Intrauterine Myoma

OVERVIEW
A uterine fibroid is the most common benign (not cancerous) tumor of a woman's uterus (womb). Fibroids are tumors of the smooth muscle that is normally found in the wall of the uterus. They can develop within the uterine wall itself or attach to it. They may grow as a single tumor or in clusters. Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination; so even though they are termed "benign (not cancerous) tumors," fibroids potentially can cause many health problems.
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These growths occur in up to 50% of all women and are one leading cause of hysterectomy(removal of the uterus) in the United States. An estimated 600,000 hysterectomies are performed in the US annually, and at least one-third of these procedures are for fibroids. Medications and newer, less invasive surgical treatments are now available to help control the growth of fibroids. Fibroids start in the muscle tissues of the uterus. They can grow into the uterine cavity (submucosal), into the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subsersoal) into the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stalk off of the uterus). Although these tumors are called fibroids, this term is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma, a type of myoma or mesenchymal tumor.

Uterine Fibroid Causes

The exact reasons why some women develop fibroids are unknown. Fibroids tend to run in families, and affected women often have a family history of fibroids. Women of African descent are two to three times more likely to develop fibroids than women of other races. Fibroids grow in response to stimulation by the hormone estrogen, produced naturally in the body. These growths can show up as early as age 20 and shrink after menopause when the body stops producing large amounts of estrogen. Fibroids can be tiny and cause no problems, but they also can grow to weigh several pounds. Fibroids grow slowly. The following factors have been associated with the presence of fibroids:
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Being overweight, obesity

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Never having given birth to a child (called nulliparity) Onset of the menstrual period prior to age 10 African American heritage (occurring 3-9 times more often than in Caucasian women)

Uterine Fibroid Symptoms

Most fibroids, even large ones, produce no symptoms. These masses are often found during a regular pelvic examination. When women do experience symptoms, the most common are the following:
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irregular vaginal bleeding or an increase in menstrual bleeding, known as menorrhagia, sometimes with blood clots; pressure on the bladder, which may cause frequent urination and a sense of urgency to urinate and, rarely, the inability to urinate; pressure on the rectum, resulting inconstipation; pelvic pressure, "feeling full" in the lower abdomen, lower abdominal pain; increase in size around the waist and change in abdominal contour (some women may need to increase their clothing size but not because of a significant weight gain); infertility, which is defined as an inability to become pregnant after 1 year of attempting to get pregnant; and/or a pelvic mass discovered by a health care practitioner during a physical examination.

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When to Seek Medical Care

If a woman has any questions about her uterine health, seek medical assistance as soon as possible. If a woman has any of the following, she should notify her health care practitioner:
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Irregular or heavy menstrual cycle, bleeding between periods Pelvic or abdominal pain Fever or night sweats Increasing abdominal girth Concerns about pregnancy or inability to become pregnant

If a woman has any of the following signs or symptoms she should contact a health care practitioner immediately or go to a hospital's emergency department.
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Menstrual bleeding soaking through more than 3 pads per hour Severe or prolonged pelvic or abdominal pain Dizziness, lightheadedness, shortness of breath, or chest pain associated with vaginal bleeding Vaginal bleeding associated with pregnancy or possible pregnancy

Uterine Fibroids Treatment

Treatment for fibroids depends on the symptoms, the size and location of the fibroids, age (how close the person is to menopause), the patient's desire to have children, and the patient's general health.

*Medications
Patients may be given nonsteroidal anti-inflammatory drugs, oral contraceptives (birth control pills), gonadotropin releasing hormone agonists, or RU-486.
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Nonsteroidal anti-inflammatory agents, such as ibuprofen (Advil is one example), have been shown to relieve pelvic pain associated with fibroids. Oral contraceptive pills are also commonly used in women with fibroids. Although the hormones (including estrogen) in such birth control pills may increase the size of the fibroid, they often decrease perceived menstrual blood flow and help with pelvic pain. Gonadotropin releasing hormone (GnRH) agonists are medications that act on the pituitary gland to decrease estrogen produced by the body. A decrease in estrogen causes fibroids to decrease in size. This type of medication often is used prior to surgery to shrink the fibroid, to decrease the amount of blood loss during surgery, or to improve preoperative blood count. The size of the fibroid can be reduced by 50% in three months with of this type of therapy. But fibroids can regrow once treatment is stopped. Long-term therapy with these medications is limited by the side effects of low estrogen (much like menopause caused by drugs), which include decreased bone density, osteoporosis, hot flashes, and vaginal dryness. The antihormonal drug RU-486 (mifepristone) has also been shown to reduce fibroid size by about half. This drug has also been shown to reduce pelvic pain, bladder pressure, and lower back pain. Low doses of this drug may reduce the size of fibroids in preparation for surgery to remove them. It may also help some patients avoid surgery entirely by shrinking the fibroids and the problems they are causing. Side effects related to low estrogen, seen

with GnRH analogs, may be less common. RU-486 can induce miscarriage, so this medication should be used with caution if a woman is trying to conceive.
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The drug danazol (Danocrine) has been used to reduce bleeding in women with fibroids, since this drug causes menstruation to cease, but it does not shrink the size of fibroids. Danazol is an androgenic (male) hormonal drug that can cause serious side effects including weight gain, muscle cramps, decreased breast size, acne, hirsutism (inappropriate hair growth), oily skin, mood changes, depression, decreased high density lipoprotein (HDL or 'good cholesterol') levels, and increased liver enzyme levels. Another new drug may eventually be useful in treating some uterine fibroids. It is a progesterone receptor modulator named EllaOne. It is used in Europe as an emergency contraception drug but was found to shrink fibroids and reduce bleeding associate with fibroids. The drug is likely to be considered for FDA approval for use in the U.S. in the near future.

Uterine Fibroid Prevention

Women should avoid weight gain after age 18 and maintain a normal body weight compared to height. Body weight tends to increase estrogen production, thus aggravating fibroid growth. Exercise can help women control weight and additionally decrease hormone production that stimulates fibroid growth. Tobacco use has not been proven to be linked to an increase in fibroids. But quitting smokingwill improve general health and well being of women that have fibroids. Routine health visits with a health care practitioner may allow for early detection of fibroids.