American Medical Association Family Medical Guide - American Medical Association [585]
Symptoms and Diagnosis
Most women with fibroids have no symptoms, especially if the fibroids are small. Other women experience heavy bleeding, discomfort or pain in the pelvis, or pressure on nearby organs. Fibroids that lie just under the lining of the uterus can cause excessive blood loss from heavy periods, which can lead to iron deficiency anemia (see page 610). Fibroids under the uterine lining can cause infertility by taking up space that a fertilized egg could use to implant successfully in the uterine wall. Occasionally, a fibroid enlarges rapidly during pregnancy, causing pain, miscarriage, or obstruction during delivery.
Uterine fibroids
A fibroid is a noncancerous tumor that develops inside the uterus. Uterine fibroids are very common—up to 30 percent of all women have fibroids at some time in their life.
A doctor can often detect a fibroid during a routine pelvic examination. He or she can confirm the diagnosis with an ultrasound scan (see page 111), MRI (see page 113), or CT scan (see page 112).
Treatment
Small fibroids that don’t cause symptoms do not require treatment. Pain relievers such as ibuprofen can help relieve minor discomfort. If fibroids cause abnormal bleeding, the bleeding can often be controlled with oral contraceptives.
If you have symptoms and you eventually plan to become pregnant, your doctor may recommend a procedure called myomectomy. In myomectomy, the doctor removes the fibroids but leaves the uterus intact. Myomectomy carries a slightly increased risk of bleeding and, if a woman becomes pregnant after myomectomy, she is more likely to have a cesarean delivery (see page 534).
Women who are no longer planning a pregnancy may choose to have a procedure called endometrial ablation, in which low-voltage heat is applied to the lining of the uterus to permanently block its growth. In cases of severe bleeding or when fibroids grow large enough to cause distortion of the abdomen, a doctor may recommend a hysterectomy (see page 870), in which the uterus is surgically removed.
Endometrial Hyperplasia
Endometrial hyperplasia is a condition in which the lining of the uterus (the endometrium) becomes overly thick and does not shed as it normally does during menstruation. The disorder usually develops when ovulation is not regular, such as in women who are approaching or who are past menopause. Endometrial tissue builds up and can harbor abnormal cells, which can eventually become cancerous. Doctors consider endometrial hyperplasia a precancerous condition caused by the presence of too much estrogen, which can occur in women taking estrogen in hormone therapy (see page 853) without the counterbalancing hormone progesterone.
Endometrial hyperplasia occurs in stages. The mild stages are usually noncancerous, but they need to be treated to prevent them from developing into severe hyperplasia, in which suspicious, abnormal cells can develop into cancer of the uterus (see next page).
Symptoms and Diagnosis
In women of childbearing age, a common sign of endometrial hyperplasia is irregular or heavy periods. The most common symptom after menopause is abnormal vaginal bleeding.
To diagnose endometrial hyperplasia, a doctor takes a sample of endometrial tissue from the uterus for examination under a microscope. This procedure, called endometrial biopsy (see page 849), is done in the doctor’s office. Tissue samples can also be taken during a hysteroscopy (see page 849) or a D and C (see next page).
Treatment
If you have missed two consecutive periods and are definitely not pregnant, your doctor will probably recommend inducing a period by prescribing the hormone progesterone to take for 10 days to stimulate the endometrium to shed. If you have endometrial hyperplasia, your doctor will prescribe birth-control pills or progesterone supplements to stimulate shedding of the uterine lining. Surgical removal of the uterus (hysterectomy; see next page) is usually used only