Uterine fibroids are non-cancerous (benign) protuberances in or within the muscular walls of the uterus. They can be as small as a pea or as big as a melon. They are clinically apparent in 25% of the women and with modern imaging techniques this incidence may be greater.
What Are The Symptoms Of Fibroids In The Uterus?
Some women may not know they have fibroids whereas on the other hand some women may experience symptoms like severe bleeding, pain, or abdominal swelling. The symptoms of fibroids in the uterus are dependent on the location and size of the fibroid and include:
- Prolonged and intense menstruation, sometimes with clots.
- Pain in the pelvis, pressure or heaviness.
- Pain in the back or legs may also be the symptoms of fibroids in the uterus.
- Urinary urgency due to excess pressure on the bladder.
- Constipation and swelling due to pressure exerted on the bowels by the fibroids.
- Abnormal enlargement of the abdomen.
The diagnosis is suspected based on the palpation of an increased and irregular contour of the uterus in the pelvic evaluation. Ultrasonography is used, commonly, to confirm the diagnosis and rule out ovarian cancer. Nuclear magnetic resonance gives better visualization but its excessive cost does not justify it.
Most fibroids in the uterus are asymptomatic, which means that they do not cause symptoms, but those women who present them merit treatment. The symptoms of fibroids in the uterus are classified into three categories: abnormal uterine bleeding, pain and pelvic pressure, and reproductive dysfunction. The most characteristic bleeding pattern of fibroids is menorrhagia or hypermenorrhea (prolonged or excessive menstruation). Bleeding at other times of the cycle are not characteristic of them.
Epidemiology
Fibroids respond to gonadal steroids (estrogen and progesterone) and its epidemiology is parallel to the development and hormonal evolution of the patient. They have not been reported in prepubertal girls and, very occasionally, in teenage girls. In most cases they become symptomatic at ages between the 30’s and 40’s. In many women, these discomforts improve with menopause as menstrual cycling and hormonal concentrations dissipate. In some cases, the symptoms persist or return in those patients with hormone replacement therapy.
With regard to race, the black race has a higher incidence of uterine disorders and the age is earlier at the time of diagnosis as well as the performance of the hysterectomy. Those women with parity (one or more pregnancies older than 20 weeks) have a lower incidence in the appearance of uterus fibroids. Pregnancy and the use of oral contraceptives reduce the risk of the appearance of uterus fibroids, despite the fact that estrogen and progesterone levels are high.
What Are The Causes Of Fibroids In The Uterus?
Actually, it is not well known. What is true is that it consists of a combination of genetic predisposition, levels of steroid hormones, as well as growth factors that are important in the fibrotic process and of angiogenesis (it is the physiological process that consists of the formation of new blood vessels from pre-existing vessels).
We have two processes: the first, the transformation from normal to abnormal myocytes and the second, its growth to tumors of clinical appearance. This last happens by cloning the cells through an increased mitotic activity, which is the cell reproduction process associated with a decrease in cellular programmed death (apoptosis).
Women Can Present With Any Of The Three Main Types Of Uterine Fibroids:
-Intramural fibroids. They are the most common. They have arisen within the lining of the uterus and grow inward. They make the uterus feel larger than normal and often cause heavy bleeding during menstruation, pelvic pain, back pain or frequent urination.
-Subserosal fibroids. They are found under the outer covering of the uterus and grow toward the wall, giving the uterus a gnarled appearance. It can cause pelvic pain and back pain.
-Submucosal fibroids. They are the least common type. It occurs just below the lining of the uterus. Even the smallest can cause prolonged and intense menstruation.
Treatment For Fibroids In The Uterus
Doctors have two modalities, surgical and medical. Medical management seeks to achieve a non-surgical response to the problem. The patient may have fibromatosis but its irregular bleeding may be due to oligo-ovulation or perimenopausal anovulation and the use of oral contraceptives or progestogen therapy may be useful. Non-steroidal anti-inflammatories, with a local effect of decreased bleeding, are used in cases of menorrhagia (regular but abundant bleeding).
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