Myomas are benign growths of the uterus and commonly known as uterine tumors. Smaller fibroids are harmless and rarely require medical treatment. However, if symptoms develop, a visit to the doctor is essential to keep fibroids under control and remove them if necessary.
What is a fibroid?
A fibroid is a benign growth that grows slowly in the muscle wall of the uterus. Myomas do not metastasize and may grow or bulge in the wall of the uterus. A smaller fibroid is about the size of a pea. The size of an orange is also not uncommon. In extreme cases, the size of a fibroid can simulate pregnancy. A myoma develops from muscle fibers and enlarges due to hormonal influence. More than 20% of all women are affected by fibroids. It most often affects women between the ages of 35 and 55. In less than one percent of all cases, a fibroid can be malignant.
Causes
Why a fibroid develops cannot be clearly defined. It has been proven that fibroids can be partially inherited. Likewise, it is considered certain that the sex hormone estradiol plays a role in the development of fibroids. Myomas do not appear in girls before puberty. They only grow when the body has an elevated estrogen level. This is the case, for example, during pregnancy or when taking hormone preparations. During menopause, the estrogen level decreases and causes the fibroids to shrink. Myomas no longer appear in women after menopause.
Symptoms, complaints and signs
Fibroids cause different symptoms, depending on their size and location. If they are still small, they often do not cause any symptoms at all and are therefore only discovered by chance. The most common symptom is pain, which can increase to extremely severe, labor-like cramps, usually during the menstrual phase. Depending on their location, it is possible that fibroids exert pressure on nerves, which can lead to pain that radiates to the legs or back. Unpleasant painful pressure may be felt during physical exertion or sexual intercourse. Large fibroids may constrict the bladder or bowel and cause increased urination or constipation. Rarely, it happens that the urethra is completely squeezed off and urination is no longer possible. This would require immediate medical attention. Extremely large fibroids can increase the abdominal girth. In addition, bleeding disorders develop. The period may be unusually heavy because the bleeding vessels are prevented by the growths from closing again quickly enough. Menstruation often lasts longer than normal. The amount of blood excreted is markedly increased, sometimes passing in gushes. Due to the increased blood loss, the blood iron level drops and iron deficiency develops. Typical signs include fatigue, listlessness, palpitations, pale skin color, brittle nails and hair loss.
Diagnosis and course
Infographic on the different types of fibroids. Click image to enlarge. A smaller fibroid often goes unnoticed and is discovered only by chance during routine examinations. If menstrual cramps or spotting or continuous bleeding occur, a doctor should be consulted. He or she will first perform a gynecological examination. A fibroid can often be felt by palpation. Ultrasound or a cell examination, in which a smear is taken, bring certainty. If a uteroscopy is performed, a special endoscope is inserted into the uterus through the vagina. The uterus is filled with gas and illuminated. A smaller fibroid will not cause any symptoms. If the fibroid is larger, it may cause pain or complications with menstruation. Larger fibroids change the shape of the uterus. In pregnant women, the fetus is forced into unusual positions. It can lead to miscarriages. Likewise, a fibroid can put pressure on the rectum and urinary bladder.
Complications
A uterine fibroid can cause a variety of symptoms. First and foremost, women suffer from disruptions of the menstrual cycle and thus relatively severe period pains. These can also lead to mood swings and thus significantly reduce the quality of life of those affected. Furthermore, there is also dizziness and pallor. Those affected appear fatigued and weak and also suffer from circulatory problems.It is not uncommon for loss of consciousness to occur. Especially in pregnant women, a uterine tumor can be a serious complication and, in the worst case, lead to a miscarriage. In most cases, no specific treatment is necessary for a uterine tumor. However, those affected depend on regular visits and checkups with a gynecologist. In some cases, the uterine tumor must also be surgically removed. However, there are no complications and the patient’s life expectancy is not reduced. The uterine tumor may recur even after the treatment. In many cases, the fibroid can also be treated with the help of medication.
When should you go to the doctor?
Disorders and irregularities of menstruation in a sexually mature woman should be clarified by a doctor. If bleeding or spotting occurs outside the normal menstrual cycle, a follow-up visit to a physician should be made. If discomfort occurs during sexual intercourse, there is cause for concern. Pain, a feeling of pressure or a pulling sensation in the lower abdomen should be examined and treated. Disturbances of the digestive tract, diarrhea or constipation are signs of health impairment. A visit to the doctor is necessary as soon as the complaints persist over a longer period of time or they increase in extent as well as intensity. In case of swelling in the abdomen, palpable lumps or changes in the appearance of the skin, the symptoms should be presented to a doctor. If there is a decrease in general performance, faintness or internal weakness, a doctor is needed. Palpitations or irregularities of the heart rhythm should be discussed with a physician. States of anxiety, an inner insecurity, sleep disturbances or changes in urination are indications that should be further observed. If they have a constant occurrence, consultation with a physician is advised. A pale appearance, sudden hair loss or irregularities of the finger or toenails should be checked by a doctor. Various tests will be performed to determine the cause so that treatment can be initiated to alleviate the symptoms.
Treatment and therapy
A small fibroid does not necessarily need to be treated. Regular check-ups by the gynecologist are sufficient. Removal of a smaller fibroid can be done during a uterine endoscopy. For this rather unpleasant procedure, the patient receives local anesthesia or anesthesia. Larger fibroids require surgical removal through an incision in the abdomen. If multiple fibroids have formed, the entire uterus often needs to be removed. A larger fibroid can be made to shrink by administering hormones. After that, surgical removal is possible, and the uterus can be preserved. In special clinics, a new method is making a splash. Here, the fibroid is shrunk by blocking the surrounding blood vessels. This is done by injection. The type of therapy can depend on various factors. These include the size and location of the growth, the symptoms caused, or the age of the patient and the associated status of family planning. Therapy is usually aimed at preserving the uterus. However, if the fibroid is proliferating severely and causing great pain, uterus removal is often unavoidable.
