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Fibroid : symptoms, risks, treatment

by Josephine Andrews
Published: Last Updated on 228 views

fibroid is a benign tumor that develops from muscle cells. The term fibroid is often used synonymously for uterine myoma. Fibroids in the uterus are the most common benign tumors in women. They are not dangerous in themselves, but in some cases they cause unpleasant discomfort and serious complications. Read here what fibroids are, about symptoms, their treatment and prognosis.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

C49 D21 N85 D25

quick overview

  • Course of the disease and prognosis: Depends on the location and size of the fibroid; mostly good prognosis; complications possible
  • Symptoms: Depending on size, number and location; sometimes without symptoms, sometimes increased menstrual bleeding, pain, fertility problems
  • Treatment: No treatment if there are no symptoms; otherwise: medicinal, surgical and other invasive treatment methods
  • Examination and diagnosis: Ultrasound examination (sonography), if necessary additional examination (eg if anemia is suspected)
  • Causes and risk factors: Unclear, possibly genetic predisposition, hormonal influences

What is a fibroid?

A fibroid is a tumor that develops from muscle cells. Depending on which type of muscle cell is affected, a distinction is made between:

  • Leiomyoma : It develops from smooth muscle cells. These are found in the internal organs, for example in the uterus (uterine fibroids), in the kidneys and in the gastrointestinal tract.
  • Rhabdomyoma : It develops from striated muscle found on the heart and skeletal muscles.
  • Fibroleiomyoma : This tumor also develops from smooth muscle cells, but also contains parts of connective tissue.

Myoma is a benign tumor. Benign means that the tumors grow slowly. They do not penetrate the surrounding tissue – they just displace it. In contrast to malignant tumors (cancer), benign tumors do not form secondary tumors (metastases).

Fibroids therefore do not harbor the same dangers as malignant cancerous tumors. Nevertheless, they sometimes affect the quality of life of those affected or cause serious complications.

Fibroids: classification according to location

Depending on where a fibroid develops in the uterus and in which direction it expands, doctors differentiate between different types of fibroids:

  • Subserous fibroid: It sits on the outside of the uterus and grows outward from the muscular layer of the uterine wall into the “outer” layer (serosa or peritoneum). Sometimes subserous fibroids are pedunculated. If the fibroid rotates around its own axis on the stem, this leads to complications.
  • Intramural fibroid: Here the fibroid only grows inside the muscular layer of the uterus. This type of fibroid is the most common.
  • Transmural fibroid: Here the fibroid develops from all layers of the uterus.
  • Submucosal fibroids: This rather rare and often small type of fibroid grows from the muscular layer of the uterus into the lining of the uterus (endometrium). This usually leads to bleeding disorders.
  • Intraligamentous fibroids: This type of fibroid develops in the connective tissue adjacent to the uterus.
  • Cervical myoma: This relatively rare type of myoma develops in the muscular layer of the neck of the womb (cervix).

What is a uterine myomatosus?

Fibroids in the uterus occur either singly or in large numbers. If only a single tumor is present, specialists speak of a solitary fibroid. If several fibroids form at the same time, there is a so-called uterus myomatosus. This is usually greatly enlarged and leads to complications.

facts and figures

A leiomyoma of the uterus (uterine myoma) is the most common benign tumor in the female genital tract. About ten to 20 percent of all women over the age of 30 have a myoma in the uterus. Fibroids usually develop between the ages of 35 and 50. Before the age of 25 they are very rare.

About 25 percent of all affected women have no symptoms from the fibroid. The rest have more or less severe symptoms. The fibroid symptoms sometimes require a hospital stay.

How dangerous are uterine fibroids?

The course of the disease with a fibroid depends on the location and size of the benign tumor. Accordingly, the symptoms and complications vary in severity. In order to avoid complications, it is advisable to have regular check-ups at the gynecologist.

Possible complications include:

  • Urinary tract infections and pain when urinating when the fibroid presses on the bladder/ureter
  • Functional disorders of the bladder, intestines or kidneys if the fibroid presses on these organs
  • Anemia with heavy and/or prolonged menstrual bleeding due to iron deficiency (iron deficiency anemia)
  • Sudden pedicle rotation in a pedunculated subserous fibroid, severe pain and the need for rapid surgery
  • Problems with fertility or during pregnancy

Fibroid & Pregnancy

In principle, a fibroid in the uterus is not an obstacle to pregnancy. Only in rare cases do affected women experience fertility problems, for example if the fibroid is in front of the fallopian tubes .

