Leiomyoma (FIBROIDS)
A Leiomyoma also has known as fibroids, is a benign smooth muscle tumor that very rarely becomes cancer. They can occur in any organ, but the most common forms occur in the uterus, small bowel, and the esophagus. Polycythemia may occur due to increased erythropoietin production as part of a paraneoplastic syndrome.
Non-cancerous growths in the uterus that can develop during a woman's childbearing years. The cause of fibroids isn't well understood. Risk factors include a family history of fibroids, obesity, or early onset of puberty. Symptoms include heavy menstrual bleeding, prolonged periods, and pelvic pain. In some cases, there are no symptoms. Treatment includes medication and removal of the fibroid.
More than 1 million cases per year in India.
Symptoms:
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size, and the number of fibroids.
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
fibroid can cause acute pain when it outgrows its blood supply.
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.
Uterine fibroids are leiomyomata of the uterine smooth muscle. As other leiomyomata, they are benign, but may lead to excessive menstrual bleeding (menorrhagia), often cause anemia and may lead to infertility.
A rare form of these tumors is uterine lipoleiomyoma- benign tumors consisting of a mixture of adipocytes and smooth muscle cells. Uterine lipoleiomyoma has been observed together with ovarian and other pathologies and some of them may develop into liposarcoma.
These tumors are monoclonal, and non-random chromosomal abnormalities have been seen in 40% of the tumors.
See your doctor if you have:
- Pelvic pain that doesn't go away
- Overly heavy, prolonged or painful periods
- Spotting or bleeding between periods
- Difficulty emptying your bladder
- Unexplained low red blood cell count
Seek prompt medical care of you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.
Causes:
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 normal uterine muscle cells.
Hormones: Estrogen and progesterone, two hormones that stimulate the 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 normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
- Other growth factors: Substance that helps the body maintain tissues, such as insulin-like growth factors, 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 cause 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 normal size.
Complications:
Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as a drop in red blood cells (anemia). which causes fatigue, from heavy blood loss.
Pregnancy and fibroids:
Fibroids usually don't interfere with getting pregnant. However, it's possible that fibroids, especially submucosal fibroids- could cause infertility or pregnancy loss.
Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction, and preterm delivery.
Prevention:
Although researchers continue to study the causes of fibroids tumors, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible, but only a small percentage of these tumors require treatment. But, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, you may be able to decrease your fibroid risk.
Diagnosis:
Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids.
- Ultrasound: If confirmation is needed, your doctor may order an ultrasound.
- Lab- tests: If you have abnormal menstrual bleeding. These might include a complete blood count (CBC).
- Magnetic resonance imaging(MRI)
- Hysterosonography
- Hysterosalpingography
- Hysteroscopy
Surgical procedures:
- Abdominal myomectomy: multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdomeinal sutgical procedure to remove the fibroids.
- Hysterectomy: Surgery, the removal of the uterus- remains the only proven permanent solustion for uterine fibroids, but hysterectomy is major surgery.
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