New drug treatment options
Hormone treatment with GnRH analogues, which has been tried and tested for many years, is now supplemented by the new therapy for symptomatic uterine fibroids with the active substance ulipristal acetate. It is taken in tablet form. Indications include the preoperative treatment of moderate and severe symptoms – such as lower abdominal discomfort, fatigue or pain – as well as long-term treatment. One tablet is taken daily for a period of up to twelve weeks. If necessary, the treatment can be repeated; there is no time limit for this. The active ingredient ulipristal acetate reduces the volume of the fibroids and thus also the associated discomfort. This means that surgical intervention can often be avoided. The aforementioned long-term therapy is best suited for women who are still pre-menopausal and who want to get through menopause without surgery. Once menopause is over, the risk of fibroids also diminishes.These no longer grow due to the reduction of the hormones progesterone and estrogen. In addition, long-term therapy is also suitable for women who complain of severe symptoms, want to control them effectively and permanently, and who have not yet completed their family planning.
The mode of action of the tablet
Ulipristal acetate belongs to the selective progesterone receptor modulators, so the active substance is used for causal drug therapy. This directly influences the cause of the disease. Not only are the symptoms alleviated, the aim is also to bring about healing. The activity of progesterone, a hormone that occurs naturally in the body, is inhibited by ulipristal acetate. However, the drug itself is not a hormone, which means that it is well tolerated and leads to permanent and rapid relief of symptoms. Bleeding is reduced or stopped altogether, fibroids become smaller, and pain subsides.
Outlook and prognosis
The course of the disease depends on the size and location of the tumor. Affected patients should go for regular checkups with their gynecologist, thus avoiding complications. This applies even if fibroids do not show any symptoms. Urinary tract infections and pain during urination can occur if the tumor presses on the bladder. Also, dysfunction of the bladder, intestines as well as kidneys may occur if the tumor presses on the organs. In the case of heavy or prolonged menstrual bleeding, anemia often occurs as a result of iron deficiency. Furthermore, there are problems with fertility as well as during pregnancy. Basically, however, the myoma is not an obstacle to pregnancy. This is because infertility only occurs in a few cases, for example if the tumor is located in front of a fallopian tube. In pregnancy, the myoma can cause different problems. As an estrogen-dependent tumor, a fibroid grows faster during pregnancy because the body then produces more sex hormones. The increasing size and location of the fibroid can cause pain. Positional abnormalities of the unborn child may also occur or even block the birth canal. In addition, premature labor may occur. Myoma has been shown to increase premature birth and miscarriage rates. If the tumor grows in the uterine cavity or under the lining of the uterus, miscarriage and ectopic pregnancies can occur.
Prevention
There are no known preventive measures against fibroid. Women between the ages of 35 and 55 should attend biannual checkups with their gynecologist. Palpation examinations and ultrasound can detect a fibroid at an early stage. In this way, complications can be eliminated that may arise if the fibroid is detected too late. Once a fibroid has been removed, the patient is not immune to this growth. A fibroid can recur at any time. Women who have already had problems with a fibroid and consider their family planning complete should think about having the uterus removed. A fibroid grows only in the muscles of the uterus and thus cannot recur in patients who have undergone surgery.
Follow-up care
Most often, a fibroid is not treated because it has a small size and does not cause acute discomfort. Doctors instead choose to monitor the benign tumor as part of follow-up care. This is done for two reasons: On the one hand, the fibroid can grow and thus disrupt the function of other organs. On the other hand, scientists assume that in a fraction of cases the myoma degenerates and then tends to metastasize. Follow-up care therefore serves to prevent complications. The doctor and patient agree on a quarterly or half-yearly rhythm. In addition to a palpation examination, an ultrasound examination also takes place. Doctors believe that diagnosing a change at an early stage brings the best chances of cure. Therefore, the scheduled examinations must be conscientiously adhered to. If the doctor and patient decide to remove a fibroid, follow-up care is also indicated. The aim of this is to remedy any subsequent symptoms of the operation and to prevent the tumor from recurring. This is because the uterine tumor can form again under certain circumstances. The scope of follow-up is the same as described above. Participation in rehabilitation immediately after surgery may be necessary.In addition, patients should of course see their doctor immediately if acute problems arise.
What you can do yourself
Since fibroids do not usually pose a health risk, symptoms can be alleviated with self-treatment. Depending on the severity and duration of symptoms, prompt medical consultation is advised. If fibroids are present, regular gynecological examinations should be performed. Usually fibroids cause more severe symptoms during menstruation and a few days before. In order to counteract cramping pain, it is recommended to avoid alcohol and salty foods – as they dehydrate the body – and to increase fluid intake to compensate. This also counteracts frequently occurring circulatory problems. Coffee and dairy products also put a strain on the body and should be reduced. Some women suffer from an iron deficiency due to fibroids. Here, the consumption of green leafy vegetables (chard, kale, nettle, herbs) or the intake of a ready-made preparation as available in pharmacies helps. Also, taking magnesium has been found to relieve symptoms. Nuts, avocados, algae and legumes provide important vitamin B, which is also effective against muscle cramps. To help the body in the healing process, stress avoidance and light exercise are paramount. Alternative healing methods such as acupuncture, acupressure or aromatherapy can also help. Local heat application with heating pads or warm compresses relaxes the muscles of the uterus and provides holistic relaxation. St. John’s wort oil can be added to a tub bath.