants.  Surgical removal can correct the condition but there is a chance they may re-develop."

The exact cause of uterine fibroids is unknown, although there does seem to be a hereditary factor.  "If your mother or grandmother had them, there is a better chance that you will also," Dr. Piekos says.  "There are indicators that they require estrogen for growth, which probably explains why they can get smaller after menopause.  They may increase in size rapidly during pregnancy, when the woman's body is making a lot of estrogen.  It is rare for them to require treatment after menopause.  Fibroids also appear to be sensitive to progesterone as well."

Uterine fibroids are usually located in the body of the uterus, but they may also be found outside the uterus and in the cervix.  They are divided into three categories, based on their location: subserous, amounting to about 55 percent of all fibroids, are located just beneath the covering of the uterus; intramural fibroids are located in the muscular wall of the uterus and account for an additional 40 percent of patients; and finally submucous fibroids which are found under the uterine lining and account for only about 5 percent of fibroids.

Symptoms vary depending on the size and location of the fibroid.  Many women have no symptoms.  "In a third of patients the woman has detected a mass herself, has abnormal bleeding, and pressure or pain in the lower abdomen," Dr. Piekos says.  "Large fibroids can distort the uterine cavity and create a larger surface area which will result in heavier periods and changes in the blood flow pattern."

Pressure from the fibroid on the endometrium  or lining of the uterus can also cause abnormal bleeding.  "It is important to note that though uterine fibroids rarely become cancerous, other conditions including uterine cancer can also cause abnormal bleeding," Dr. Piekos cautions.  "So it is important for any woman with abnormal bleeding to have a thorough and complete medical examination to determine that cancer or other conditions are not present along with the fibroids."

When fibroids begin to grow rapidly there is more chance of cancer.  The fibroid may outgrow its blood supply and may cause pain and cramping.  This frequently happens during pregnancy when hormonal changes make rapid growth possible.  "If there is sudden pain, the fibroids may have become inflamed or twisted and it may signal a medical emergency," Dr. Piekos says.

Very large fibroids, or large masses of them, may place pressure on the internal organs of the abdomen, such as the bladder, rectum or uterus.  "Urinary urgency may occur and continued compression of these organs may damage the kidneys," the doctor said.  Symptoms of this pressure may include changes in bowel habits, constipation or hemorrhoids.

Fibroids may contribute to infertility also.  "Most often fibroids located inside the uterus are associated with infertility," Dr. Piekos said. "However, only 2-3 percent of infertility is caused by fibroids.  It is important to identify the cause of infertility in order to be able to treat it."

Uterine fibroids may cause infertility by causing changes in the lining of the uterus making it impossible for the egg to attach, or the fallopian tubes may be compressed, causing difficulty for the sperm to meet the egg.

"The conception rate after surgery to eliminate uterine fibroids is good," Dr. Piekos says.  "But that is influenced by the woman's age, ovulatory status, previous pregnancies, and of course the quality of the male partner's semen."

The rate of miscarriage in women with uterine fibroids is high, as many as 40 percent of women with fibroids miscarry, particularly when the fibroids increase or decrease in size.  "In addition, an increase in the rate of premature births is noted in women with uterine fibroids.

"Surgical removal of the fibroids can result in a 50 percent pregnancy rate," Dr. Piekos says.

Some statistics indicate cancer only occurs in one woman in 10,000 who have fibroids, but if they begin to grow rapidly it can suggest cancer, especially for post menopausal women.

Diagnosis is done with a simple pelvic exam, though more testing may be necessary to eliminate other conditions and to locate the fibroid and to tell their size.  Ultrasound may be used to create a picture of the uterus, but if the fibroids are very small, or very large, the picture will not be clear and definitive.

Other testing may include a CT scan or an MRI which may determine the size and location of the fibroids.  And MRI can also be used to determine if the fibroid is disturbing the uterine cavity.

"With a hysterosalpingography or HSG, the physician uses x-ray and the injection of dye to see the fibroids and to tell if they are distorting the uterine cavity," Dr. Piekos said.  "Another option is hysteroscopy, where a telescope-like instrument is introduced into the uterine cavity.  The procedure is one under local anesthetic, often in the doctor's office, and sometimes may actually be removed during the procedure."

With diagnostic laparoscopy, which may also be used to actually remove the fibroids, a slender instrument is inserted into the abdominal cavity.  It is an outpatient procedure done under general anesthetic and recovery is usually in one to seven days.

Treatment varies, depending on the size, location and number of fibroids present.  "Not all women need surgery," Dr. Piekos says.  "If there are no symptoms the woman needs periodic examinations to determine if the fibroids are growing.  This wait and see attitude is especially useful for those nearing menopause or women who might want to have more children.  If the fibroids are causing symptoms, surgery may be necessary.  Usually we perform a myomectomy, removing only the fibroid, and preserving the uterus."

Copyright © 2004 Reproductive Health Specialists, Ltd. 
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