Uterine Fibroids
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PAUL S. LIN
Uterine Fibroids Uterine fibroids are the most common of the noncancerous (benign) tumors of the uterus. The medical term that is synonymous with uterine fibroids is leiomyoma. The cause of fibroids is unknown. However, the hormone estrogen plays a dominant role, since fibroids and associated symptoms are prevalent during the reproductive years and decline during menopause. Fibroid-related symptoms resolve during the menopause and rarely occur during puberty or adolescence. The mean age group for symptoms related to fibroid tumors is between 30 and 50 years old. The incidence of uterine fibroids ranges from 10% to 50%. Factors affecting the incidence include age, race, genetics, and family history. Luckily, most women with uterine fibroids are asymptomatic. Some fibroids may undergo cancerous (malignant) transformation, but fortunately, this is rare. In fact, leiomyosarcoma (the cancerous change of fibroids) is detected in only 0.1% of women with fibroids. The uterus is normally about the size of a small lemon. There are three regions within the uterus: the inner wall (endometrium), the middle wall (myometrium), and the outer wall (serosal layers). Fibroids even though originating in the myometrium can extend to any or all of these regions. Fibroids are defined as an increase in the smooth muscle component of the uterus. Generally, those originating in the endometrium (called submucosal fibroids) or myometrium (called intramural fibroids) will result in changes within the menstrual cycle. Fibroids originating in the serosa and myometrium tend to be associated with symptoms of pressure on the bladder or the bowels. The size of fibroids can range from the size of a lentil pea to the size of a watermelon. Likewise, the weight may range from a few ounces to several pounds. Symptoms from uterine fibroids include changes in menstruation, pain, infertility, urinary pressure or urinary retention, constipation, backache, leg pain or swelling, dyspareunia (painful sexual intercourse), pregnancy-related complications, infertility, and increased abdominal girth. In the past, patients were often advised to undergo removal of all or part of the affected uterine tissue (myomectomy or hysterectomy) if the size of the uterus was greater than the size of a normal uterus at 12 weeks in pregnancy. This is no longer true. Today, the caveat is “if your fibroids don’t bother you, we don’t bother them.” Some patients can experience a range of menstrual complaints associated with fibroids. These include heavier cycles, blood clots, longer duration of menses, and irregular menstruation, constant vaginal discharge,
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Uterine Fibroids or episodic bloody/fluid (serosanguineous) discharge. Severely affected patients may decrease physical activities and miss work, due to incessant need to change sanitary pads and tampons. Patients who chronically suffer from heavier menstrual cycles may develop anemia (low blood counts) and fatigue. Other patients have symptoms related to pressure on the
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