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What is uterine fibroid?
Also called uterine leiomyoma, fibroma or fibromyoma , uterine fibroid is a benign tumor that forms from the muscle of the uterus. It can grow both inside and outside the organ. It is able to change the shape of the uterus as it develops.
The fibroid is more common in women between 40 and 50 years of age and 3 to 9 times more frequent in black women. It is not particularly harmful to health and, although it may present some uncomfortable symptoms and some chance of causing infertility, it can also go completely unnoticed in a woman’s life.
Studies indicate that between 75% and 90% of women will develop a uterine fibroid at some point in their lives and half of them do not experience any symptoms.
This tumor only affects women of childbearing age. It does not appear in children. Women who have gone through menopause do not have new fibroids.
Types
There are six different types of uterine fibroids, each classified according to its location. Are they:
Subserous fibroids
This fibroid appears just below the serous wall, which is the outer layer of the uterus. It grows out of the organ and is the least related to infertility.
It can give a callous, nodular appearance to the uterus and, when large, can press organs like the bladder and intestine, giving the impression that other diseases – such as infections – are present.
Pedicled fibroids
Pedicled fibroids connect to the uterine walls through a thin cord called a pedicle. It can appear both inside and outside the uterus. When it is inside, it is classified as intracavitary , which means that it is completely inside the uterine cavity.
When large and inside, it can make pregnancy difficult. Outside, a large pedicled fibroid can put pressure on other organs such as the bladder, as well as the subserous.
Mioma intramural
This fibroid is found inside the wall of the uterus. If small, it does not have any consequences, but when it is more than 5 cm in diameter, it causes cramps, in addition to being able to deform the uterus and make pregnancy difficult.
Mioma submucoso
Submucosal fibroids are the most related to infertility and bleeding. Its growth takes place on the inner wall of the uterus, just below the endometrium, where the embryo attaches, and grows into the uterus. Because of its location, even small children can make a pregnancy unfeasible if the embryo fixes itself on it.
Parturition fibroids
When a pedicled fibroid enters the cervical canal, it is said to be parturition. It is a very rare type of fibroid, which is usually accompanied by severe pain, similar to that of labor.
Depending on the size, it can also cause cervical dilation, as well as a normal delivery. Removal through the vagina is necessary and surgery may be necessary.
Intraligamentary myoma
A fibroid that is found in the ligaments between the ovaries, the uterus and the tubes. It can cause infertility when it grows, by blocking the path between the eggs and the uterus.
Cervical fibroids
This type of fibroid is rare. It is located on the cervix and can cause pain during sex. It can also go into parturition, causing the characteristic symptoms of this type of fibroid: severe pain like labor and the possibility of cervical dilation.
Can uterine fibroids turn into cancer?
Fibroids do not develop into malignant tumors, so they cannot become cancer and there is nothing to worry about. There is a possibility to remove them if they are causing pain or preventing a pregnancy, but no one dies of fibroids.
Causes
There is no identified cause of myoma, but it is known that there is an influence of female hormones such as progesterone and estrogen on its growth.
During menopause, when hormone levels decrease, fibroids tend to decrease in size and may even disappear. During pregnancy, fibroids grow due to the high hormonal quantity.
Risk factors
Uterine fibroids affect between 75 and 90% of women of childbearing age. There is a drastic drop in its frequency after menopause and there are no reports of uterine fibroids in girls who have not yet entered puberty.
Basically, being a woman and being of childbearing age, you can have a fibroid. However, some factors can increase the chances of presenting them:
Age
Women aged 40 to 50 are more likely to develop uterine fibroids than younger women. After menopause, new fibroids do not appear and existing ones are reduced in size and may disappear. However, in the years leading up to it, they can arise and grow more frequently.
Ethnicity
The reason is not known, but fibroids are considerably more common in black women. Compared to other ethnicities, they have 3 to 9 times more fibroid formation. Uterine leiomyomas of black women also tend to be more bulky.
Heredity
Uterine fibroids are a hereditary feature. If your mother has fibroids, you are likely to develop them as well.
