Uterous Fibroids

A uterine fibroid is the most common benign (not cancerous) tumor of a woman’s uterus (womb). Fibroids are tumors of the smooth muscle found in the wall of the uterus. They can develop within the uterine wall itself or attach to it. They may grow as a single tumor or in clusters. Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination.

  • These growths occur in up to 50% of all women and are one leading cause of hysterectomy (removal of the uterus) in the United States. An estimated 600,000 hysterectomies are performed in the US annually, and at least one-third of these procedures are for fibroids. Medications and newer, less invasive surgical treatments are now available to help control the growth of fibroids.
  • Fibroids start in the muscle tissues of the uterus. They can grow into the uterine cavity (submucosal), into the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subsersoal) into the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stalk off of the uterus).
  • Although these tumors are called fibroids, this term is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma, a type of myoma or mesenchymal tumor.
Picture of uterine fibroids

What Causes Uterine Fibroids?

The exact reasons why some women develop fibroids are unknown. Fibroids tend to run in families, and affected women often have a family history of fibroids. Women of African descent are two to three times more likely to develop fibroids than women of other races.

Fibroids grow in response to stimulation by the hormone estrogen, produced naturally in the body. These growths can show up as early as age 20 but tend to shrink after menopause when the body stops producing large amounts of estrogen.

Fibroids can be tiny and cause no problems, or they also can grow to weigh several pounds. Fibroids generally tend to grow slowly.

The following factors have been associated with the presence of fibroids:

  • Being overweight, obesity
  • Never having given birth to a child (called nulliparity)
  • The onset of the menstrual period prior to age 10
  • African American heritage (occurring 3-9 times more often than in Caucasian women)

What Are the Symptoms of Uterine Fibroids?

Most fibroids, even large ones, produce no symptoms. These masses are often found during a regular pelvic examination.

When women do experience symptoms, the most common are the following:

  • an increase in menstrual bleeding, known as menorrhagia, sometimes with blood clots;
  • pressure on the bladder, which may cause frequent urination and a sense of urgency to urinate and, rarely, the inability to urinate;
  • pressure on the rectum, resulting in constipation;
  • pelvic pressure, “feeling full” in the lower abdomen, lower abdominal pain;
  • increase in size around the waist and change in abdominal contour (some women may need to increase their clothing size but not because of a significant weight gain);
  • infertility, which is defined as an inability to become pregnant after 1 year of attempting to get pregnant; and/or
  • a pelvic mass discovered by a healthcare practitioner during a physical examination.

 

When Should I Call the Doctor about Uterine Fibroids?

If a woman has any questions about her uterine health, seek medical assistance as soon as possible. If a woman has any of the following, she should notify her health care practitioner:

  • Irregular or heavy menstrual cycle, bleeding between periods
  • Pelvic or abdominal pain
  • Fever or night sweats
  • Increasing abdominal girth
  • Concerns about pregnancy or inability to become pregnant

If a woman has any of the following signs or symptoms she should contact a healthcare practitioner immediately or go to a hospital’s emergency department.

  • Menstrual bleeding soaking through more than 3 pads per hour
  • Severe or prolonged pelvic or abdominal pain
  • Dizziness, lightheadedness, shortness of breath, or chest pain associated with vaginal bleeding
  • Vaginal bleeding associated with pregnancy or possible pregnancy

Uterine Fibroid Symptoms

Common Symptoms of Uterine Fibroids

Most fibroids, even large ones, produce no symptoms; however, when women do experience symptoms, the most common are the following:

  • irregular vaginal bleeding;
  • pressure on the bladder, which may cause frequent urination;
  • pressure on the rectum, resulting in constipation;
  • pelvic pressure, “feeling full” in the lower abdomen, lower abdominal pain;
  • increase in size around the waist and change in abdominal contour…
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gynaecology

A Picture Guide to Uterine Fibroids

 

How Are Uterine Fibroids Diagnosed?

A woman’s health care practitioner will discuss her medical history and conduct a physical examination that includes a pelvic exam. Often a doctor can feel an irregularly shaped uterus when fibroids are present.

