GSE
Uterine fibroids and their treatment
What are
Uterine Fibroids (UFs)?
(a.k.a. Uterine leiomyoma, myoma,
fibromyoma, leiofibromyoma, fibroleiomyoma,
and fibroma)
Uterine fibroids are BENIGN i.e.
non-cancerous), usually clusters of TUMORS in, on or
within the uterine walls
Originate from and
are composed of SMOOTH MUSCLE cells of the
uterine wall's muscle layer (called the myometrium, the middle layer of the uterine wall used for
contracting the uterus) and
its accompanying connective tissue ;
It is RARE for benign uterine
leiomyomas to progress to cancerous leiomyosarcomas (1.7 women per 100,000 women are diagnosed annually with
uterine sarcoma, which includes leiomyosarcoma)
(National Cancer Institute )
Vary in size - from microscopic to very large (can weigh several pounds).
Fibroids are often described by their location in
the uterus:
Myometrial - in
the muscle wall of the uterusSubmucosal -
just under the surface of the uterine liningSubserosal
- just under the outside covering of the uterusPendunculated -
occurring on a long stalk on the outside of the uterus or inside the cavity of
the uterus
Called DIFFUSE uterine leiomyomatosis - when there are too
many fibroids to count.
Diagnosis of uterine fibroids
Diagnosis can be wrong - pelvic
examination may show an irregularly shaped, lumpy, or enlarged uterus, but in
obese women it is difficult to diagnose fibroids, which may be mistaken for:
Pregnancy
Ovarian tumors
Inflammation of the fallopian tubes
Uterine adenomyosis (a
condition in which the uterine lining grows into the muscle wall of the uterus)
Fibroids can be confirmed - by a transvaginal ultrasound , a pelvic
ultrasound or a pelvic MRI.
Who gets uterine fibroids?
UFs are the most common pelvic tumor in females,
typically found during the mid- to late-reproductive years
Uterine fibroid incidence
rate is 70% by age 50 in U.S. white women and 80% in African-American women -
with a staggering half of reproductive age U.S. women having fibroids. Typically affects women over 30, but not under 20;
(Baird et al, 2003) More common in
African-American women than Caucasian
women - ~25% of white women and 50% of black women have
symptomatic (Wise,
2005) More common in overweight
women - perhaps
because of increased
estrogen from adipose aromatase
enzyme
activity that converts the androgens
ANDROSTENEDIONE and
Testosterone to
estrogens UFs often have a
growth spurt before menopause -and then become
quiescent Higher UF incidence in women who have not given
birth or had early menarche or have a UF history in first degree relatives Smokers have LESS
risk of UFs Physical activity
seems to protect against having UFs (Baird
et al, 2007) (Flake et al, 2003)
What are the symptoms of
uterine fibroids
What are the symptoms of
uterine fibroids?
What causes uterine fibroids?
Hormonal influences and growth factors are involved in
UF growth and development:
Causes of uterine fibroids
Estrogen
and PROGESTERONE generally promote uterine fibroid growth
How to treat uterine fibroids
Mainstream treatments
for uterine fibroids
Alternative therapies
for uterine fibroids
References Baird DD, Dunson DB, Hill MC, et al. (2003) High cumulative incidence of uterine
leiomyoma in balack and white women: ultrasound evidence. Am J Obstet Gynecol; 188: 100-107
Baird DD, et al. (2007) Association of physical activity with
development of uterine leiomyoma. Am. J. Epidemiol.
(2007) 165 (2): 157-163.
Study
Flake GP, Andersen J, Dixon D. (Jun. 2003) Review Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health
Perspect. Environ Health Perspect.111(8):1037-54.
PubMed
Ishikawa, H.; Reierstad,
S.; Demura, M.; Rademaker, A. W.; Kasai, T.; Inoue, M.; Usui, H.; Shozu, M. et
al. (2009). "High Aromatase Expression in Uterine Leiomyoma Tissues of
African-American Women". Journal of Clinical Endocrinology & Metabolism 94 (5):
1752.
PubMed
Wise, L.,
Palmer, J., Bernard, H., Stewart, E., Rosenberg, L., (2005) Age-Specific
Incidence rates for Self-Reported Uterine Leiomyomata in the Black Women's
Health Study Obstet Gynecol 105(3): 563-568
