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Uterine fibroids are benign growths that occur within the uterus usually during the midpoint of a woman’s childbearing years. While they may cause some initial concern, they are not cancerous and do not always require medical intervention except in serious cases. Many women are not aware of a fibroid until it is discovered in a routine gynecological exam. Uterine fibroids can be confined to the inner lining of the uterus or may bulge outward into the surrounding body cavity. Some smaller fibroids may present problems for a woman trying to have a child and may require surgical removal before a successful pregnancy can happen. Excessively large fibroids are relatively rare, although they can cause more severe discomfort and possible health compilations if left untreated. A woman experiencing at least one symptom of a fibroid for a noticeable length of time should discuss it with her gynecologist.
The most common symptom of a possible uterine fibroid is heavy menstruation in a woman who has previously had shorter, more manageable cycles for a number of years. Menstruation can be heavy during for a few years after first beginning in the early teens, but suddenly heavy and long periods in an older premenopausal woman may indicate the possibility of a uterine fibroid. Heavy menstrual bleeding does not automatically indicate a fibroid; it may also be a result of normal hormone fluctuations or even diet changes in some women. Menstruation that is abnormally painful or lasts longer than seven or eight days should be reported to a gynecologist.
Larger uterine fibroids that project outwards can often press on other organs and cause additional symptoms. Persistent pelvic pain with difficulty passing urine or moving bowels may indicate a fibroid placing pressure on the bladder or rectum. Some of these uterine fibroids may also press against the lower sections of the spinal cord. These often cause back pain that does not go away with normal home remedies such as over-the-counter pain medicine or the use of a heating pad.
Uterine fibroids vary widely in size and growth rate. Some are so small and confined to the inner uterine tissue that they are difficult to detect. Others can grow large enough to stretch and significantly expand the uterus. Fibroids begin with single-cell replication in the smooth uterine muscle and may grow slowly over several years depending on individual cases. This replication’s exact cause is unknown, but medical professionals conclude that a few different health factors may contribute to uterine fibroids.
Hormones are thought to have a definite role in the growth of fibroids. Estrogen and progesterone feed uterine fibroids, and researchers have found an abnormally high number of these hormone receptors in biopsies of larger fibroids that required surgical excision. Minute genetic mutations within the uterine muscle cells are also possible causes of this abnormal cell replication. A woman with a family history of uterine fibroids usually has a higher chance of developing a fibroid as well. Some evidence suggests that women who have never had children may have a higher risk of uterine fibroids, but different medical researchers debate this factor.
Treatments for large and pain-inducing fibroids consist of several options such as hormone therapy and surgery. Injections of drugs known as gonadotropin releasing hormone agonists (GRHAs) are effective at reducing the size of excessively large fibroids. One notable side effect is that these medications cut off the flows of estrogen and progesterone to the fibroids, essentially “starving” the growths. Doctors intending to surgically remove large fibroids often prescribe a course of GRHA treatment beforehand to make the fibroids less difficult to remove and reduce the associated risks of surgery such as blood loss. GRHAs induce some temporary menopausal symptoms including depression and hot flashes, although these usually pass following the end of the GRHA treatment.
Surgery for serious cases of uterine fibroids can include excision of only the fibroids or of the uterus itself in the most severe cases. Other procedures may be required to remove the uterine lining in cases of both large fibroids and of severe menstrual bleeding that alternate methods are unable to control. Operations for fibroid removal include can include, a myomectomy, an endometrial ablation, or a hysterectomy in cases of multiple large fibroids that are too severe for other surgical options.
A myomectomy is the best possible option for a woman with fibroids who wants to be able to bear children in the future. Surgeons often perform this procedure through laparoscopy whenever possible because it carries a lower risk of complications from open abdominal surgery. Healing time from this kind of laparoscopic surgery is typically shorter as well. A woman is determined to be a good candidate for a myomectomy depending on the number, size, and locations of the existing fibroids.
An endometrial ablation is an out-patient procedure usually reserved for uterine fibroids that are confined to the inner cavity of the uterus and do not bulge outward. This treatment option involves cutting away the uterine lining along with the fibroids with the use of a surgical laser or a traditional surgeon’s cutting instrument. This procedure has one of the fastest recovery times, and complications are rare. A woman who has opted for endometrial ablation is unable to become pregnant after the procedure, so this treatment is normally reserved for fibroid patients who are close to menopause or who definitely do not want children at a future date.
A hysterectomy is a major operation that entails removal of the entire uterus along with the fibroids. Doctors usually recommend this option as a last resort in cases of uterine fibroids that are abnormally large and that are causing severe pain. Some of these rare fibroids can grow larger than grapefruits and present some of the most serious prognoses. Most surgeons recommend a vaginal hysterectomy if the size of the fibroids permits, but often the only option involves cutting into the abdomen and removing the expanded uterus in sections. The ovaries are normally left in younger women who have not yet undergone menopause. A hysterectomy carries a longer recovery time and is also the only definite cure for severe uterine fibroids.
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