Uterine Fibroids Booklet
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Conditions & treatment options.
- Breast disorders (non-cancerous)
- Breast cancer
- Depression & anxiety attacks
- Dyspareunia (painful intercourse)
- Early menopause
- Endometrial hyperplasia
- Estrogen dominance
- Fibrocystic breast disease
- Hot flashes
- Low libido in women
- Menorrhagia (heavy periods)
- Night sweats
- Oophorectomy (removal of the ovaries)
- Ovarian cysts
- Polycystic ovarian syndrome
- Post partum depression
- Premenstrual syndrome
- Turner's syndrome
- Uterine fibroids
- Vaginal dryness
Non-cancerous growths or lumps of muscle tissue that form within the walls of the uterus.
About the Condition
Fibroids are usually benign (non-cancerous) smooth muscle tumors which occur in the womb (uterus). They are also referred to as leiomyoma, leiomyomata, or myoma.
Fibroids usually occur in groups; it is uncommon to have just one fibroid tumor. They can grow inside the uterus, within its walls, or on its outer surface. Fibroids are the major cause of hysterectomies (removal of the womb).
Fibroids occur in about 50 per cent of women. Many women will go through life not even knowing that they have fibroids as they do not commonly cause symptoms.
Progesterone deficiency or estrogen dominance during reproductive the years results in fibroid development and growth. Fibroids diminish in size with declining estrogen levels at menopause.
Untreated fibroids will continue to grow under the influence of estrogen dominance.
Symptoms of Uterine Fibroids
Although 50% of all women may have fibroids, only 30% have pain due to fibroids. Symptoms of fibroids include:
- May affect the menstrual cycle or period, fertility, or be the cause of miscarriage or premature labor.
- Heavy or prolonged periods
- Iron deficiency (anaemia)
- Frequent urination or incontinence
- Pressure sensation on the bladder, bowel or back
- Constipation or difficult defecation (hard stools)
- Chronic low back or abdominal pain
- A lump or swelling in the abdomen
- Period pain
- Pain during pregnancy
- Complications during childbirth
- Painful sex
- Miscarriage or premature labor
Many fibroids are slow-growing, so symptoms may not develop until a woman is over 35, especially when the fibroids have enlarged to the same size as a three-month pregnancy – enough to interfere with menstruation and fertility.
Only 1 woman in 1,000 who has fibroids develops leiomyosarcoma, which is cancer of the muscle layer of the uterus. Affected women average 58 years old. It is extremely rare for younger women to develop cancer in conjunction with fibroids. Clues that you may have leiomyosarcoma are very quickly growing fibroids and postmenopausal bleeding.
If you were diagnosed with fibroids before menopause and experience vaginal bleeding after your periods have stopped for at least 12 consecutive months, then see your doctor as soon as possible.
Causes of Uterine Fibroids
Fibroids may be genetic; if women in your family have fibroids, you are more likely to have them, too. Fibroid growth is associated with too much estradiol, the most active form of estrogen hormone produced by the ovaries, and too little progesterone.
This hormonal imbalance is most common during perimenopause, which takes place from age 35 to 50 in most women. The reproductive systems of perimenopausal women are winding down towards the end of their childbearing years:
- Progesterone production post ovulation declines with ageing from the late 20’s onwards
- Sex hormone-binding globulin (SBHG) levels drop by 50% from age 25 to age 49, which allows estradiol to become more active on body tissues
- Inhibin levels in the ovaries drop, allowing Follicle Stimulating Hormone (FSH) levels from the pituitary gland in the brain to rise
- FSH signals more follicles in the ovaries to grow each cycle than is usual during the early reproductive years
- FSH builds slowly during perimenopause and peaks a year or two before the last menstrual cycle
- High levels of estradiol relative to progesterone or “estrogen dominance” causes fibroids to grow, causing heavy, irregular, unpredictable bleeding and sore, swollen breasts
- The ovaries’ overstimulation by FSH causes a quick drop in the number of follicles available to develop into a pregnancy and high levels of estradiol for several months to several years before menstruation finally stops
- Fluctuating hormones mean irregular ovulation and periods, and an increased chance of unplanned pregnancy
- The ovaries finally stop producing progesterone, which normally keeps the uterine lining (endometrium) thin
- High estradiol unopposed by progesterone allows the endometrium to thicken and it may become precancerous
- Low SHBG and high androgens become noticeable about two years before the last period as increased facial hair, male-pattern belly fat, and acne
- Estradiol lowers for a year or so prior to menopause and for a few years thereafter, causing hot flashes
- Postmenopausal women achieve a steady, low level of estradiol, which reduces the size of the fibroids that enlarged the uterus, but thins and dries out the vagina, causing pain on intercourse and susceptibility to infections
Fibroid growth is associated with too much estradiol, the most active form of estrogen hormone produced by the ovaries, and too little progesterone. This hormonal imbalance is most common during perimenopause, which takes place from age 35 to 50 in most women.
Tests: Ultrasound or laparoscopic examination.
Usually found during a gynaecological exam, ultrasound, hysteroscopy, laparoscopy, or during surgical procedures for other conditions.
Secondary Consideration: Fertility probably affects less than three per cent of women. In very rare instances, a fibroid may become cancerous and is called a sarcoma.
Treatments for Uterine Fibroids
If your fibroids cause no symptoms (are asymptomatic), then your doctor will probably adopt a course of watchful waiting. That means measuring the fibroids once every six months to their detect growth, and asking you if your periods have changed. Your doctor will probably advise you to leave your fibroids alone until they exceed 2.5 cm in size (less than one inch), or if they start to produce symptoms that degrade your quality of life.
If your fibroids are large, they pressurize your other internal organs, so you should give serious consideration to their removal if they are symptomatic.
Treatment options include:
- Your doctor may prescribe a daily iron tablet to prevent anemia from heavy bleeding.
- If you do not wish to conceive, your doctor may suggest you take combined birth control pills indefinitely to stop the rapid fluctuations of your hormones and estrogen dominance that encourage your fibroids to grow.
- Many women successfully control their fibroid symptoms with natural progesterone cream. This can relieve heavy bleeding associated with uterine fibroids and reduce the size of small and medium sized fibroids.
- If you are perimenopausal, anemic, and do not want surgery, you may opt for a gonadotropin-releasing hormone agonist (GnRH agonist).
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Topics discussed in the Understanding Uterine Fibroids booklet include:
- What are fibroids?
- What causes fibroids?
- Why are fibroids dangerous?
- What are the symptoms of fibroids?
- Who develops fibroids?
- How are fibroids classified?
- How are fibroids diagnosed?
- When do I need treatment?
- What is the first-line treatment?
- What is the second-line treatment?
- What is the third-line treatment?
- How are fibroids removed?
- How can I decrease my symptoms?
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