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August 26, 2007
By age 50 many women have experienced Fibroids
By: Dr. S. Lawson
Uterine fibroids are benign (medically harmless) tumors of the uterus. These tumors result from abnormal growth of muscle cells and fibrous connective tissue in the uterus. By the age of 50 years old the overall incidence of fibroids are 70-80% for women. Fibroids can vary in size from being undetectable by human eyes to the size of a full term pregnancy. In studying the origin of fibroids, they have been linked to hormonal imbalance, obesity, xeno-estrrogen, heavy metal toxicity, infectious microorganisms, stress and high blood sugar level. Fibroids can cause complications such as menstrual problems, pelvic and lower back pain, constipation, urinary problems, hemorrhoids, infertility, ectopic pregnancy and miscarriages. Black women are four times more likely to develop fibroids than Caucasian women. They also have larger fibroids and develop fibroids at a younger age. Treatment includes hysterectomy, myomectomy, Uterine Artery Embolization (UAE), gonadatropin releasing hormones (GnRH) antagonists, androgens (danazol), and focused ultrasound surgery (FUS), and essential oils.
Signs and symptoms that presents with uterine fibroids include heavy menstrual bleeding, prolonged menstrual bleeding, bleeding between periods, period pain, urinary incontinence, urinary frequency, severe acute abdominal pain, constipation, hemorrhoids, anemia, back pain and leg pain.
Fibroids can be categorized into three types which include submucosal, myometrial and subserosal. Submucosal fibroids are located in the lining of the uterine cavity. Myometrial fibroids are located in the muscular layers of the uterus. Subserosal fibroids are located on the outer surface of the uterus. Fibroids can be detected by using pelvic examination, ultrasound, hysterosonography, hysteroscopy, hysterosalpingography.
Women who have excessive amounts of estrogen and insufficient amounts of progesterone are more predisposed to developing uterine fibroids. Women with excessive body fat are in an estrogen dominant state because fat tissues acts as an estrogen-producing organ similar to the ovaries and the adrenal gland. Estrogen is a inexhaustible hormone that stimulates DNA replication that in excess can stimulate the smooth muscle cells of the uterus to replicate excessively and cause the overgrowth of fibrous connective tissue resulting in fibroids. Xeno-estrogens are pesticides, herbicides, heavy metals, and other toxic substances that act similar to estrogen causing DNA dysfunction resulting in abnormal replication that causes fibroids. The excessive growth of these fibroids can cause submucosal irregularity resulting in dysmenorrhea and miscarriages.
Fibroids in the subserosal layer of the uterus can cause obstruction of the colon resulting in constipation and the formation of hemorrhoids (dilated veins located in the region of the anus). Branchlike fibroids in the submucosal and subserosal layers can twist on themselves cutting off their blood supply and causing severe abdominal pain that may require surgery. Excessive menstrual bleeding due to fibroids can result in anemia and its associated complications.
Hysterectomy is the most commonly used method of treating fibroids and can be performed vaginally or abdominally. The American College of Obstetrician and Gynecology suggest that vaginal hysterectomy is the most appropriate for women with benign diseases and mobile uteri that are less than 12 weeks gestation in size.
Myomectomy is the surgical removal of the actual fibrotic tissue without removing the uterus. Myomectomy can be approached by open abdominal surgery or laproscopically (small incision in the abdomen to insert remote control camera and miniature surgical devices are used to excise the fibroid) or vaginally removing the fibrotic tissue. Another method is the Uterine Artery Embolization (UAE). UAE is a procedure where a catheter is used to deliver small particles that block the blood supply to the fibroids.
GnRH is a peptide hormone that is used to down regulate the production of FSH and LH which results in the reduction of estrogen. Two examples of GnRH are lupron and synarel. Danazol, a synthetic androgen can be used to shrink fibroids, reduce anemia, and stop menstruation. Another treatment is the focused ultrasound surgery which was approved by the FDA in 2004. It is a non-invasive procedure that preserves the uterus where the patient is placed in a MRI scanner and is subject to focused high frequency, high energy ablation of the fibroid. However, the long term adverse effects of this high frequency, high energy waves are not known.