الأحد، 12 يونيو 2011

Uterine Fibroids


Overview, Causes, & Risk Factors

A uterine fibroid is a noncancerous growth in the wall of the uterus. A fibroid can be any size from microscopic to as large as a cantaloupe.
What is going on in the body?
Fibroids are firm, round lumps that often occur in groups on the uterine wall. They are made up of muscle and fibrous tissue. Fibroids usually grow very slowly in the wall of the uterus. They respond to increased levels of estrogen, one of the female hormones. Increased hormone levels in some conditions can increase the rate of the fibroid's growth. These conditions include the following:
  • hormone replacement therapy for menopause

  • oral contraceptives, or birth control pills

  • pregnancy


  • After menopause, fibroids may shrink or disappear completely.
    What are the causes and risks of the condition?
    No clear cause of uterine fibroids is known. Research indicates that fibroids may be influenced by estrogen and progesterone, but hormones are not the cause of fibroids. Fibroids are diagnosed in black women two to three times more often than in white women.

    Symptoms & Signs

    What are the signs and symptoms of the condition?
    Some women have no symptoms with uterine fibroids. Symptoms depend on the number, size, and location of fibroids. Some of the common symptoms are as follows:
  • anemia, or a low red blood cell count, from heavy bleeding

  • bleeding between periods

  • dyspareunia, or painful intercourse

  • frequent urination, caused by tumor pressure on the bladder

  • heavy or prolonged menstruation

  • pain or pressure in the lower abdomen or lower back


  • Diagnosis & Tests

    How is the condition diagnosed?
    Fibroids are very common, especially in women older than 35 years of age. They rarely become malignant or cancerous. Fibroids that grow near the outer surface of the uterus can be felt as lumps during a pelvic exam. Fibroids growing in the lining of the uterus may be harder to detect during a pelvic exam.
    The diagnosis can be confirmed by an ultrasound. Sometimes a dilation and curettage, or D & C, will be performed. This is a minor surgical procedure in which tissue is scraped from the inside of the uterus. A hysteroscopy, in which a fiberoptic tube is used to examine the inside of the uterus, may also be done. These procedures may be ordered to rule out other problems, such as uterine cancer or polyps.

    Prevention & Expectations

    What can be done to prevent the condition?
    Since the cause of uterine fibroids is not yet known, no way is known to prevent them.
    What are the long-term effects of the condition?
    Fibroids can make it difficult to conceive a baby. During pregnancy, a fibroid can cause a miscarriage or difficulty with delivery. A fibroid can also become twisted and need emergency surgery. Although rare, it is possible for a fibroid to become cancerous.
    What are the risks to others?
    Fibroids are not contagious. A fibroid may pose a risk to the fetus during pregnancy.

    Treatment & Monitoring

    What are the treatments for the condition?
    Most fibroids do not cause symptoms and don't need treatment. Sometimes, medicines are used to shrink the tumor by decreasing the level of estrogen in the blood.
    Women with symptoms like heavy bleeding and pain may need surgery. If the woman is not planning to have any more children, a hysterectomy may be recommended. This is surgery to remove the uterus. If the woman would like to become pregnant in the future, a myomectomy may be done instead. This is surgery to remove only the fibroid. The uterus is left intact.
    Another procedure that may be performed is an arterial embolization. A tube is threaded into a uterine artery. Small beads are injected into the artery leading to the tumor. This blocks the blood flow to the artery, shrinking the fibroid.
    Laser treatment, called myolysis, is another procedure used to destroy fibroids. The woman takes medication for 3 to 4 months to shrink the tumor before the laser treatment is done.
    What are the side effects of the treatments?
    Surgery carries a risk of bleeding, infection, and allergic reaction to anesthesia.
    What happens after treatment for the condition?
    If a hysterectomy was done, no more fibroids can develop. If the ovaries were removed with the uterus, hormone replacement therapy may be necessary. Fibroids do grow back about 10% of the time after a myomectomy.
    How is the condition monitored?
    Women with fibroids should be examined every 6 months to monitor the size of the fibroid. Any unusual symptoms or concerns should be reported to the healthcare provider.

    Attribution

    Author:Eileen McLaughlin, RN, BSN
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:07/31/01
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:07/09/01
    Sources
    Mayo Family Health Book, DE Larson, 1996.
    Understanding Your Body, F Stewart et al, 1987.
    Merck Manual of Medical Information, 1997.

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