Fibrous Uterus: is it Cancerous? Cause, Treatment and Future Risk
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We have two types of muscles: skeletal and smooth. Skeletal muscles move bones and are under your voluntary control. You can't control smooth muscles, which line blood vessels and organs, such as the uterus and gastrointestinal tract.
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The uterus is divided into the corpus (form during menstrual cycle and secretes estrogen and progesterone hormone) and the cervix (circular in shape ,lowest part of the womb, or uterus, through which babies pass when they are born) .The corpus consists of the fundus, the upper portion of the uterus between the points where the fallopian tubes attach, the body of the uterus, and the isthmus, which is the narrow lower segment of the uterus just superior to the cervix. The cervix extends from the isthmus into the vagina.
The tube in a woman's body that runs beside the urethra and connects the uterus (womb) to the outside of the body sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina. Fibroid tumors of the uterus are nodules; as common, noncancerous (benign) growths that develop in the walls of the uterus. They are made up of fibrous connective tissue and muscle tissue and can range in size from tiny growths to the size of cantaloupes.
In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.
Uterine fibroids can remain stable for years with few or no symptoms, or there can be sudden rapid growth of multiple fibroids. Although uterine fibroids may be present in up to 75% of all women, 50% to 55% of these women do not have symptoms. Symptoms may develop slowly over a period of several years or rapidly over a period of several months. The two most common symptoms of uterine fibroid tumors that cause women to seek the advice of their health care providers are
- Excessive uterine bleeding or menorrhagia that lasts longer than seven days
- A feeling of pelvic pressure – somewhat like the pressure experienced during pregnancy when the uterus grows larger.
Endometriosis is the ectopic growth (a pregnancy that occurs outside the uterus, often in the fallopian tubes) of endometrial glands and stroma outside the endometrial cavity. It affects 3 to 10 percent of all women of reproductive age. About 4 of every 1000 women between 15 and 64 years of age are hospitalized with endometriosis each year. The disease is a major cause of infertility and chronic pelvic pain.4 The most common extrauterine sites involved include the ovary, fallopian tube, and adjacent pelvic tissues. Pelvic spread is thought to occur by retrograde menstruation by way of the fallopian tube, during which viable endometrial cells are implanted in dependent portions of the pelvis.
Uterine leiomyomas (i.e., fibroids, myomas) are the most common gynecologic tumors in women of reproductive age .As the number one cause of hysterectomy in the United States, with an estimated 200,000 hysterectomies performed annually in women, leiomyomas have a profound effect on women’s health. Although uterine leiomyomas are benign tumors of smooth muscle origin that rarely progress to malignancy, they are often associated with reproductive and gynecologic isorders ranging from infertility and pregnancy loss, to pelvic pain, and excessive uterine bleeding.
Uterine fibroid tumors are usually benign tumors. They are solid masses made of fibrous tissue. Fibroid tumors are rarely malignant. Symptoms of fibroid tumors vary among women, with some women never experiencing any symptoms at all. Women who can wait until menopause will see their fibroids shrink and disappear once their bodies stop producing estrogen. It's important that women with fibroids make sure they never take estrogen, in any form including birth control pills, since estrogen increases fibroid growth.
Cause:
- Abdominal pain that occurs during menstruation may be from menstrual cramps or it may indicate a problem in a reproductive organ. This includes conditions such as endometriosis (when tissue from the uterus is displaced to somewhere else like the pelvic wall or ovaries), uterine fibroids (thick bands of muscular and fibrous tissue in the uterus), ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID) infection of the reproductive organs, usually from a sexually transmitted disease.
- Soft tissue sarcomas [Sarcomas are malignant (cancerous) tumors that develop in tissues which connect, support, or surround other structures and organs of the body] can arise almost anywhere in the body. About 43 percent occur in the extremities (e.g., arms, legs); 34 percent occur in and around the internal organs (e.g., uterus, heart); 10 percent occur in the trunk (e.g., chest, back); and 13 percent occur in other locations.
