Large Uterine Fibroid: Symptoms, Causes, Test, And Treatment

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Introduction

A fibroid is benign basically over Growth Lumps growing in the uterus.

Sometimes these lumps become fully large and cause severe stomach pain and a Heavy Period.

To get started, you’ll need to read: What is Uterine Abnormalities?: Symptoms, Causes, Treatment

Uterine Fibroid
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Table of Contents

Signs and symptoms of uterine fibroids

  • Heavy Menstrual Bleeding. 

I had earlier shared Menstrual Disorder: Symptoms, Types, And Treatment . I hope you read the post.

  • Pain in the lower back.
  • Constant urination with constipation.
  • Difficulty emptying the Bladder.
  • Pelvic pain and Pressure.
  • Pain during Intercourse
  • Menstrual abnormalities (menorrhagia, metrorrhagia)
  • Dysmenorrhea associated with pelvic congestion or endometriosis
  • Abnormal gynecological hemorrhage 
  • Heavy or painful periods
  • Abdominal discomfort, bloating sound
  • Infertility
  • Backache, defecation 
  • may cause miscarriage
  • premature labor.

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Causes of uterine fibroids

  • Genetic factor
  • Chromosomal abnormalities
  • Growth factors( epidermal growth factor, insulin growth factors – stimulate via estrogen), this growth can show at age 20 and shrink  after menopause. 
  • Hormones (Estrogen and progesterone )
  • Family history
  • Extracellular matrix(EMC): the material that makes cell stick together, also stores growth factors and cause biologic changes in cell themselves.

Also see: At What Age Does Menopause Start? | When Do Women Go Through Menopause?

Types of uterine fibroids ( according to location)

1) Interstitial/ intamural

  • Located within the wall 
  • Do not produce any symptoms, if not large
  • Begins as a small nodule in a muscular wall
  • May expand inward slowly, causing distortion and elongation of the uterine cavity

2) Subperitoneal/ subserosal

  • located underneath the mucosal(peritoneal)surface of the uterus and can become very large
  • Fibroids are either wholly or partially covered by peritoneum-    
  • Can also grow out in a papillary manner to become pedunculated fibroids
  • On rare occasions, the pedicle may be torn from the uterus to become a parasitic leiomyoma 
  • Sometimes, an intramural fibroid may be pushed out between the layers of broad ligaments and is called broad ligament fibroid.

3) Submucosal 

  • Located beneath the endometrium of the uterus
  • Even small lesion in this location may make the uterine cavity irregular and distorted and lead to bleeding and infertility
  • A pedunculated lesion within the cavity can be passed through the cervix.

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Diagnostic evaluation of uterine fibroid

  • Family history
  • Physical examination
  • USG
  • lab test
  • pelvic USG
  • MRI
  • Hysterosonography 
  • Hysterosalpingography 
  • Hysteroscopy
  • Endometrial biopsy

Management of uterine fibroids

1)Expectant management

  • It is followed in the cases where the fibroid is asymptomatic.
  • The presence of fibroids doesn’t mean they need to be treated
  • Lesions can be managed expectantly depending on the symptomatology 
  • Most cases are handled by “watchful waiting,” which includes the periodic sonographic assessment.
  • After menopause, fibroids shrink, and it is unusual for fibroids to cause problems.

2) Medical management

  • Drug therapy is mainly given to minimize blood loss, as there’s a lot of blood loss due to excessive vaginal bleeding.
  • Progestrones, such as norethisterone acetate or medroxyprogesterone acetate is administered periodically from day 5 of the cycle for 20 days 
  • Prostaglandin synthetase inhibitors are given to relieve pain.
  • Antifibronylitics, such as tranexamic acid, is shown to reduce blood loss.
  • Danazole can minimize the volume of the fibroid slightly.
  • Gnrh antagonist cause suppression of pituitary and ovaries, and the onset of amenorrhea is rapid.
  • Ibuprofen and acetaminophen to relieve pain.
  • Anti hormone drugs such as mifepristone 

3) Surgical management

  • Hysterectomy
  • Myomectomy(0nly fibroids)
  • Myolysis 
  • Hysteroscopy
  • Laproscopy(subserios/intramural)
  • Endometrial ablation

Conclusion

Uterine fibroids are typical growths that occur in the woman’s uterus. In some cases, they do not cause symptoms and do not require treatment.

If there are any severe symptoms, various medical or surgical treatments help relieve the pain and discomfort.

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