Approximately 50 to 70 percent of all women of childbearing age will suffer from a uterine fibroid during their lifetime. Myomas are also the most common cause of uterine removals at this age.
What is a uterine fibroid?
The term uterine fibroid, also known as a uterine tumor, refers to a benign growth in the uterine muscle layer. Myomas are composed proportionately of connective tissue and can develop a size up to several centimeters. As growth progresses, they can even fill the entire uterus as in pregnancy. A uterine fibroid is a hormone-dependent growth and is stimulated to grow by estrogen. Therefore, growth is dependent on intact function of the ovaries, where sex hormones are produced. Therefore, uterine fibroids occur only during a woman’s childbearing years and usually slowly regress during menopause.
Causes
Exactly how a uterine fibroid develops has not yet been adequately researched scientifically, but it is considered certain that there is a connection between estrogen balance and the appearance of hormones. The benign tumor develops from cells of the muscles in the uterus. It is not unlikely that they arise from a surge of energy normally provided by the body for pregnancy. There also seems to be a genetic predisposition, because uterine fibroids are clustered in families where the mother already suffered from fibroids. It is also known that high estrogen levels promote the growth of fibroids and that they occur mainly during the period of conception. Before puberty fibroids do not appear and during menopause they recede.
Symptoms, complaints and signs
The symptoms and discomfort caused by a fibroid depend greatly on what size it is and whether one or more fibroids are present. Prolonged menstrual bleeding may occur, and the amount of bleeding usually depends on the size and location of the fibroid. Some women may experience anemia from the increased bleeding. Other symptoms can include feelings of pressure and discomfort in the abdomen because the fibroid can press on other organs. In the bladder, this can lead to a stronger urge to urinate or disturbances in bladder emptying. If the fibroid presses on the rectum, constipation is favored. Discomfort during sexual intercourse is also common. Women with fibroids who want to have children often do not become pregnant because the fibroid can prevent implantation of the fertilized egg in the uterus. When fibroids grow during pregnancy, they can cause miscarriage, discomfort during pregnancy, and preterm labor.
Diagnosis and course of the disease
In most cases, uterine fibroids are detected during a gynecologic examination. Sometimes, the history interview already yields a suspicion. The interview is followed by a physical examination, and if a fibroid is suspected, an ultrasound examination, in which fibroids can be easily identified. The size and location can also be determined precisely. In addition, other examinations such as magnetic resonance imaging (MRI) or computer tomography (CT) can sometimes be performed, especially if fibroids need to be surgically removed. A hysteroscopy (endoscopy of the uterus) can examine fibroids that protrude into the uterus in more detail. If they grow into the abdomen, a laparoscopy can provide information. In most cases, however, this is not necessary. It is not easy to distinguish benign uterine tumors from malignant ones. In most cases, a tissue examination is necessary for this purpose.
Complications
A uterine fibroid is usually harmless and does not result in any other symptoms. Complications can occur if there is a so-called uterus myomatosus, meaning that the uterine wall is riddled with numerous fibroids. This increases the risk of malignant degeneration, which occurs rather rarely in a classic uterine fibroid (in less than one percent of all those affected). Furthermore, a uterine fibroid favors urinary tract infections and occasionally causes pain during urination. If the myoma presses on the urinary bladder or ureters, functional disorders can occur. Involvement of the intestines and kidneys also carries the risk of sensitive organ dysfunction.In the case of a pedunculated suberous fibroid, sudden stalk rotation may occur, associated with severe pain and serious complications that require rapid surgery. In the long term, a uterine fibroid can cause fertility problems. If the growth occurs during pregnancy, there is a risk of preterm labor. Above a certain size, fibroids can also cause positional abnormalities of the baby. If the uterine fibroid is located directly under the endometrium, this can cause an ectopic pregnancy or miscarriage. There are typical risks associated with surgical or drug removal. Surgery can always result in infection and injury. Drug therapy is associated with the risk of side effects and interactions.
When should you see a doctor?
