By: Jean Johnson for Fibroids1Part 1: Female Reproductive Anatomy and Intramural Fibroids
Have we made enough progress as women to be forthright with our physicians when we discuss concerns related to fibroids? Do we feel empowered enough to be our own advocates? To educate ourselves about our situation and then take that information in to conversations with our health care providers?
If any of these questions resonate with you, read on. With this article, we at Fibroids1 begin our investigation of the emotional issues surrounding fibroids. It is also our goal to dispel the confusion that can arise as a result of medical terminology.
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Fibroids are a common cause of heavy uterine bleeding, but other factors can be at the root of the problem. These include:
Hormone imbalances
Polyps
Thyroid problems
Uterine cancers of either the endometrium or the cervix, which are more common in older women than those in their childbearing years
Talk with your doctor if you notice heavy bleeding or other symptoms – he or she can work with you to determine next steps. |
Female Reproductive AnatomyIt is in the uterus that fibroid masses grow. The uterus is a muscular organ designed to not only greatly expand during pregnancy, but ultimately to engage in the strong contractions needed to bear a child. Fibroids can grow in a number of places within the hollow, pear-shaped uterus: in the outside covering, just under the lining of the uterine cavity, or directly within the wall of the uterus itself.
Intramural Fibroids
Fibroids that grow in the muscular wall of the uterus are called intramural. Intramural fibroids are the most common type of uterine masses and are found in 70 percent of women during their childbearing years. They are usually small, but in some women fibroids will grow to the size of a grapefruit.
While fibroids are almost always benign, they can create problems by the sheer virtue of their bulk. In the case of intramural masses, symptoms can result when the tumors either expand inwards to distort and elongate the uterine cavity, grow into the endometrial lining of the uterus itself, or push up to the outer covering of the uterus.
Symptoms of intramural fibroids include heavy menstrual bleeding and generalized pelvic pain. Depending on their exact location, these types of fibroids can also cause low back pain and pain down the back of the legs. If they press on the bowel or bladder, fibroids can also be the source of constipation, bloating, and a frequent urge to urinate.
Similarly, if the fibroids grow near the cervix, which connects the uterus to the vagina, discomfort or pain during intercourse can occur. Intramural fibroids can also result in a distended or abnormally large abdomen, along with a feeling of lower abdominal pressure or heaviness that comes from the weight of the fibroid masses themselves.
As far as fertility and intramural fibroids are concerned, the ability to conceive and carry a child to term is generally not affected. About three percent of women with intramural fibroids have trouble becoming pregnant.
But, when fibroids grow in the uterine wall near the cervix, they can actually block sperm from entering the uterus. Further, intramural fibroids can increase the size of the uterus, making the distance sperm have to travel to the fallopian tubes farther than they are capable. Intramural fibroids can also adversely affect the uterus’s ability to contract, influencing both egg and sperm motility. And even if fertilization and implantation do take place, the presence of fibroids within the uterine wall and their growth during pregnancy can interfere with development of the fetus, causing abnormalities or miscarriage.
Treatment of intramural fibroids is only necessary if they are causing distressing symptoms like pain, or if they are interfering with a woman’s ability to get pregnant. Women opting for treatment must choose between three types of procedures.
Uterine fibroid embolization (UFE) was developed over the past decade, and treats uterine masses in a minimally invasive way. Experts in the circulation system – physicians called interventional radiologists – perform UFE. Through a small nick in the groin, they run a catheter to the uterus via an imaging screen. There, they inject US Food and Drug Administration-approved polyvinyl alcohol beads that effectively cut off the blood supply to the fibroids.
In the ensuing weeks and months, the fibroids gradually shrink and the symptoms disappear. Increasing numbers of women (Condoleezza Rice was one) are choosing UFE because the recovery time is as short – one week – and the procedure can be done on an outpatient basis.
More traditional approaches to treating symptom-producing intramural fibroids include two types of major abdominal surgery. The least life-changing of these surgeries is called a myomectomy, where the fibroids themselves are removed. It is termed such since fibroids are also called myomas by those in the field.
A hysterectomy removes the uterus and can throw a woman into premature menopause. It is the most drastic way to treat symptom-producing intramural fibroids. For many years it was the preferred procedure, and only more recently has it become less favored compared to less invasive methods.
Join us in Part Two to learn about two more types of uterine fibroids and their treatment.
