Causes of uterine fibroids And Treatments

 

Since fibroids usually do not pose a health risk, symptoms can be alleviated by self-treatment. Depending on the severity and duration of the symptoms, a prompt medical consultation is advisable. In the case of existing fibroids, a regular gynecological examination should be carried out.

Fibroids usually cause more severe symptoms around the time of menstrual bleeding and a few days before. In order to counteract spasmodic pain, it is recommended to avoid alcohol and salty foods - as they remove water from the body - and to compensate for increased fluid intake beforehand. This also counteracts frequently occurring circulatory problems. Coffee and dairy products also put a strain on the body and should be reduced. Some women are iron deficient due to fibroids. Eating green leafy vegetables (chard, kale, nettle, herbs) or taking a ready-made preparation like the ones available in pharmacies can help here is available. It was also possible to determine that the symptoms were alleviated by taking magnesium. Nuts, avocados, algae and legumes provide important vitamin B, which also works against muscle cramps.

In order to support the body in the healing process, stress avoidance and light exercise are the top priorities. Alternative healing methods such as acupuncture, acupressure, or aromatherapy can also help. The local application of heat with heating pads or warm compresses relaxes the musculature of the uterus and ensures holistic relaxation. 

                             A uterine fibroid is a benign muscular growth of the uterus consisting mainly of muscle and connective tissue cells. Fibroids can be a few millimeters to a few centimeters in size.

Fibroids most commonly affects women after the age of 30: almost a third of women of childbearing age develop a fibroid. The most common type of fibroid is the intramural fibroid (90%), which arises in the muscular layer inside the uterus.

 

Causes of uterine fibroids  

 

The causes of the development of fibroids have not been fully clarified, but a genetic predisposition on the one hand and hormonal reasons on the other are considered to be certain. The growth of uterine fibroids is stimulated by the hormone estrogen and, to a lesser extent, progesterone. For example, during pregnancy, the increased estrogen level promotes fibroid growth, while the hormone progestin inhibits growth. After menopause, the significantly lower estrogen levels cause fibroids to shrink and regress. Fibroids, therefore, do not develop after menopause if none have previously developed.

 

Symptoms of uterine fibroids

 

Depending on the type, location and size, fibroids can show different symptoms. The most common complaints are:

·         Heavy menstrual bleeding (hypermenorrhea)

·         Bleeding disorders, intermenstrual bleeding

·         menstrual pain that can progress to labor-like pains

·         Formation of blood clots during heavy bleeding

·         Spasms in the area of ​​the uterus

·         urge to urinate

·         Feeling of pressure on the bladder or kidney

·         back or sciatic pain

 

Types of uterine fibroids

 

Basically, doctors differentiate between 3 types of fibroids, which, depending on their size, cause different symptoms and each requires different therapies:

TYPE OF MYOMA	SYMPTOMS	THERAPY	IMPACT ON FAMILY PLANNING
INTRAMURAL fibroids inside the uterus, most commonly in the muscular layer (90%)	bleeding disorders menstrual pain pain when urinating Back pain (when the fibroid presses on nerve endings)	Hysteroscopy (scope of the uterus) Drugs (GnRH analogs)	If the fibroid is larger than 4 cm, there may be a lower pregnancy rate. A gap of ½-1 years between surgery and pregnancy is recommended. If the fibroid is not treated and is located on the cervix, a cesarean section may be necessary.
SUBSEROUS MYOM lying on the outside of the uterus, often only connected to the uterus with a peduncle rare (approx. 5%)	No bleeding disorders Pain when the handle turns Back and pelvic pain, urge to urinate bladder infection With increasing growth, the complaints intensify	Removal by laparoscopy (stomach examination)	Only rarely causes disturbances in fertility, except when pressure is applied, for example, to the fallopian tube.
SUBMUCOUS MYOMA lying under the lining of the uterus rare (approx. 5%)	Bleeding disorders (up to 95%) continuous bleeding Labor-like pains, and cramps due to irritation of the mucous membranes Sometimes tissue detachment	hysteroscopy	Depending on the location and size, surgical ablation can lead to a reduced pregnancy rate.

 

Fibroids in pregnancy

                                                                          

Fibroids usually do not need to be treated during pregnancy if they have not previously caused any symptoms. However, the growths may grow faster during this time due to increased estrogen levels. Complaints or complications always cause fibroids that are over 4 cm in size. This can lead to positional anomalies in the child. If the fibroid is near the cervix, a cesarean section is usually recommended. Preterm labor is also a possible complication. Submucosal fibroids (lying under the lining of the womb) can pose risks of ectopic pregnancy or miscarriage to join. Large intramural fibroids can result in significant blood loss during childbirth. Fibroids do not pass with the placenta but remain in their original position. However, they usually decrease back to their original size.

 

Tumors (sarcoma)

 

The probability of a fibroid developing into a malignant tumor (sarcoma) is extremely low at 0.001%. It forms on the uterus, especially in post-menopause, but very rarely. Therefore, hormone treatment against fibroids should only be carried out during the pre-menopause. However, sarcoma arises from other causes unrelated to the occurrence of fibroids.

 

Uterine fibroids: Diagnosis

 

In the event of heavy bleeding or pain, the gynecologist will first take a detailed anamnesis. The next steps are

·         Gynecological examination

·         ultrasound examination

·         Uterine or laparoscopy

·         Magnetic resonance imaging (if the findings are unclear)

Gynecological examination

With the help of a palpation examination, the gynecologist can already feel large fibroids on the front or back of the uterus or near the cervix. If the growths are small, they usually cannot be diagnosed with this examination.