First early menstruation
Women who had their first period before the age of 10 are more likely to have uterine fibroids.
Alcohol abuse
Drinking alcohol in an abusive manner increases the chances of fibroids. Studies indicate that beer, in particular, is more likely to cause fibroids when compared to wine.
Hypertension
Hypertensive women are at increased risk of developing uterine fibroids.
Contraceptives
Although birth control pills are one of the drugs used to treat fibroids and decrease the chances of them appearing and growing, their early use (before 16) is related to an increased risk.
Symptoms
50% of the time, the uterine fibroid has no symptoms at all. They are only symptomatic when they grow old enough to influence something in the womb. However, there are symptoms that can be bothersome.
Each type of fibroid has varying symptoms. Are they:
Change in menstrual cycle
Thanks to fibroids, the menstrual cycle can be more prolonged and irregular, in addition to being abundant and with the possibility of being painful.
Bleeding
Submucosal fibroids are the ones that are most related to bleeding, which can happen between menstrual cycles, but that usually appear during the cycle, in the form of more abundant and bulky bleeding. There may be clots in the bleeding.
Intramural, pedicled and parturition fibroids may also bleed.
Pelvic pain
Pain in the pelvis region may appear if one or more fibroids are large and putting pressure on an organ.
Infertility
Like bleeding, infertility is much more common in fibroids that are found inside the uterus or affect the inside. This applies to intramural, subserous and pedicular, in addition to parturition.
Volume abdominal
If a fibroid grows too much, especially those external to the uterus, it can affect the volume of the abdomen, leaving the woman looking and feeling bloated.
Other bodies
Abdominal space being occupied by the fibroid also means that it has less space for the other organs.
If a fibroid external to the uterus grows too large, it can cause pressure on the bladder or rectum, leading to difficulty holding urine, increased frequency of trips to the bathroom and constipation.
These symptoms can be confused with infections and other illnesses.
Pain during sex
Normally, fibroids are born in the body of the uterus, but they can rarely appear in the cervix. At such times, there may be pain during sex when the partner’s penis comes into contact with the fibroid.
Pain similar to labor
When the large fibroid enters parturition, it is leaving in the same way that a baby being born would leave. This can lead to pain and contractions similar to that of childbirth.
How is the diagnosis of uterine fibroids made?
The diagnosis of uterine fibroids can be made by the gynecologist through imaging exams after the suspicion arises in the office.
Routine touch exam
This exam looks for irregularities in the ovaries, tubes and uterus. If a large external or intramural uterine fibroid is present, it is possible that the gynecologist will feel it in the shape of a uterine deformity.
Transvaginal ultrasound
Through the insertion of a small ultrasound device in the vagina, it is possible to obtain images of Organs internal organs such as the tubes, ovaries and uterus. This test is able to clearly demonstrate the presence of fibroids, including those that have not grown much.
Often, fibroids are found by chance through an ultrasound that looks for other things, as they may not show symptoms.
MRI
When detailed examination is required, MRI can be used. This examination allows a more accurate analysis of fibroids, including the smallest. Asymptomatic fibroids are also found by chance through this exam.
Magnetic resonance imaging is recommended for adolescents and women close to menopause, as it can identify a malignant tumor. It is also recommended if there is any doubt as to the malignancy of the tumor.
Infertility
Infertility is a problem related to fibroids and a major concern for women who are surprised by the tumor. Fibroids cause infertility depending on location and size.
Mioma submucoso
Most of the time, infertility is caused by internal fibroids. The submucosal is the type of fibroid that most often causes problems getting pregnant. This is because they prevent the fetus from attaching to the endometrium, even when its size is not large.
Mioma intramural
Likewise, intramural fibroids, when large enough to cause deformation of the uterine anatomy – more than 5 cm -, can reduce the chances of pregnancy and increase the chances of recurrent miscarriage.
Locks
Internal fibroids located near the implantation of the tubes may obstruct the path of eggs and sperm. Intraligamentants can also grow to the point of blocking the tubas.
