Fibroids (Recent And Orthodox Discoveries)

Medical and Health Science Project and Seminar Material

Fibroids (Recent And Orthodox Discoveries)


Chapter One


1.0 Introduction

1.1 Fibroids

Fibroids are lumps that grow on the inside and outside walls of a woman’s uterus. They are considered the most common pelvic tumor which affects one in five women of childbearing age.

A fibroid is a leiomyoma (benign (non-cancerous) tumor from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus (Cucinella et al., 2011). Fibroids are often multiple and if the uterus contains too many leiomyomata to count, it is referred to as diffuse uterine leiomyomatosis. The malignant version of a fibroid is extremely uncommon and termed a leiomyosarcoma. Other common names are uterine leiomyoma, myoma, fibromyoma, fibroleiomyoma (Boynton-Jarrettn et al., 2005). Fibroids are the most common benign tumors in females and typically found during the middle and later reproductive years. While most fibroids are asymptomatic, they can grow and cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. Some fibroids may interfere with pregnancy although this appears to be very rare.

In the United States, symptoms caused by uterine fibroids are a very frequent indication for hysterectomy. The effects of fibroids have been known to cause infertility and miscarriages in women, resulting in both physical and emotional distress. The main method of getting rid of fibroids are medical procedures, however some seems to think the holistic approach is better. A mind over matter approach seems to be highly recommended for treating fibroids naturally.

Fibroids tend to be more common in African American women than in women of other racial groups. Studies have shown that fibroids are three times more likely to occur in African American women than in Caucasian women (Cucinella et al., 2011). African American women are not only at a greater risk of developing fibroid tumors, their growths tend to be larger. According to one study, an estimated 80% of African American women are affected by fibroid tumors by age 60. It is also estimated that these tumors cause symptoms in half of all African American women by age 50, compared to 30% in Caucasian women (Cucinella et al., 2011).

Uterine fibroids may occur singly but most often are multiple and vary in size from an unnoticeable few millimetres to over 20 cm in diameter, significantly enlarging the abdominal cavity. They are named according to their location. Intramural fibroids lie wholly within the uterine walls, submucosal fibroids project into the uterine cavity and subserosal fibroids project from the outer surface of the uterus. They may also be pedunculated, where they are attached to the uterine wall by a stalk-like structure (Galvin et al., 2010).

The aetiology and pathogenesis of fibroids are not fully understood, but their occurrence during the female reproductive lifespan indicates an association with the hormones oestrogen and progesterone. The prevalence of clinically significant fibroids peaks in the peri-menopausal years, declining after the menopause. Known risk factors for fibroids include early menarche, nulliparity, later reproductive years, obesity, Afro- Caribbean ethnic origin and tamoxifen (Massart et al., 2003).

Conversely, menopause, increasing parity and smoking reduce the risk. There is thought to be a genetic element to the development of fibroids suggested by biochemical and epidemiological evidence. Fibroids appear to be 2–3-fold more common in first-degree relatives of women with fibroids, compared with the general population.


1.2 Signs and Symptoms of Fibroids

Fibroids, particularly when small, may be entirely asymptomatic. Symptoms depend on the location of the lesion and its size. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, painful defecation, back ache, urinary frequency or retention, and in some cases, infertility. There may also be pain during intercourse, depending on the location of the fibroid. During pregnancy they may be the cause of miscarriage, bleeding, premature labor, or interference with the position of the fetus (Wallach et al., 2004). While fibroids are common, they are not a typical cause for infertility accounting for about 3% of reasons why a woman may not have a child. Typically in such cases a fibroid is located in a submucosal position and it is thought that this location may interfere with the function of the lining and the ability of the embryo to implant. Also larger fibroids may distort or block the fallopian tubes (Zhang et al., 2008).

The most common symptoms of fibroids are;

Menstrual discomfort – Periods may be abnormally heavy and last more than a week. Some women are concerned about socially embarrassing bleeding and hesitate to engage in their normal activities. Bleeding may be severe enough to cause anemia. Bleeding between periods – Submucosal fibroids are most likely to cause abnormal bleeding, but any bleeding between periods should be checked by a physician (Alhendy and Salama, 2006). Leg, back, or pelvic pain or pressure – A fibroid increases the size of the uterus, sometimes to the size of a 4 or 5 month pregnancy. The enlarged uterus is often “lumpy” and presses on nearby structures such as the bladder and lower intestine, causing constipation or frequent urination. Difficulty conceiving or miscarriage – Most women with fibroids do not have fertility problems, but sometimes fibroids make it more difficult to become pregnant by natural methods. Fibroids large enough to significantly change the shape of the uterine cavity can be associated with miscarriage, premature labor, and complications of labor (Cesen-Cummings et al., 2003).


1.3 Causes of Fibroids

Some factors leading to fibroid growth are;

Hormones: Fibroids are associated with increased estrogen production. They are rare in women less than 20 years of age as well as in postmenopausal women. Estrogen levels vary with menstruation, with menopause, and with some medications Environment: Alcohol consumption and a sedentary lifestyle have been associated with fibroids. Researchers are investigating how environmental toxins affect gene activity in the uterus (Fischer et al., 2010). BMI: Women who are overweight or obese, based on their BMI (body-mass index), have a slightly higher risk of developing fibroids. Pregnancy: Women who have given birth seem to have a lower risk of developing uterine fibroids. Recent information indicates that pregnancy may protect against fibroids – one theory is that fibroids are lost during the uterine changes (involution) in the weeks following childbirth. Ethnicity: Not only are African-American women more likely to develop fibroids, their fibroids occur at a younger age, and are often larger and more numerous than in other ethnic groups. Asian women have a lower incidence of symptomatic fibroids (Garg et al., 2011).


1.4 Epidemiology

Globally approximately 235 million people are affected with uterine fibroids as of 2010 (6.6% of females). About 20–40% of women will be diagnosed with leiomyoma at some point in their life but only a fraction of those will cause problems or require treatment.

Leiomyomata are more common in obese women. Fibroids are dependent on estrogen and progesterone to grow and therefore relevant only during the reproductive years, they are expected to shrink after menopause. Uterine leiomyomas are the most common pelvic tumor in women. A hysterectomy study found myomas in 77 percent of uterine specimens.

The epidemiology of leiomyomas parallels the ontogeny and life cycle changes of the reproductive hormones estrogen and progesterone. Although the growth of fibroids is responsive to gonadal steroids, these hormones are not necessarily responsible for the genesis of the tumors. Leiomyomas have not been described in prepubertal girls, but they are occasionally noted in adolescents. Myomas are clinically apparent in approximately 12 to 25 percent of reproductive age women and noted on pathological examination in approximately 80 percent of surgically excised uteri. In hysterectomy specimens sectioned at 2-mm intervals, premenopausal women had an average 7.6 fibroids. Most, but not all, women have shrinkage of leiomyomas at menopause.

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