Fibroids are benign growths of the uterus and commonly known as the uterine lining. Smaller fibroids are harmless and rarely require medical treatment. If it comes to complaints, but a visit to a doctor is essential to keep fibroids under control and remove if necessary.

What is a fibroid?

A fibroid is a benign tumor that grows slowly in the muscular wall of the uterus. Fibroids do not form metastases and may grow or bulge in the wall of the uterine body.

A smaller fibroid is about pea-sized. Even the size of an orange is not uncommon. In extreme cases, the size of a fibroid may mimic a pregnancy. A fibroid arises from muscle fibers and increases by hormone influence.

More than 20% of all women are affected by fibroids. Most commonly, it affects women between the ages of 35 and 55 years. In less than one percent of cases, a fibroid can be malignant.

causes

Why a fibroid develops can not be clearly defined. It has been shown that fibroids can be partially inherited. It is also considered certain that the sex hormone oestradiol plays a role in the development of myomas.

Fibroids do not occur in girls before puberty. They only grow when the body has an elevated estrogen level. This is the case, for example, with pregnancies or when taking hormone preparations.

During menopause, the estrogen level drops and causes the fibroids to shrink. In postmenopausal women no fibroids occur.

Symptoms, complaints & signs

Fibroids cause different symptoms, depending on their size and location. Are they still small, they often do not cause any discomfort and are therefore only discovered by accident. The most common symptom is pain, which can increase to extremely strong, labor-like cramps, usually during the menstrual phase.

Depending on their location, it is possible for fibroids to put pressure on nerves, which can lead to pain radiating down to the legs or back. Physical exertion or sexual intercourse can cause unpleasant painful pressure. Large fibroids can constrict the bladder or bowel and increase urination or constipation.

Rarely it happens that the urethra is completely squeezed off and no urination is possible. This would require immediate medical attention. Extremely large fibroids can increase the size of the abdomen. In addition, bleeding disorders arise. The period may be unusually strong, as the bleeding vessels are prevented by the tumors from closing again quickly enough.

Frequently, menstruation takes longer than usual. The amount of excreted blood is significantly increased, sometimes it gushes off. Due to increased blood loss, the level of blood ice drops and iron deficiency develops. Typical signs are tiredness, slackness, palpitations, pale skin color, brittle nails and hair loss.

Diagnosis & History

Infogram about the different types of fibroids. Click on the image to enlarge.

A smaller fibroid often goes unnoticed and is only discovered by chance during routine examinations. If it comes to menstrual cramps or lubricating or chronic bleeding, a doctor should be consulted.

This will first make a gynecological examination. A fibroid can often be felt by touching. Certainty bring ultrasound or a cell examination, whereby a smear is made. When a uterine scan is performed, a special endoscope is inserted through the vagina into the uterus. The uterus is filled with gas and illuminated.

A smaller fibroid causes no symptoms. If the myoma is larger, it can cause pain or complications of menstruation. Larger fibroids alter the shape of the uterus. In pregnant women, the fetus is forced into unusual positions. It can lead to miscarriages. Likewise, a fibroid can exert pressure on the rectum and urinary bladder.

complications

A uterine tumor can lead to various complaints. First and foremost, women suffer from disturbances of the cycle and thus also from relatively severe menstrual pain. These can also lead to mood swings and thus significantly reduce the quality of life of those affected. It also leads to dizziness and paleness.

The affected people are weak and weak and also suffer from circulatory problems. It is not uncommon for a loss of consciousness. Especially in pregnant women, a uterine tumor can be a serious complication and in the worst case lead to a miscarriage. In most cases, no targeted treatment for a tumor of the uterus is necessary. Those affected, however, depend on regular visits and checks with a gynecologist.

In some cases, the uterine lining must also be surgically removed. However, complications do not occur and the life expectancy of the patient is not reduced. Even after the treatment it can come again to a uterine tumor. In many cases, the fibroid can also be treated with the help of medication.

When should you go to the doctor?

Disorders and irregularities of the menstrual period in a sexually mature woman should be clarified by a doctor. If bleeding or spotting occurs outside the normal menstrual period, a check-up should be made with a doctor. If it comes to complaints during intercourse, there is cause for concern. Pain, a feeling of pressure or an abdominal distention should be examined and treated. Disorders of the digestive tract, diarrhea or constipation are signs of ill health. A visit to the doctor is necessary as soon as the symptoms persist over a longer period of time or increase in size and intensity.

If swelling in the abdomen, tactile knots or changes in the appearance of the skin, the symptoms are presented to a doctor. If it comes to a decrease in overall performance, fatigue or inner weakness, a doctor is needed. Tachycardia or irregular heart rhythm should be discussed with a physician. Conditions of anxiety, inner insecurity, sleep disturbances, or changes in urination are indications that should be further observed.

If they have a constant appearance, the consultation of a doctor is advisable. A pale appearance, sudden hair loss or irregularities of the fingernails or toenails should be checked by a doctor. The cause is identified in various tests to initiate treatment to relieve the symptoms.

Treatment & Therapy

A small fibroid does not necessarily have to be treated. Regular check-up by the gynecologist is sufficient. The removal of a smaller fibroid can be done with a womb mirroring. For this rather unpleasant procedure, the patient receives local anesthesia or narcosis.

Larger fibroids require surgical removal by cutting into the abdomen. If multiple fibroids have formed, it is often necessary to remove the entire uterus. A larger fibroid can be made to shrink by the administration of hormones. Thereafter, surgical removal is possible, whereby the uterus can be obtained.