If further studies are indicated, the doctor may choose one of the following tests to help decide if the patient has fibroids and to exclude other and potentially more serious causes of ongoing symptoms:

  • An abdominal, transvaginal or pelvic ultrasound can help identify the number, size, and shape of most fibroids. These test uses sound waves to give doctors an image of the pelvic area. A wand is passed over the abdomen (abdominal ultrasound) for one type of view. Another probe (or wand) may be inserted into the vagina to obtain additional views (pelvic or transvaginal ultrasound).
  • An endometrial biopsy is performed by taking a tissue sample from the uterus. A small instrument is passed through the cervical opening to “grab” small samples of tissue inside the uterus. It can be performed at a doctor’s office.
  • A hysteroscopy looks inside the uterus by passing a small fiberoptic camera through the opening of the cervix.
  • Hysterosalpingography involves an injection of dye into the uterus and Fallopian tubes, which is then X-rayed to identify the anatomy of these structures.
  • Laparoscopy is a surgical procedure. The surgeon will insert a small fiberoptic camera into the abdomen through small abdominal incisions to look directly at internal organs.

 

What Is the Treatment for Uterine Fibroids?

Treatment for fibroids depends on the symptoms, the size and location of the fibroids, age (how close the person is to menopause), the patient’s desire to have children, and the patient’s general health.

 

Are there Home Remedies for Uterine Fibroids?

No specific self-care is available for fibroids. However, if a woman has abnormal or heavy menstrual bleeding, she should keep a diary of her menstrual cycle in order to provide the information to her health care practitioner.

 

What Is the Medical Treatment for Uterine Fibroids?

In most cases, treatment is not necessary, particularly if the woman has no symptoms, has small tumors, or has gone through menopause. Abnormal vaginal bleeding caused by fibroids may require surgical scraping of the uterine cavity in a procedure known as a dilation and curettage (D&C). If no malignancy (cancer) is found, this bleeding often can be controlled by hormonal medications. The following treatment options should be discussed with a healthcare practitioner.

Observation

The woman’s doctor may follow the size and growth of the fibroids over time to make sure no indicators of cancer are present. If the person does not have symptoms such as vaginal bleeding or pelvic pain, and if the fibroid is not growing rapidly, no treatment may be needed. Some patient may, however, require more frequent pelvic exams, such as every 6 months, to check on changes with the fibroid(s).

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Nephrology (from Greek nephros “kidney”, combined with the suffix -logy, “the study of”) is a specialty of medicine and pediatrics that concerns itself with the kidneys: the study of normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy (dialysis and kidney transplantation). Nephrology also studies systemic conditions that affect the kidneys, such as diabetes and autoimmune disease; and systemic diseases that occur as a result of kidney diseases, such as renal osteodystrophy and hypertension. A physician who has undertaken additional training and becomes certified in nephrology is called a nephrologist.

The term “nephrology” was first used in about 1960. Before then, the specialty was usually referred to as “kidney medicine.”

Scope

Nephrology concerns the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, and the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Many diseases affecting the kidney are systemic disorders not limited to the organ itself and may require special treatment. Examples include acquired conditions such as systemic vasculitides (e.g. ANCA vasculitis) and autoimmune diseases (e.g., lupus), as well as congenital or genetic conditions such as polycystic kidney disease.

Patients are referred to nephrology specialists after a urinalysis, for various reasons, such as acute kidney failure, chronic kidney disease, hematuria, proteinuria, kidney stones, hypertension, and disorders of acid/base or electrolytes.

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Nephrologist

A nephrologist is a physician who specializes in the care and treatment of kidney disease. Nephrology requires additional training to become an expert with advanced skills. Nephrologists may provide care to people without kidney problems and may work in general/internal medicine, transplant medicine, immunosuppression management, intensive care medicine, clinical pharmacology, perioperative medicine, or pediatric nephrology.

Nephrologists may further sub-specialize in dialysis, kidney transplantation, chronic kidney disease, cancer-related kidney diseases (Onconephrology), procedural nephrology or other non-nephrology areas as described above.

Procedures a nephrologist may perform include native kidney and transplant kidney biopsy, dialysis access insertion (temporary vascular access lines, tunnelled vascular access lines, peritoneal dialysis access lines), fistula management (angiographic or surgical fistulogram and plastic), and bone biopsy

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