UTERINE FIBROID (DISORDER OF THE FEMALE REPRODUCTIVE SYSTEM)

WHAT IS UTERINE FIBROID?

Uterine fibroid is an abnormal benign tumor growth on the muscular wall of the uterus, which is non-cancerous also known as leiomyoma, leiomyomata and myoma. They are onion like in structure, it varies in size due to their microscopic masses, it also occurs in more than one location in the uterus which can also fill up the entire uterine cavity. This disorder can affect women of all ages, but it is common in women aged between 35-50 years of age.

DIAGRAM OF UTERINE FIBROID

The Uterine fibroids consist of dense fibrous tissues, which are usually supplied by blood from the uterine artery, which occurs in three different locations:

  1. Submucosal Fibroids:  This type of fibroid is located in the endometrium of the uterus, inner layer and sometimes they also protrude inwards causing heavy bleeding and prolonged menstrual period. It can occur individually or in clusters.
  2. Subserousal Fibroids: This type of fibroid occurs in the outer layer of the uterus and protrudes outwards it causes pelvic pain and bladder pain. This fibroid grows in a thin stalk attached to the uterus also known as penduculated fibroid which causes severe pelvic pain because of the twists. 
  3. Intramural Fibroids: Intramural fibroid occurs in the muscular layer of the uterus, they grow large in size and cause protrusion of the abdomen which causes pelvic pain, discomfort and affects one health. It is the most common type of fibroid.

WHAT ARE CAUSES OF UTERINE FIBROIDS?

The cause of uterine fibroid is unknown but there are some associated factors which will be listed below:

  1. Hormonal variation that could cause the growth of fibroids to occur, when the progesterone and estrogen hormone is not balanced.
  2. Genetic changes which causes the growth of uterine fibroids.
  3. Having less than two children, it is believed that having more children reduces the risk of having fibroid.
  4. Excessive intake of alcohol especially beer which increases the risk of developing fibroid.
  5. Less intake of fruits, research has shown regular intake of citrus fruits prevents fibroid from occurring.
  6. Early occurrence of menstruation: because of the early production of hormone which is not regulated yet, could cause occurrence of fibroids.
  7. Vitamin D deficiency: less intake of food solid in vitamin D causes occurrence of fibroid, it is recommended that we take food rich in vitamin D which prevents the growth of fibroid cells.
  8. Stress
  9. Excessive use of relaxers: Relaxer contains high levels of phthalate, which disrupts the reproductive hormones. It is advised to use them not too often to reduce risk of having fibroids.
  10. Age: Women that are within 35-50 years of age, have higher risk of having fibroid.

SYMPTOMS OF UTERINE FIBROID

The symptoms of fibroid are listed below:

  1. Pelvic pain or pressure
  2. Heavy menstrual flow
  3. Prolonged menstrual periods for more than a week
  4. Bladder pain or pressure
  5. Backache or leg pain
  6. Frequent urination
  7. Constipation due to pressure on the bowel
  8. Abdominal swelling
  9. Weight gain
  10. Painful sexual intercourse
  11. Infertility
  12. Varicose veins on the back of the legs

HOW IS UTERINE FIBROIDS DIAGNOSED?

Uterine fibroids are diagnosed in the following ways:

  1. Ultrasonography: it is an imaging test, which uses sound waves to detect the mass of the fibroid in the uterine cavity. It can be done by either placing the transducer on the abdomen to get the images or the transvaginal inside the vagina to get the images, which can show presence of fibroid.
  2. Pelvic exam: Fibroid can be detected incidentally by the doctor, if there is any irregularity in the shape of the uterus during the pelvic examination.
  3. Magnetic Resonance Imaging: This imaging test gives detailed information about the location of the fibroid, size of the fibroid and the type of growth in the uterine cavity. It is mostly used in cases where the woman has enlarged uterus and approaching menopause.
  4. Hysterosonography: This test uses saline water to infuse the uterine cavity to make it enlarged, so as to detect the fibroids in the submucosal layer of the uterus. It is also done in women who have complains of failed pregnancy and heavy menstrual flow.
  5. Hysterosalpingography: In this test the examiner makes use of dye to highlight the uterine cavity an fallopian tubes, it is mostly done to detect causes of infertility ad can also detect submucosal fibroids.
  6. Laboratory test:  Complete blood count sometimes is carried out to rule out anemia if there is history of bleeding and know the specific cause of the bleeding.

TREATMENT OF UTERINE FIBROIDS

Treatment of fibroid can be done using:

  1. Medical Therapy
  2. Surgical Therapy

Medical Therapy

Depending on the Symptoms presented by the individual, the health care personnel may suggest medical treatments which are listed below:

  1. Over the counter pain medications: for the pain felt in an individual with fibroid, Non-steroidal anti-inflammatory drugs like paracetamol is prescribed for the relieve of pain.
  2. Intra uterine device (Progestin-releasing): it is prescribed to reduce heavy bleeding during menstruation in women with very large fibroids. It is not used to treat fibroid itself it is just used so as to relieve pain for women with painful bleeding.
  3. Hormone Modulators or anti hormonal agents (Progesterone receptor modulators):  it is used to stop or reduce the growth of fibroids, reduce bleeding and improve symptoms. Examples are mifepristone, lextrozole and ulipristal acetate.
  4. Gonadotropin-releasing hormone agonists (GnRHa): This class of drug helps in the reduction in growth of fibroid and it blocks the hormones in the woman body that causes the woman not to ovulate. The side effects associated with this drug can be harmful so its advisable not to be on it for long term use. It causes bone loss, mimics menopause signs like hot flushes, night sweats and vagina dryness.

Surgical therapy

The surgical therapies towards treating fibroids are listed below:

  1. Fibroid radiofrequency ablation: It makes use of two important instruments which are the Acessa and Sonata. The technique used is introducing a probe into the uterine cavity to identify the fibroids, accompanied with a metallic device which is inserted and shrinks the fibroid totally with minimal bleeding by inducing coagulative necrosis.
  2. Myomectomy: It is the removal of the uterine fibroid completely and still keeping the womb intact if the woman wants to still continue childbearing process. It could be done in three ways but all under anesthesia. The ways are: Hysteroscopy, laparoscopy and Abdominal Laparotomy (mainly for women with large fibroids).
  3. Hysterectomy: This procedure is the total removal of the uterus and the fibroid, women who don’t want to continue the child bearing process; most women opt out for this procedure. The surgeons leave the cervix and the ovaries in place so as to ensure that hormones can still be produced.

This surgery is done in three ways depending on the type of fibroid one has, the types of surgeries are listed below:

Vagina hysterectomy: Removing the uterus through the vagina which doesn’t work for people with big fibroids

Abdominal hysterectomy: Removing the uterus by making a cut in the lower abdomen, mostly done for big fibroids

Laparoscopic hysterectomy: The surgeon inserts the instruments and removes the uterus through small incision. For this procedure, it takes 6-8weeks for the individual to heal completely.

    Hysterectomy is the only cure to removing uterine fibroids completely, but the disadvantage is the woman won’t be able to conceive anymore.  

COMPLICATIONS OF FIBROID

The complications of fibroid are listed below:

  1. Anemia due to the heavy bleeding
  2. Chronic pain
  3. Infertility
  4. Torsion of fibroids
  5. Miscarriages

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