WHAT ARE FIBROIDS?

Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is “leiomyoma” (leye-oh-meye-OH-muh) or just “myoma”. Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

WHY SHOULD WOMEN KNOW ABOUT FIBROIDS?

About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.

WHO GETS FIBROIDS?

There are factors that can increase a woman’s risk of developing fibroids.

AGE- Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.

FAMILY HISTORY – Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.

ETHNIC ORIGIN – African-American women are more likely to develop fibroids than white women.

OBESITY – Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.

EATING HABITS – Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.

WHERE CAN FIBROIDS GROW?

Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:

Submucosal fibroids grow into the uterine cavity.

Intramural fibroids grow within the wall of the uterus.

Subserosal fibroids grow on the outside of the uterus.

Some fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus. They might look like mushrooms. These are called pedunculated (pih-DUHN-kyoo-lay-ted) fibroids.

WHAT ARE THE SYMPTOMS OF FIBROIDS?

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

*Heavy bleeding (which can be heavy enough to cause anemia) or painful periods

*Feeling of fullness in the pelvic area (lower stomach area)

*Enlargement of the lower abdomen

*Frequent urination

*Pain during sex

*Lower back pain

*Complications during pregnancy and labor, including a six-time greater risk of cesarean section

*Reproductive problems, such as infertility, which is very rare.

WHAT CAUSES FIBROIDS?

No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:

*Hormonal (affected by estrogen and progesterone levels)

*Genetic (runs in families)
Because no one knows for sure what causes fibroids, we also don’t know what causes them to grow or shrink. We do know that they are under hormonal control — both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.

CAN FIBROIDS TURN TO CANCER?

Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman’s chances of getting other forms of cancer in the uterus.

WHAT IF I BECOME PREGNANT AND HAVE FIBROIDS?

Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn’t mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:

*Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.

*Baby is breech. The baby is not positioned well for vaginal delivery. Meaning that the head of the baby is pointing towards your chest and not the birth canal.

*Labor fails to progress.

*Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen and may die if no medical intervention is made.

*Preterm delivery.

Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant do not need to see an OB who deals with high-risk pregnancies.

TREATMENT OF FIBROIDS

If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.

Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.

Other drugs used to treat fibroids are “gonadotropin releasing hormone agonists” (GnRHa). The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids especially when they are not so big.

Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHs can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pain.

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