In addition, pedicles can be positioned in places that can block the path of the sperm or eggs, making pregnancy difficult.
Subserous fibroids
Large subserous fibroids can be removed before a pregnancy as, although it does not affect infertility, they can cause ischemia, which is a stop in the blood flow.
Can uterine fibroids be cured?
It is possible to perform surgery to remove the fibroids. When the tumor is small and is not causing any symptoms or complications, it is not necessary to remove it, but when it grows, removal may be a good idea.
What is the treatment?
Most of the time, there is no need for treatment for fibroids. However, when they cause symptoms that can affect a woman’s quality of life, it may be necessary. It is possible to do the following treatments:
Medicated
Medications can be used to reduce and eliminate symptoms of fibroids such as pelvic pain and bleeding.
Non-hormonal anti-inflammatories, fibrinolysis inhibitors (a process that destroys clots and is related to bleeding caused by fibroids), hormonal contraceptives and progestogens (a compound similar to that of progesterone) can be used to deal with symptoms.
GnRH analogs
This type of medication simulates a type of hormone that induces menopause, which is capable of reducing the size of fibroids.
With the use of this medicine, a chemical menopause is created which is temporary. The reduction of fibroids can cut the symptoms and facilitates the surgical extraction of the tumors.
GnRH analogues cannot be used indefinitely. This type of treatment is limited to four months, as the lack of hormones can compromise the woman’s bone mass.
On the other hand, if the medication is simply stopped, the tumors grow back quickly. Therefore, this treatment is not used to relieve symptoms, but to facilitate the removal of fibroids.
Hormonal IUD
Hormonal intrauterine device (IUD) can be used to control bleeding, cramps and fibroid growth. Like contraceptives, the hormonal load can be enough to reduce tumors, making them a good option for women who cannot use the pill and who do not need to undergo surgery.
Miomectomia
The myomectomy is the removal of fibroids surgery. There are studies that indicate that healing can make pregnancy difficult compared to a woman without fibroids, so the reduction of tumors is important, to reduce the scar area.
There are three types of myomectomy and their indications vary according to the location of the fibroid:
Abdominal myomectomy
This surgery is very similar to a caesarean section. A cut is made in the patient’s abdomen and the uterus is reached, where the myoma is extracted. It is indicated for intramural and external fibroids, such as subserous and external pedicles.
This procedure does not normally affect fertility, but a future pregnancy will require a caesarean section.
Laparoscopic
Laparoscopy is a technique for removing fibroids – and other bodies – that consists of making small cuts in the abdomen, where microcameras and instruments for tumor removal are inserted. The advantage of this technique is that it is not very invasive and the recovery period is short.
Laparoscopy can be used to remove small subserous tumors. The morcellation technique can also be applied through laparoscopy.
Morcellation can be used to remove the uterus as a whole or tumors, and consists of cutting the organ or fibroid into small pieces and then aspirating them through laparoscopic incisions.
There are studies that question the safety of morcelation. If there is a malignant tumor in the uterus, the technique spreads cancer cells in the patient’s abdomen when making the cut.
Hysteroscopic
Used only in cases of internal fibroids such as internal and submucosal pedicles, hysteroscopic myomectomy is performed through the vaginal entrance, without cuts.
A camera is inserted through the vagina next to instruments that will remove the tumor. The doctor can remove the fibroid without making cuts and with a minimum recovery period.
Embolization
This treatment technique is indicated by the gynecologist, but performed by an interventional radiologist. Embolization does not need to be performed in a surgical center, but it does need controlled sedation.
In this procedure, a catheter is inserted through the femoral artery and goes to the arteries that nourish the fibroid. Through the catheter, some materials are injected that block these arteries, removing the nutrition of the tumor, which dries out, reducing its size and causing the symptoms to disappear.
In some cases, the fibroid can even be eliminated by menstruation after applying the technique.
The advantage of embolization is recovery, which is easy, since it is a procedure with minimal invasiveness. However, there are cases in which the reduction of the fibroid is not enough to rid the patient of the symptoms.
