Uterine Fibroids: Symptoms, Causes and Diagnosis
Uterine fibroids are noncancerous tumors that originate in the uterus. These are also known as leiomyomas or myomas. Most women usually unaware of the presence of uterine fibroids because they often cause no symptoms. However, fibroids can cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. The symptoms are most commonly abnormal bleeding, pain and pressure. Uterine fibroids are diagnosed by pelvic exam and by prenatal ultrasound.
The most common symptoms of uterine fibroids include:
When the fibroid outgrows its blood supply, and begins to die it can cause acute pain.
Uterine fibroids are often described based upon their location within the uterus. Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle. Submucosal (submucous) fibroids are located inside the uterine cavity beneath the inner lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus.
Usually fibroids do not interfere with ovulation, but they may impair fertility and lead to poorer pregnancy outcomes. In particular, submucosal fibroids that deform the inner uterine cavity are most strongly associated with decreases in fertility. Occasionally, the cause of recurrent miscarriages are due to fibroids. The woman may not be able to sustain a pregnancy if they are not removed in these cases.
Exact cause of developing uterine fibroid in women is not known so far. However genetic abnormalities, alterations in growth factor expression(proteins formed in the body that direct the rate and extent of cell proliferation), abnormalities in the vascular (blood vessel) system, and tissue response to injury plays an important role in the development of fibroids.
Since there is often a history of fibroids developing in women of the same family, family history is a key factor. Other factors that are associated with an increased risk of developing fibroids include having the first menstrual period prior to age 10, consumption of alcohol, uterine infections, and elevated blood pressure.
Estrogen and progesterone are two hormones that stimulate 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, but postmenopausal hormone therapy may cause symptoms to persist.
Insulin, that help the body maintain tissues may affect fibroid growth. Uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus. A single cell divides repeatedly creating a firm, rubbery mass distinct from nearby tissue. Uterine fibroids may remain the same size or may grow slowly or rapidly. Some fibroids may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.
Most women usually unaware of the presence of uterine fibroids because they often cause no symptoms. However, fibroids can cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. The symptoms are most commonly abnormal bleeding, pain and pressure.
Uterine fibroids are diagnosed by pelvic exam and by prenatal ultrasound. Ultrasound is very helpful in differentiating fibroid from other conditions such as ovarian tumors. It is the simplest, cheapest, and best technique for imaging the pelvis. MRI and CT scans can also play a role in diagnosing fibroids. A hysterosonogram (HSG) is done if the presence of fibroid in the uterine cavity (endometrial cavity) has to be determine.
In this procedure, contrast fluid is injected into the uterus through the cervix and an ultrasound is done. The fluid within the endometrial cavity can help outline any masses that are inside, such as submucosal fibroids.
A complete blood count (CBC) test can be done to determine if you have anemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.