Various problems can be caused by a fibroid during pregnancy. As estrogen-dependent tumors, fibroids grow faster during pregnancy because the body then produces more of the sex hormones.

Due to their increasing size and location, fibroids sometimes cause pain, cause the child to have anomalies (such as breech presentation), or block the birth canal. A caesarean section is sometimes necessary. Preterm labor is also possible. Fibroids have been shown to increase the rate of premature birth and miscarriage.

If the fibroid grows directly under the uterine lining or in the uterine cavity, there is a risk of an ectopic pregnancy in addition to the risk of a miscarriage.

No risk of cancer

Experts now assume that no cancer (sarcoma) will develop from a fibroid. Genetic studies suggest that a sarcoma develops independently of a fibroid.

Nevertheless, it makes sense to have gynecological check-ups regularly. Complications caused by a fibroid can thus be recognized and treated at an early stage.

What are the symptoms of a fibroid?

Fibroids cause no symptoms in about a quarter of affected women. The gynecologist often discovers the benign tumor in the uterus by accident during a routine examination.

In all other cases, fibroids cause symptoms. What these are and how severe they are depends on the size and location of the fibroid.

Common signs of a fibroid are:

  • Bleeding disorders: Fibroids sometimes cause increased menstrual bleeding (hypermenorrhoea), increased and prolonged menstrual bleeding (menorrhagia) and bleeding between periods outside of the menstrual cycle (metrorrhagia).
  • Violent, sometimes labor-like, pains during menstruation. In the case of severe bleeding caused by fibroids, blood clots sometimes form, the elimination of which is accompanied by cramps.

Less common symptoms of a fibroid are:

  • abdominal pain
  • Swollen abdomen (in case of large fibroids)
  • Back pain and/or leg pain if the fibroid presses on sites in the spinal cord where nerves exit.
  • kidney or side pain
  • Strong urge to urinate when the fibroid presses on the adjacent bladder
  • Constipation (constipation) when the fibroid presses on the adjacent rectum
  • pain during sexual intercourse

Which examinations can be used to detect a fibroid?

Symptoms such as increased menstruation or an increased urge to urinate are sometimes an indication of a uterine myoma. In order to investigate such a suspicion, the gynecologist first inquires in detail about existing symptoms and any previous illnesses ( anamnesis ).

After the medical history has been taken, a gynecological examination follows: once through the vagina and once simultaneously through the rectum and over the abdominal wall. A larger fibroid or several fibroids can usually be felt (uterus myomatosus).

The suspected myoma can usually be confirmed with the ultrasound examination (sonography). This allows the exact position and size of the fibroid or fibroids to be determined. The ultrasound examination is carried out either via the abdominal wall or – more frequently – via the vagina (vaginal sonography).

If the ultrasound does not provide an exact diagnosis, the doctor may perform a reflection of the uterus (hysteroscopy) or the abdomen (laparoscopy) .

If the fibroid is pressing on the ureter, it may be necessary to examine the kidneys and urinary tract using ultrasound and an X-ray with contrast medium ( pyelogram ).

If the test results are unclear, the doctor sometimes orders a magnetic resonance imaging (MRI) . If necessary, a blood test (if anemia is suspected) and a measurement of the hormone level are also carried out.

Which treatment is suitable for a fibroid?

As long as fibroids do not cause any symptoms, treatment is usually not necessary. However, it is advisable to have a gynecological check-up every six to twelve months. The doctor then precisely assesses the fibroid, uterus and any symptoms.

As soon as symptoms or complications occur as a result of a fibroid (or multiple fibroids), there are various treatment options available. Decisive in the choice of therapy are, among other things, the age of the woman, family planning, type and extent of the symptoms as well as the location and size of the fibroid.

Basically, fibroids can be treated with drugs (GnRH antagonists), surgically (myomectomy) or by means of special procedures (embolization, focused ultrasound). In extreme cases, removal of the uterus is a treatment option.

medication

There are various options for treating fibroids with medication. The aim is that the fibroids no longer grow due to the preparations used and may even shrink. Therefore, all preparations act at the hormonal level.

progestins

Progestins are hormones that are also found in many birth control pills. They are an antagonist of the sex hormone estrogen. In many cases, treatment with progestins slows the growth of fibroids and sometimes even shrinks fibroids.