- Adhesions between the ovaries, fallopian tubes or pelvic walls can prevent an egg from the ovaries from getting into and through the fallopian tubes. Adhesions around the fallopian tubes may make it difficult or impossible for sperm to reach the egg. One study found adhesions in 37% of 733 infertile women; in 41 of these women, adhesions were the only reason for their infertility. Overall, some experts suspect that pelvic adhesions may be responsible for up to 40% of infertility.
- Schistosomal involvement of the female genital tract is manifested by granulomatous inflammation and fibrous adhesions, which can lead to infertility. Tubo-ovarian lesions also increase the risk of ectopic pregnancy.
- A study by University Hospitals Leuven B-3000 Leuven, Belgium concluded that it is clear that tamoxifen, given for an average of two years, reduces mortality in patients with breast cancer. However, the optimal duration of treatment remains controversial. Our current policy is to continue adjuvant tamoxifen treatment for five years, unless there is atypical hyperplasia, endometrial cancer, or recurrent breast cancer.
- Changes in a woman’s hormone levels, specifically estrogen, can affect fibroid growth. Fibroids tend to grow rapidly during pregnancy when hormone levels are high, and shrink in size after menopause when hormone levels decrease. Women who are obese and of African-American heritage also seem to be at an increased risk, although the reasons for this are not clearly understood.
- Eating red meat has been associated with the growth of fibroids. The NUFF cites research that eating a diet high in green vegetables, fruits, and fish may reduce the growth of fibroids.
Treatment:
Uterine fibroids can be treated in a variety of ways including surgically and non-surgically. The first approach is through medications or hormonal therapies. The second is with interventional radiology that injects a chemical into the fibroid which blocks the blood supply to the tumor thereby causing it to shrink. The third is surgically either by a hysterectomy or a myomectomy. Myomectomy is the removal of a fibroid tumor from the uterus while leaving the uterus intact. A total hysterectomy (panhysterectomy) applies only to the removal of the uterus and cervix. When the ovaries and fallopian tubes on both sides of the uterus are also removed, the procedure is called a hysterectomy and bilateral salpingo oophorectomy.
A study by JAMA shown that about 50 percent of the women taking medication to control bleeding eventually had a hysterectomy because of dissatisfaction with the more conservative therapy.
Endometriosis is diagnosed using a surgical procedure called laparoscopy. During laparoscopy, a thin viewing tube (called a laparoscope) is passed through a small incision in the abdomen. Endometrial lesions (implants of endometrial tissue outside of the endometrium) can be cut away (excised) or burned away using a high-energy heat source, such as a laser (ablation).
A recent study by the Canadian Collaborative Group on Endometriosis demonstrates that using laparoscopy to remove diseased tissue in minimal and mild endometriosis enhances fecundity (fertility) in infertile women.
Some studies, of small numbers of women, have indicated that women who have had two live born children have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children.
Alternatives to a hysterectomy and possible effect after hysterectomy:
If you are of childbearing age, perhaps the most important reason is that you would no longer be able to have a baby. Women who want to preserve this ability need to see if they have options besides hysterectomy, the possibility that your sex life might change somewhat. Between 10 and 40 percent of women who have a hysterectomy report some loss of sexual desire or function after a hysterectomy, according to various studies. The drop in libido seems to be linked with changes in hormone levels.
Routine pelvic exam as prevention:
A pelvic exam is an examination of external genitals, vagina, uterus and ovaries. You should have a pelvic exam when you have a pap smear. Your provider may then insert one or two fingers into the vagina while pressing on your abdomen with the other hand to detect abnormalities in the shape of the uterus and ovaries, as well as any tenderness that might indicate a problem.
Dietary recommendations include eating soy protein, which contains weak estrogen-like substances. The theory states that soy protein might compete with your body's own estrogen and prevent it from stimulating fibroid growth. Another suggestion is to reduce your intake of meat and dairy products, which can contain estrogen-like compounds that could promote fibroid growth.
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