Benign Tumour of Uterus
Uterine fibroids
Myomas ,Liomyomous
Definition
Uterine fibroids develop from the smooth muscular
tissue of the uterus (myometrium) and fibrous
tiussue.
It is the most common tumour in the women.
A single cell reproduces repeatedly, eventually
creating a pale, firm, rubbery mass distinct from
neighboring tissue.whorle-like appearance with
blood vessele at the prephery of tumour ,poor
blood supply inside it
Risk factors
other than being a woman of reproductive age
Other factors include:
Heredity. mother or sister had fibroids,
Race. Black women are more likely to have
fibroids than are women of other racial groups &
fibroids at younger ages, and they're also likely
to have more or larger fibroids
obese women are at higher risk of fibroids, other
studies have not shown a link.
a lower risk of fibroids
take oral contraceptives
athletic women may have,
pregnancy and giving birth may have a
protective effect,
but results remain unclear.
Causes
Fibroids range in size from seedlings, undetectable by the human eye,
to bulky masses that can distort and enlarge the uterus. They can be
single or multiple, in extreme cases expanding the uterus so much
that it reaches the rib cage.
several factors:
Genetic alterations. Many fibroids contain alterations in genes that
code for uterine muscle cells.
Hormones. It isa hormone(estrogen) dependent tumour
Fibroids contain more estrogen and estrogen receptors than do normal
uterine muscle cells.
Other chemicals. Substances that help the body maintain tissues,
such as insulin-like growth factor, may affect fibroid growth.
Sign& Symptoms
A symptomatic
Heavy menstrual bleeding
Prolonged menstrual periods or bleeding between periods
Pelvic pressure or pain •
Urinary incontinence or frequent urination •
Constipation •
Backache or leg pains •
Rarely, a fibroid can cause acute pain when it outgrows •
its blood supply. Deprived of nutrients, the fibroid begins
to die. Byproducts from a degenerating fibroid can seep
into surrounding tissue, causing pain and fever. A fibroid
that hangs by a stalk inside or outside the uterus
(pedunculated fibroid) can trigger pain by twisting on its
stalk and cutting off its blood supply.
: •
Fibroid location influences signs
and symptoms
Submucosal fibroids. Fibroids that grow into the
inner cavity of the uterus (submucosal fibroids)
are thought to be primarily responsible for
prolonged, heavy menstrual bleeding.
Subserosal fibroids. Fibroids that project to the
outside of the uterus (subserosal fibroids) press
on bladder, causing urinary symptoms. If fibroids
bulge from the back of uterus, they occasionally
can press on rectum, causing constipation spinal
nerves, causing backache.
Complications of fibroids;
1-Degenerations;hylain .necrosis, red
degeneration ( pregnancy, menopause)
,calcifications
2-Sarcomatous changes;<0.05%
3-Rare:Parasitic changes; as attachment to
omentum bowel l to gain blood supply,
metastasis through blood vessels to vessel
wall,
Polycythmia associated with broud ligament
fibroid
Affect of pregnancy on
fibroid
Subinvolution
ascending infection
torsion
Affect of Fibroid on Pregnancy
Infertility •
Abortion
PUC •
preterm labor •
Abruptio placentae •
abnormal Lie & position •
, increase rate of operative delivery
PPH (uterine atony) .
•
•
Red Degeneration •
2nd trimester & menopause as abdominal pain fever ,tachycardia •
luococytosis tender abdomen ,there is no indication for myomectomy
during pregnancy (uncontrolled bleeding)
treated by rest IVF ,Opiat analgesia •
Screening and diagnosis
Uterine fibroids are frequently
found incidentally during a
routine pelvic exam.
you may feel irregularities in the
shape of your uterus throughy
abdomen,
Suggesting the presence of
fibroids.
Ultrasound
Sometimes, fibroids are discovered during an •
ultrasound conducted for a different purpose,
such as during a prenatal ultrasound
If confirmation is needed to map and measure
fibroids (transabdominal) or inside (transvaginal)
to obtain images.
Transvaginal ultrasound provides more detail •
because the probe is closer to the uterus.
Transabdominal ultrasound visualizes a larger
anatomic area..
Hysterosonography
This ultrasound variation uses sterile saline
to expand the uterine cavity, making it
easier to obtain interior images of the
uterus. This test may be useful if you have
heavy menstrual bleeding despite normal
results from traditional ultrasound
Hysterosalpingography
. if infertility is a concern fallopian tubes are
open.
