A uterine fibroid is a common type of benign (non-cancerous) tumor that develops within the uterine wall. Uterine fibroids may grow as a single tumor or in clusters. They often increase in size and frequency with age, but then revert in size after menopause. While not all women with fibroids experience symptoms, symptoms may include excessive menstrual bleeding, pelvic pain and infertility. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure.
- Myomas are rarely found in puberty, and they generally cease to grow after menopause.
- New myomas rarely appear after menopause.
- The associations of fibroids in women with hyperoestrogenism is evidenced by endometrial hyperplasia, dysfunctional metropathia bleeding and endometrial carcinoma.
- Myomas are known to increase in size during pregnancy and with oral contraceptives.
- Progesterone inhibits the growth of myomas. Relatively large doses of progestogens orally for 14 to 21 days of the cycle cause shrinkage of the tumour. GnRH also causes shrinkage of the tumour.
Most fibroids don’t cause symptoms—only 10 to 20 percent of women who have fibroids require treatment. Depending on size, location and number of fibroids, they may cause:
- Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots; this can lead to anemia
- Pelvic pain and pressure
- Pain in the back and legs
- Pain during sexual intercourse
- Bladder pressure leading to a frequent urge to urinate
- Pressure on the bowel, leading to constipation and bloating
- Abnormally enlarged abdomen
The following investigations may be carried out:
- Hysterosalpingography and Sonosalpingography identifies a submucous myoma and checks the patency of fallopian tubes in infertility.
- MRI may be used in addition to ultrasound to evaluate women with fibroids. MRI is sometimes better able to delineate the location of a myoma or differentiate a myoma from adenomyosis.
Fibroids and Pregnancy
A small number of pregnant women have uterine fibroids. If you are pregnant and have fibroids, they likely will not cause problems for you or your baby.
During pregnancy, fibroids may increase in size. Most of this growth occurs from blood flowing to the uterus. Combined with the extra demands placed on the body by pregnancy, the growth of fibroids may cause discomfort, feelings of pressure, or pain. Fibroids can increase the risk of:
- miscarriage (in which the pregnancy ends before 20 weeks)
- preterm birth
- breech birth (in which the baby is born in a position other than head down)
There are no proven measures you can take to prevent fibroids from developing. Studies show that athletic women seem to be less likely to develop fibroids than women who are obese or who don’t exercise.
- Howkins & Bourne : Shaw’s Textbook of Gynaecology .