Why do fibroids develop
Fibroids or Uterine fibroids are tumours that originate in the womb, medically termed the uterus. Fibroids arise from a layer of the wall of the womb where smooth muscles are found.
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Fibroids are usually round or semi-round in shape and are often described based upon their location within the uterus.
Subserosal fibroids are located beneath the outermost lining of the womb. These often appear on the outer surface of the uterus or may be attached to the outside surface by a stalk.
Submucosal fibroids are located inside the uterine cavity beneath the lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus.
No one knows exactly why women develop these tumours. Proposed theories include genetic abnormalities, alterations in growth factors - proteins formed in the body that direct the rate and extent of cell division, abnormalities in the blood vessel system, and tissue response to injury but none can be said to be the exact cause.
Family history is important as there is often a history of fibroids developing in the family.
Race also appears to play a role. In this respect, women of African descent are two to three times more likely to develop fibroids than women of other races.
Women of African ancestry also develop fibroids at a younger age and may have symptoms from fibroids in their 20s, in contrast to Caucasian women with fibroids, in whom symptoms typically occur during the 30s and 40s.
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Other factors that researchers have associated with an increased risk of developing fibroids include having the first menstrual period (menarche) before age 10, consumption of alcohol (particularly beer), infections of the womb and hypertension. The female hormone estrogen tends to stimulate the growth of fibroids in many cases.
During the first trimester of pregnancy, up to 30per cent of fibroids will enlarge and then shrink after the birth.
In general, fibroids tend to shrink after menopause. Pregnancy and oral contraceptives have both been noticed to decrease the likelihood of developing fibroids. .
Most of the time, uterine fibroids do not cause symptoms or problems, and a woman with a fibroid is usually unaware of its presence. However, abnormal uterine bleeding is the most common symptom.
If the tumours are near the uterine lining, or interfere with the blood flow to the lining, they can cause heavy periods, painful periods, prolonged periods or spotting between menses.
Uterine fibroids that are deteriorating can sometimes cause severe, localised pain.
Fibroids can also cause a number of symptoms depending on their size, location within the uterus and how close they are to other organs around the womb.
They can cause pain in the lower abdomen, exert pressure on the bladder with frequent or even obstructed urination, and pressure on the rectum with pain during defeacation.
Fibroids do not interfere with ovulation however some studies suggest that the submucosal ones can impair fertility and lead to poorer pregnancy outcomes.
For the most part, uterine fibroids that do not cause a problem for the woman can be left alone. In some cases, even fibroids that are not causing symptoms require removal or at least close observation.
Rapid growth is a reason to watch more carefully, since a very rare (less than 1per cent) cancerous form of fibroid is usually a fast-growing tumour, and it cannot be differentiated from a benign fibroid by ultrasound, MRI , or other imaging studies.
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Another risk of leaving these tumours alone is that they sometimes grow to a size that eventually causes significant symptoms, thus requiring removal.
If fibroids grow large enough, the surgery to remove them can become more difficult and risky.
Occasionally, fibroids are the cause of recurrent miscarriages. If they are not removed in these cases, the woman may not be able to sustain a pregnancy.
Other techniques of dealing with fibroid without resorting to surgery are usually hormonal in nature and include the use of drugs that turn off the production of estrogen from the ovaries.
These medications are given for three to six months to reduce estrogen production. When successful, they can shrink the fibroids by as much as 50per cent.
This drug causes menstruation to cease but does not appear to shrink the size of fibroids.
Low dose formulations of oral contraceptives are also sometimes given to treat the abnormal bleeding associated with fibroids, but these do not shrink the fibroids themselves.
Use of oral contraceptive pills has been associated with a decreased risk of developing fibroids, so some women may benefit from their use for this purpose.
The preferred modality of treatment of fibroids, if causing severe symptoms is to remove them. This may be done by removing the fibroids alone, or removal of the entire uterus.
The decision to do one or the other is taken in lieu of the symptoms, age, number of children and the risk of keeping it.