Hysteroscopy
the walls of uterus and the openings of
fallopian tubes.
Others
Imaging techniques that may occasionally be
necessary include computerized tomography
(CT) and magnetic resonance imaging (MRI).
Other tests
abnormal vaginal bleeding, a complete blood
count (CBC) to determine if iron deficiency
anemia because of chronic blood loss. blood
tests to rule out bleeding disorders and to
determine the levels of reproductive hormones
produced by ovaries.
TREATMENT
There's no single best approach to uterine
fibroid treatment
A -Watchful waiting
no signs or symptoms, watchful waiting
(expectant management) could be the
best course.
They usually grow slowly and tend to shrink
after menopause when levels of
reproductive hormones drop
B-Medications
Medications for uterine fibroids target
hormones that regulate your menstrual
cycle,
treating symptoms such as heavy menstrual
bleeding and pelvic pressure. They don't
eliminate fibroids, but may shrink them.
Medications include:
Gonadotropin-releasing
hormone (Gn-RH) ago
Medications called Gn-RH agonists (Lupron, Synarel,
others) act at the same sites that Gn-RH does. But when
taken as therapy, a Gn-RH agonist produces the
opposite effect to that of your natural hormone.
Estrogen and progesterone levels fall, menstruation stops,
fibroids shrink and anemia often improves. , less blood
loss during surgery, and shorter operations.
However, side effects; the shrunken, softened fibroids that
result can be more difficult to detect and remove,. hot
flash,osteoproses,costy,recurrance
*Androgens.
Danazol, a synthetic drug similar to
testosterone, has been shown to shrink
fibroid tumors, reduce uterine size, stop
menstruation and correct anemia.
However, occasional unpleasant side
effects such as weight gain, dysphoria
(feeling depressed, anxious or uneasy),
acne, headaches, unwanted hair growth
and a deeper voice, make many women
reluctant to take this drug.
medications. Oral contraceptives
or progestins
can help control menstrual bleeding, but
they don't reduce fibroid size. Nonsteroidal
anti-inflammatory drugs (NSAIDs), which
are not hormonal medications, are
effective for heavy vaginal bleeding
unrelated to fibroids, but they don't reduce
bleeding caused by fibroids.
C-Surgery
Three surgical approaches
This operation remains the only proven
permanent solution for uterine fibroids. But
hysterectomy is major surgery. It ends
ability to bear children
!- Hysterectomy
2_Myomectomy
surgeon removes the fibroids, leaving the uterus in
place. If want to bear children, this option. With
myomectomy, as opposed to a hysterectomy,
there is a risk of fibroid recurrence.
#Patient who need myomectomy they should
signed for hysterectomy which may needed at
same time as emergency.
#Stormy postoperative period as fever abdominal
pain, systemic reaction to collected blood in
cavity of removed myoma
There are several ways a myomectomy can be
done:
a-Abdominal myomectomy
. If you have multiple fibroids, very large or
very deep fibroids.
•
b-Laparoscopic
myomectomy
. If the fibroids are small and few in number
c-Hysteroscopic myomectomy
. This if the fibroids (submucosal)
(hysteroscopy) is passed through vagina
and cervix and into uterus
D-Myolysis
Variations of myomectomy — in which uterine
fibroids are destroyed without actually removing
them — include:
1-Myolysis. In this laparoscopic procedure, an
electric current destroys the fibroids and
shrinks the blood vessels that feed them.
2-Cryomyolysis. In a procedure similar to
myolysis, cryomyolysis uses liquid nitrogen to
freeze the fibroids.
The safety, effectiveness and associated risk of
fibroid recurrence of myolysis and cryomyolysis
have yet to be determined.
3-Uterine artery embolization
Small particles injected into the arteries
supplying the uterus cut off blood flow to
fibroids, causing them to shrink..
Advantages over surgery include:
No incision
Shorter recovery time
Complications may occur if the blood supply
to your ovaries or other organs is
compromised.
4-Focused ultrasound
surgery
MRI-guided focused ultrasound surgery (FUS), approved
by the Food and Drug Administration in October 2004, is
a newer treatment option for women with fibroids. Unlike
other fibroid treatment options, FUS is noninvasive and
preserves uterus
.
This procedure is performed crafted MRI scanner they
locate and destroy (ablate) fibroids inside uterus without
making an incision. Focused high-frequency, highenergy sound waves are used to target and destroy the
fibroids. Initial results with this technology are promising,
but its long-term effectiveness is not yet known.