In special clinics, a new method causes a sensation. This causes the fibroid to shrink, blocking the surrounding blood vessels. This is done by injection. The type of therapy may depend on several factors. These include the size and location of the proliferation, the symptoms caused or the age of the patient and the associated status of family planning.

A therapy usually aims to maintain the uterus. However, if the fibroid is proliferating and causing great pain, womb removal is often necessary.

New drug treatment options

The tried and tested hormone treatment with GnRH analogues, which has been tried and tested for many years, will now be supplemented with the active ingredient ulipristal acetate by the new therapy for symptomatic uterine fibroids. The intake takes place in tablet form. Indications include the preoperative treatment of moderate and severe symptoms - such as lower abdominal pain, exhaustion or pain - and long-term treatment. A tablet is taken daily over a period of up to twelve weeks. If necessary, the treatment can be repeated, there is no time limit for it.

The active substance ulipristalacetate reduces the volume of the fibroids and thus the associated complaints. This means that surgery can often be avoided. The mentioned long-term therapy is ideal for women who are still in menopause and who want to get through the menopause without surgery. As soon as the menopause is over, the danger of fibroids disappears. They are not growing any further because of the reduction of the hormones progesterone and estrogen. Long-term therapy is also suitable for women who complain of severe complaints, want to control them effectively and permanently and who have not yet completed their family planning.

The mode of action of the tablet

Ulipristalacetat is one of the selective progesterone receptor modulators, so the drug is used for causal drug therapy. This will directly affect the cause of the disease. Not only the complaints are alleviated, it is also about bringing about healing. The activity of progesterone, a hormone naturally occurring in the body, is inhibited by ulipristal acetate. The preparation itself is not a hormone, which means it is well tolerated and leads to permanent and rapid relief of the symptoms. The bleeding is reduced or completely stopped, the fibroids become smaller and the pain subsides.

Outlook & Forecast

The course of the disease depends on the size and location of the tumor. Affected patients should regularly go to check-ups at the gynecologist in order to avoid complications. This is true even if fibroids show no complaints. Urinary tract infection and pain during urination can occur when the tumor presses on the urinary bladder.

Also, dysfunction of the bladder, bowel and kidneys can occur when the tumor presses on the organs. Strong or prolonged menstrual bleeding often leads to anemia due to iron deficiency. Furthermore, there are problems with fertility and during pregnancy. In principle, however, the fibroid does not represent an obstacle to pregnancy. Only in a few cases does infertility occur, for example if the tumor lies in front of a fallopian tube.

In pregnancy, the myoma can cause different problems. As an estrogen-dependent tumor, a fibroid grows faster during pregnancy because the body then produces more sex hormones. Due to the increasing size and position, the myoma can cause pain. Also, abnormalities of the unborn child may occur or even block the birth canal. In addition, premature labor can occur. A fibroid has been shown to increase early and miscarriage rates. If the tumor grows in the uterine cavity or under the lining of the uterus, it can lead to miscarriage and ectopic pregnancies.

prevention

Against a fibroid, no preventive measures are known. Women between the ages of 35 and 55 should have semi-annual check-ups at the gynecologist. By tactile examination and ultrasound, a fibroid can be detected early.

This can eliminate complications that can arise if the fibroid is recognized too late. If a fibroid has been removed, the patient is not immune to this tumor. A fibroid can reappear anytime. Women who have had problems with a fibroid and have completed their family planning should consider removal of the uterus. A fibroid grows only in the muscles of the uterus and thus can no longer occur in operated patients.

aftercare

Usually, a fibroid is not treated because it is small in size and does not cause acute discomfort. Doctors opt instead to observe the benign tumor as part of the aftercare. This happens for two reasons: On the one hand, the fibroid can grow and thereby disturb the function of other organs. On the other hand, scientists assume that the fibroid degenerates in a fraction of the cases and then tends to metastasis.

The aftercare serves thus the complication avoidance. Physician and patient arrange a quarter or half-yearly rhythm. In addition to a palpation examination also takes place an ultrasound examination. Doctors believe that the diagnosis of a change in the early stages of the best healing prospects. Therefore, the scheduled investigations must be conscientiously adhered to.

If the doctor and the patient decide to remove a fibroid, follow-up treatment is also indicated. This aims to remedy any subsequent complications of the procedure and to prevent recurrence of the tumor. Because the uterine tumor may possibly form again.

The scope of the follow-up corresponds to the above descriptions. Participation in a rehabilitation program immediately after surgery may be necessary. In addition, patients should of course consult their doctor immediately if acute problems arise.

You can do that yourself

As fibroids are usually not a health hazard, symptoms in self-treatment can be mitigated. Depending on the severity and duration of the complaints, a timely medical consultation is recommended. Existing fibroids should have a regular gynecological examination.

In most cases, fibroids cause stronger symptoms during menstruation and a few days before. In order to counteract spasmodic pain, it is advisable to avoid alcohol and salt-containing foods - as they withdraw water from the body - and to compensate for an increased Flüssigkeitszuvor. This also counteracts common circulatory problems. Similarly, coffee and dairy products stress the body and should be reduced. Some women suffer from iron deficiency due to fibroids. Here, the consumption of green leafy vegetables (chard, kale, stinging nettle, herbs) or taking a finished product as it is available in pharmacies help. It was also found by taking magnesium to relieve the symptoms. 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 prevention and easy movement come first. Likewise, alternative healing methods such as acupuncture, acupressure or aromatherapy can help. The local use of heat with heating pads or warm compresses relaxes the muscles of the uterus and ensures holistic relaxation. St. John's wort oil can be added to a bath.

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