Why should women know about fibroids?
About 70 percent of black women develop fibroids by the time they reach menopause. The vast majority of women with fibroids go through life, have their children without knowing they harbor fibroids in their wombs. These women with fibroids have no symptoms of their condition. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing constipation and rectal pressure or discomfort. Occasionally, the fibroids get very large and can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.
Growth and location are the main factors that determine if a fibroid leads to symptoms and problems. A small lesion can be symptomatic if located within the uterine cavity while a large lesion on the outside of the uterus may go unnoticed. Different locations are classified as follows:
- Intramural fibroids are located within the wall of the uterus and are the most common type; unless large, they may be asymptomatic. Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity.
- Subserosal fibroids are located underneath the mucosal (peritoneal) surface of the uterus and can become very large. They can also grow out in a papillary manner to become pedunculated fibroids. These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma.
- Submucosal fibroids are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesion in this location may lead to bleeding and infertility. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix.
- Cervical fibroids are located in the wall of the cervix (neck of the uterus). Rarely fibroids are found in the supporting structures (round ligament, broad ligament, or uterosacral ligament) of the uterus that also contain smooth muscle tissue.
- Most fibroids start in an intramural location, that is the layer of the muscle of the uterus. With further growth, some lesions may develop towards the outside of the uterus or towards the internal cavity. Secondary changes may develop within fibroids. Fibroids may undergo hemorrhage, necrosis, calcification, and cystic changes.
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.
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.
Leiomyomata grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance on histological section. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall.
Majority of fibroids do not cause problems to the patients but some present with complications . some of these are outlined below:
Menorrhagia
Large uterine fibroids can lead to menorrhagia (heavy menstrual bleeding),
During a normal menstrual cycle , you may lose 30 to 44 milliliters of blood within 4 to 5 days. With menorrhagia, you may lose approximately 81 or greater milliliters of blood within 4 to 5 days. Signs of heavy menstrual bleeding include soaking one or more tampons or sanitary pads every hour. Your menstrual cycle may last for more than seven days and you may notice large blood clot formations. Excessive blood loss can lead to anemia , a condition that can lead to fainting episodes and easy fatigue.
PATHOLOGICAL CAUSES OF INFERTILITY*
The most classic example of a pathological process in the uterus that can cause infertility is the existence of fibroids. About 3 to 4 percent of infertility is traceable to the presence of fibroids in the female. The size and location of the fibroid determine its effect on fertility
Other conditions existing in the uterus that can impair fertility include adenomyosis, polyps and chronic infections called endometritis. The aging endometrium should also be considered when there is failed endometrial implantation.
Large uterine fibroids can lead to miscarriages or infertility. Large uterine fibroids can affect your womb's ability to carry a growing baby. In some instances, the fibroids may grow near your ovaries and affect your ability to successfully release an egg during ovulation. Fibroids can also exert contiguous pressure to occlude the fallopian tubes. Intracavitary submucous fibroids can cause miscarriages at any stage of pregnancy depending on the size and location of the fibroids.
Painful Sexual Intercourse
Large uterine fibroids can lead to painful sexual intercourse, medically known as dyspareunia. Burning, aching and a deep pain are some symptoms of dyspareunia.
Pain and Pressure
Large uterine fibroids can cause excruciating pain in your stomach or lower back. This pain can be heavy, dull or sharp. These fibroids may compress your bladder and cause urinary problems such as frequent or difficult urination or compression of the ureters causing hydronephrosis. Large uterine fibroids can interfere with your digestive tract and cause bloating, rectal pain and constipation.