In the case of uterine fibroid, the affected person is usually always in need of medical treatment by a doctor. Since this disease cannot heal on its own, a doctor must be contacted at the first signs and symptoms to prevent further complications. Early diagnosis usually has a positive effect on the further course of the disease. A doctor should be consulted in the case of uterine fibroid if the woman suffers from a significantly prolonged menstrual period. This can also be very irregular, which can have a negative effect on the psyche. Many women also suffer from anemia as a result of the disease. In many cases, severe pain in the abdomen or pain during sexual intercourse can also indicate this disease and should also be examined by a doctor. Some women continue to suffer from pain during urination. Uterine fibroid can be treated by a general practitioner or by a gynecologist. Usually, this disease can be treated well, so that there are no further complications and also no reduced life expectancy of the affected person.
Treatment and therapy
If there are no complaints, fibroid treatment is not necessarily required, but there should be a check-up approximately every six to twelve months. If there are complaints, the therapy depends on various factors such as the age of the woman or whether there is still a desire to have children or family planning has been completed. The size and location of the uterine fibroid is also decisive. Basically, fibroids can be treated with different methods: surgically, with medication or newer methods such as embolization or focused ultrasound. In younger women, uterus-preserving measures are preferred; in older women with completed family planning, the common therapy is usually removal of the uterus (hysterectomy). In the case of drug treatment, progestins are most commonly used for treatment to reduce the body’s production of estrogen and inhibit fibroid growth so that symptoms decrease. If a fibroid is very small and there is still a desire to have a child, it is also possible to excise individual fibroids, either through a small abdominal incision, vaginal or a laparoscopic procedure. Embolization involves occlusion of the blood vessels, which ideally leads to regression of the fibroid. In focused ultrasound, beams are directed at the site where the fibroid is located. The resulting heat is said to cause the fibroid to die. However, this procedure is still new, very expensive and often not covered by health insurance.
Prevention
Meaningful prevention is not possible for uterine fibroid. Women of childbearing age should attend regular checkups so that fibroids can be detected early. Early treatment can prevent worse symptoms from undetected fibroids. Even if surgery has been performed, it does not mean that fibroids can no longer occur. They can always grow again because they are located in the uterine muscles. Only surgery can prevent them from forming again.
Aftercare
Usually, a uterine fibroid is not treated because it is mostly small and does not cause discomfort. However, it is monitored regularly and consistently during follow-up. Typically, affected women should see a gynecologist for checkups at intervals of about three to six months. The attending physician decides on the exact time intervals. In exceptional cases, shorter or longer intervals between follow-up examinations may be necessary.This depends above all on any previous gynecological diseases. On the one hand, these checks examine whether the uterine fibroid is growing and possibly affecting other organs in the process. On the other hand, the potential development of a malignant tumor should be detected in time. However, this happens only in extremely rare cases. Usually, the gynecologist performs both palpation and ultrasound examination. Rarely, other measures such as blood tests are common. After surgical removal of a uterine fibroid, strict follow-up examinations are also necessary. In the first few weeks after the procedure, these are used to address any subsequent symptoms from the surgery. In addition, quarterly or semi-annual check-ups with the gynecologist are performed to check whether new uterine fibroids may form. The procedure is similar to that already described.
What you can do yourself
Uterine fibroids do not necessarily need to be treated. If clinical symptoms occur, the gynecologist should be consulted. The individual therapy options can be supported by the affected person through self-help measures. In the case of drug therapy, first and foremost the intake of the medication should be adhered to. Any hormonal complaints should be reported to the doctor. Affected women should also take it easy and pay careful attention to possible side effects and interactions. Drug treatment is usually carried out in preparation for surgery. After an operation, rest is again important. If the pain persists, natural herbal remedies can help, such as pain-relieving teas with valerian or cooling and warming compresses applied to the lower abdomen. If the fibroids are treated by focused ultrasound, no further self-help measures are necessary. The most important measure is to observe the physical symptoms. After one or two weeks, the gynecologist must be consulted again. If the fibroid has shrunk as desired, the treatment can be repeated. Accompanying general relaxation measures help to reduce the stress of the treatments and to improve the well-being beyond the therapy. If interstitial bleeding or pain persists, the physician should be informed.