This reduces the discomfort and simplifies subsequent surgery. The inhibitory effect of the progestins on the growth of the lining of the uterus also usually reduces the strength of the menstrual period.

GnRH analogues

GnRH analogues imitate a specific control hormone for the female hormonal balance: gonadoliberin (also known as gonadotropin-releasing hormone, GnRH). It stimulates the pituitary gland ( pituitary gland ) to release gonadotropins in spurts. These hormones in turn stimulate the ovaries to produce estrogen.

However, when GnRH analogues are used continuously, estrogen levels drop. As the GnRH analogs are consistently stimulating, the pituitary becomes less and less responsive. As a result, it makes fewer gonadotropins, which reduces estrogen production.

The fibroid is no longer stimulated to grow and ideally even shrinks.

ulipristal acetate

The selective progesterone receptor modulator ulipristal acetate inhibits the progesterone docking sites of myoma cells. The fibroid cells thus lack an important growth stimulus: the fibroids shrink and fibroid-related bleeding subsides.

However, there is a risk that the drug will damage the liver. The European Medicines Agency (EMA) therefore only recommends ulipristal acetate for premenopausal women in whom surgery is not possible or has not been successful.

However, according to the Committee for Risk Assessment in the Field of Drug Safety (PRAC), ulipristal acetate is no longer suitable for generally alleviating fibroid symptoms.

  • In women taking the preparation, the doctor will check the liver function at least once a month and measure the liver values ​​​​in the blood. If they are conspicuous, the fibroid medication is discontinued and the liver function is monitored for a while.
  • If there are signs of liver damage, it is important to see a doctor immediately. Warning symptoms include upper abdominal pain, nausea, vomiting, loss of appetite, tiredness and yellowing of the skin or eyes.

The active ingredient ulipristal acetate is also contained in the morning-after pill . But this is only taken once. In this context, there have been no reports of possible liver damage to date. The EMA warning therefore only applies to the ulipristal preparation for the treatment of fibroids.

Surgical treatment

In the case of a very large fibroid, severe symptoms caused by the benign tumor or multiple fibroids (uterus myomatosus), surgery is the method of choice. Even if it is not clear whether it is a malignant tumor (sarcoma), an operation is necessary.

In most cases, the entire uterus is removed ( hysterectomy ) , usually via the vagina, an abdominal incision or a laparoscopy.

If the fibroid is small and the woman wants to have children, the doctor may try to remove fibroids in isolation. This is done by peeling out the fibroids (fibroid nucleation) . Depending on the type of fibroid, different procedures can be used.

For example, the fibroid can be removed via an abdominal incision or via the vagina. In addition, laparoscopic removal has increased significantly in recent years. Three small punctures are made in the abdominal wall before the doctor cuts out the fibroid with a long, narrow tube (the laparoscope).

embolization

Another method of treating fibroids in the uterus is percutaneous transcatheter embolization. The doctor closes the blood vessels that supply the fibroid with nutrients. As a result, fibroids regress – ideally within six months to a maximum of one year.

focused ultrasound

In the case of fibroids that are in a favorable location, another treatment option can be considered: focused ultrasound. The patient lies prone over a sound source. High-frequency sound waves emanate from this and are aimed precisely at the fibroid.

The focusing of the sound waves creates such great heat at this point that the fibroid dies. It is then broken down by the cells of the immune system. This treatment takes about three hours and is very expensive. Since the procedure is relatively new, health insurance companies usually do not cover the costs.

What is the cause of a fibroid?

How exactly a fibroid occurs in the uterus is still unknown. Scientists suspect that the female hormone estrogen plays an important role in this. Estrogen causes the growth of the mucous membrane that lines the inside of the uterus (endometrium).

It also affects the growth of the muscle layer in the wall of the uterus. A dysregulation may be responsible for the leiomyoma of the uterus. When estrogen production decreases after menopause (climacteric), fibroids usually no longer appear. Existing fibroids often stop growing during the menopause or even regress.

genetic cause for the development of fibroids is also being discussed. Fibroids occur more frequently in certain families. In addition, according to studies, women with African roots are about nine times more likely to develop a fibroid than European women. A single gene is said to be responsible for the development of myomas.

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