FIBROID TUMORS OF THE UTERUS

General Information

DEFINITION--An abnormal, benign (noncancerous) growth of cells in the muscular wall of the uterus (myometrium). It is a common disorder in women. The term "fibroids" is misleading. The cells are not fibrous; they are composed of abnormal muscle cells. They can grow to the size of a cantaloupe.

BODY PARTS INVOLVED--Uterus; cervix (sometimes).

SEX OR AGE MOST AFFECTED--Fibroids affect 20% to 40% of all women over 35. They don't develop after menopause.

SIGNS & SYMPTOMS

• No symptoms (often).
• More frequent menstruation, frequently associated with large clots and discomfort.
• Increased menstrual flow and discomfort.
• Bleeding between periods.
• Painful sexual intercourse or bleeding after intercourse.
• Anemia (weakness, fatigue and paleness).
• Feelings of pressure on the urinary bladder or rectum.
• Increased vaginal discharge (rare).

CAUSES--Exact cause is unknown. Estrogen is required for their stimulation and growth, as they are rare in prepubertal girls or menopausal women.

RISK INCREASES WITH

• Use of oral contraceptives.
• Genetic factors. Fibroid tumors are 3 to 5 times more common in black women than Caucasian women.

HOW TO PREVENT--Cannot be prevented at present, but avoiding the use of oral contra-ceptives decreases risk of developing fibroids.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory studies, such as ultrasound, laparoscopy or hysterogram (See Glossary).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• For minimal symptoms, no treatment may be needed and you will be re-examined in 3-6 months.
• Surgery may be recommended for certain situations and different surgical options are possible, depending on whether or not reproductivity is desired.

POSSIBLE COMPLICATIONS

• Complications can occur in pregnancy such as spontaneous abortion and premature labor.
• Fibroids may return following surgery to remove them.
• Malignant change in the fibroid tumor (occurs in less than 0.5%). This rare complication is usually signaled by very rapid growth.

PROBABLE OUTCOME--If surgery is not necessary prior to menopause, these tumors usually decrease in size without treatment after menopause. Fibroids can often be removed surgically without removing the entire uterus. The ability to conceive continues as long as the uterus remains.

How To Treat

GENERAL MEASURES--

• Be sure you understand all the options concerning treatment and you decide with your doctor what you want to do.
• For minimal symptoms, no treatment may be needed and you will be re-examined in 3-6 months.
• Record dates of bleeding and number of pads used each day.

MEDICATION--

• If you have a small fibroid, don't take contraceptive pills with a high estrogen content. Estrogen may cause fibroids to enlarge. Consider other forms of contraception, such as a diaphragm, cervical cap, IUD, condom or contraceptive foam, sponge or jelly.
• Danazol to stem heavy menstrual bleeding.
• Your doctor may prescribe: Iron supplements if you are anemic from excessive blood loss. A gonadotropin releasing hormone. It will induce an abrupt, artificial menopause that will stop the bleeding and reduce the size of the fibroid. Should not be used for longer than 6 months.

ACTIVITY--No restrictions unless surgery performed. Then you may need bed rest for a period of time, some restricted activity and no sexual intercourse for approximately one month.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of a fibroid tumor.
• A fibroid tumor has been diagnosed, and symptoms become more severe.
• You saturate a pad or tampon more often than once an hour.