Ultrasonic

An ultrasound head is inserted through the vagina and the doctor can determine the position and size of the fibroid on the computer screen. Ultrasound can also be used to visualize submucosal and subserous fibroids. If this examination does not produce any clear findings, a further diagnostic step is carried out:

Hysteroscopy

Intramural fibroids can be diagnosed by hysteroscopy. The examination is performed from the vagina with the gynecologist inserting a camera with a thin tube. At the same time, the uterus is slightly stretched. This can be done with carbon dioxide gas, giving the doctor a full view of the uterine cavity. If larger fibroids are suspected, the examination can also be carried out under local anesthesia.

Abdominal endoscopy (laparoscopy)   

A tummy tuck is useful to obtain precise information if the fibroid is on the outside of the uterus (subserous). During this examination, the patient is given general anesthesia. Meanwhile, the abdominal cavity is opened in the navel area with a small incision, and the uterus is expanded with carbon dioxide gas. Now the doctor can insert a camera. The advantage of this method is that a smaller fibroid can be removed immediately during the examination.

Magnetic resonance imaging

An MRI is required if the previous examination methods have not provided clear findings.

                                                                                                                                                      

Therapy of uterine myoma

 

Medical therapy

Conservative: medicine therapy, involves the administration of

·         gonadotropin antagonists (GnRH analogs) or

·         ulipristal

Gonadotropin antagonists (GnRH analogs)

These drugs influence the hormonal balance by temporarily "shutting down" the hormone production of the ovaries and thus inhibiting the growth of fibroids or causing them to shrink. Treatment with gonadotropin antagonists alone is usually not effective for large fibroids, but it is sometimes possible to reduce large fibroids and thus make them easier to operate, for example with a hysteroscopy. As a result of the treatment, the woman achieves a hormonal state similar to that of menopause. Menopausal symptoms (e.g. hot flashes) can therefore also occur in the course of this drug therapy bone loss). For this reason, this therapy should only be used to a limited extent or as a bridging measure, e.g. shortly before the onset of menopause or if an operation is planned.

Ulipristal

The active ingredient ulipristal acetate is used to reduce fibroids. The fibroids continue to grow in size, and painful bleeding is usually alleviated or stopped within a few days. This form of tablet therapy can be used before surgery and for long-term interval treatment in women of reproductive age who have moderate to severe symptoms. It is taken once a day for a period of 3 months. The drug requires a prescription and must be prescribed by a specialist.

Surgical therapy

Peeling (fibroid nucleation)

If the fibroid is operable or has been brought to an operable size by drug treatment, it can be excised. Both the size and the position of the fibroid are important.

Hysteroscopy

Myomas located in the uterine cavity can be surgically removed by means of a hysteroscopy, i.e. a reflection of the uterus in the inner cavity. A solution is introduced through the vagina to expand the uterus. The fibroid is removed via the vaginal canal using a resection snare.

Laparoscopy

If the fibroid grows into the abdomen, a laparoscopy, a reflection into the abdomen, is possible. Many fibroids can be removed easily using the laparoscopic method, even if they are up to 20 cm in size or if there are multiple fibroids. An incision of about 1 cm is made near the navel through which the fibroids can be removed. The disadvantage: later pregnancies could possibly cause problems. This is mainly due to the ingrowth of the placenta or even the rupture of the uterus at the point where the fibroid was removed. It is therefore worth considering whether you want to remove a fibroid that is not causing any symptoms and does not exceed a certain size.

Fibroid embolization

A newer, minimally invasive therapy is embolization. It is a treatment option, especially for women with bleeding problems and smaller fibroids. Small plastic particles are first introduced under anesthesia with a vascular catheter into the vessels that lead to the fibroids. These settle in the ramifications of the fibroid and block the blood supply - the fibroid shrinks. The duration of therapy varies and ranges from 6 weeks to a year. Whether it is the method of choice in the individual case depends on the size and location of the fibroids. If fibroids exceed a certain size, there is a risk that a lot of necrotic, i.e. dead tissue will accumulate. For those affected, this lost cell material often causes severe abdominal pain after the procedure. The method is only recommended

Focused Ultrasound

A non-invasive alternative to conventional surgical methods combines MRI imaging with high-intensity focused ultrasound therapy (HIFU). Ultrasound waves are only directed through the skin onto the fibroid, the ultrasound increases the temperature in the fibroid tissue to 60 degrees Celsius, and the tissue detaches. In addition, magnetic resonance imaging (MRT) offers three-dimensional therapy planning in advance. The almost painless treatment takes about 3 hours and means that the woman can go about her normal everyday life within 2 days. However, it can only be used in the case of conveniently located fibroids that are not in the vicinity of the organ. In this process, family planning should be completed.

Removal of the womb (hysterectomy)

There are still indications to remove the uterus completely, e.g.:

·         when other treatment options have failed

·         if the woman has symptoms (bleeding) due to many fibroids

·         if there is a suspicion that it is not a fibroid but a malignant tumor

Bleeding can often be significant, so the blood count deteriorates and performance and quality of life are reduced. Women who are planning to have children should also consider a hysterectomy if there is pain caused by the fibroid pressure on the neighboring organs, such as pain when having a bowel movement or urinating. Such a decision should be well considered and confirmed by a second medical opinion.

 

Uterine myoma: what else can the affected person do?

 

You can't prevent fibroids, you can only minimize the risk to a certain extent with a balanced lifestyle, such as regular endurance sports, a diet rich in vitamins, and relaxation. Long-term use of the pill can also hormonally counteract the development of fibroids in certain cases. However, this should be clarified with the treating gynecologist. A routine gynecological examination is the best way to identify and treat benign growths early on.

Traditional Chinese medicine assumes that fibroids are related to liver function disorders and recommends, among other things, appropriate herbal therapy.