It is also not possible to have an anatomopathological exam on the tumor, that is, to investigate further the nature of that specific fibroid, although in many times the MRI can provide extra information.
Hysterectomy (ablation)
Total or partial removal of the uterus may be necessary if the uterus is too full of fibroids or if any attempt to remove the tumors causes complications such as bleeding. A hysterectomy removes the possibility of pregnancy and is considered a radical approach to treating fibroids.
It can be only partial, removing only the body from the uterus, or total, in which the cervix is also removed. Which one will be used depends on the location of the fibroids which, although they are more common in the uterine body, can appear in the cervix.
There is also a radical hysterectomy, which removes the ovaries, fallopian tubes and vaginal tissue around the cervix, but this surgery is usually used only when there is an advanced cancer and is not used to treat fibroids.
After treatment, can I get pregnant?
It depends on the type of treatment. It is impossible to have a pregnancy after a hysterectomy, but if the method of treatment was a myomectomy, it is possible, although there is some decrease in the chances.
Usually, the woman who removes a fibroid may be doing this precisely because it prevents her from becoming pregnant. In relation to a woman without fibroids, the chances of pregnancy are less after treatment, but in general, they favor fertility.
Surgery to remove fibroids that are too large, in large quantities, can damage the uterus too much for the woman to be able to get pregnant, but this doesn’t always happen and pregnancy is a very real possibility for the woman who removes her fibroids,
Medicines for uterine fibroids
Medicines can be used to reduce symptoms caused by fibroids and tumors themselves. Some of them are as follows:
Non-hormonal anti-inflammatory
- Acetylsalicylic acid ( Aspirin );
- Ibuprofeno (Advil);
- Naproxen ( Flanax ).
Antifibrinolithics
- Tranexamic acid ( Transamin );
- Aminocaproic acid ( Ipsilon ).
Progestagênios
- Desogestrel (Nactali).
GnRH analogs
- Gosserrelin Acetate ( Zoladex )
- Leuprorelin acetate ( Lectrum )
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Prognosis
Fibroids are benign tumors and there is no risk of them becoming cancer. In fact, up to 40% of them regress within three years. Therefore, treating them is only indicated when they show symptoms that may impair the woman’s quality of life and her ability to become pregnant, if she so wishes.
Removing fibroids is not usually a complicated procedure, but like any surgical procedure, it has its risks.
Most women live with fibroids without even knowing it and chances are they will never know, as they may not have any symptoms in the course of a lifetime.
Complications
An untreated fibroid simply keeps its symptoms. Constipation and increased urinary frequency may occur , in addition to infertility , depending on the type of fibroid and its size. Another risk is the possibility of anemia due to heavier bleeding, which may lead to the need for iron supplementation, but in general, there are no complications and only need to be treated if there are symptoms.
How to prevent uterine fibroids?
There is no way to prevent uterine fibroids. It can appear at any point in the life of a woman in the reproductive phase, but it does not cause major health problems. Most women will develop them and treatment varies from case to case.
However, there is medical literature that indicates that some habits can reduce the chances of them developing and, if they don’t, at least make you healthier.
Physical exercises
Exercises reduce inflammatory processes in the body, which reduces the chances of tumors, both malignant and benign.
Eat well
A balanced diet is good for all organs of the body. Keeping yourself entirely healthy helps to keep your uterus healthy as well.
Avoid foods with a lot of sugar
Insulin spikes, caused by high amounts of sugar in the body, can aid in the development of fibroids.
Don’t overdo the alcohol
Drinking too much is not good for any organ and the uterus is no exception. In addition, there are studies that link excessive alcohol intake with the development and growth of uterine fibroids.
Visit the gynecologist
Frequent visits to the gynecologist can guarantee better genital health. The doctor can find and diagnose problems early.
Uterine fibroids are benign tumors that affect 75 to 90% of women in the world, with symptoms in only half of them. Many women have them and may never find out. They do not represent a major health risk and are treatable when accompanying symptoms that can cause discomfort.
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