A fibroid tumor, one of the masses a physician most frequently feels during a pelvic examination, is easily recognized during exploratory surgery. Many, many fibroid tumors, however, are discovered while a physician is looking for something elseor simply are not discovered at all. If a woman experiences no unpleasant symptoms, there may be no reason to look for them.
On the other hand, the mere presence of fibroid tumors can interfere with the doctor's general assessment of your health. Fibroid tumors that grow near the ovaries can make it impossible for the doctor to feel the ovaries and determine whether they are healthy a big concern for women older than 40 years of age.
Ultrasound scanning enables physicians to distinguish these tumors. This diagnostic procedure can confirm the presence of fibroids when a woman has symptoms that raise suspicion of the tumors. However, because certain types of fibroids look similar to ovarian tumors, and the fibrous tissue can interfere with the sound waves, it's possible for the ultrasound reading to be inaccurate.
A basic pelvic exam during which the physician determines whether the uterus has become unusually large provides a diagnosis most of the time. However, after reviewing the results of the examination and considering your specific symptoms, the physician may conduct additional procedures. For example, hysteroscopy allows the physician to "see" inside the uterus by using a small, lighted tube. Sonohysterography, a sort of "internal ultrasound," is performed through the vagina after filling the uterus with sterile water.
In rare cases the only way a physician can be sure is to look inside via an operation. The decision to operate depends on the particular symptoms, on what the doctor suspects is the cause, and on considerations such as a woman's likelihood of developing ovarian cancer or other disorders that might be overlooked because of the fibroids. The Classic Symptoms
Though most fibroids do not produce any symptoms, when they do cause problems as happens in about 25 percent of those with fibroids women are most likely to complain of (1) excessive bleeding, (2) pain, and (3) a swollen abdomen. (Actually the stomach isn't any bigger the problem is the uterus, which stretches as the fibroids grow, pushing the intestines upward.) If symptoms develop, physicians typically find six or seven tumors in the uterus.
Excessive bleeding occurs in about 30 percent of the women with fibroids. Most often the bleeding is caused by a type of fibroid tumor that grows underneath the endometrium, or lining of the uterus. As the tumors grow, the lining stretches, thins, and becomes distorted, all of which produce bleeding.
When a woman develops abnormal bleeding, she notices that her menstural flow is heavier, but that it lasts at least at first for the same number of days. She frequently will find, however, that after a while her periods are lasting longer. Some women, in fact, bleed almost constantly. Excessive blood loss drains iron from a woman's body causing anemia.
To determine whether the bleeding is related to fibroid tumors or to some other problem, the doctor may prescribe a certain type of birth control pills. It may also be necessary for the doctor to scrape the inside of the uterus and examine the tissue in a procedure called dilation and curettage or a D & C. One of the physician's major concerns is to make sure that a cancerous growth is not present alongside fibroids.
Pain, if it accompanies fibroids, will generally occur during the menstrual cycle but, more commonly, will not occur at all. With fibroid-related pain, women who have had relatively pain-free menstrual cycles for years may suddenly become very uncomfortable. They experience painful spasms or cramps similar to those felt during labor. Indeed, the fibroid may act like a foreign body, and the uterus responds by contracting, trying to get rid of it.
If a fibroid presses on the pelvic nerves, the woman may feel hip or back pain. If the tumor becomes twisted or begins to deteriorate, the pain may be felt as a sudden severe stabbing in the lower abdomen. Sexual intercourse may also become uncomfortable.
Pain that occurs between menstrual periods is seldom caused by uncomplicated fibroid tumors. When this kind of pain is the problem, the doctor needs to seek another cause. There could be a problem with a previously undiagnosed pregnancy or with a nonfibroid tumor.
Swollen Abdomen. As fibroid tumors grow, they can push other organs out of the way resulting in all kinds of discomfort. A growing fibroid can flatten the bladder, making it necessary to go to the bathroom more frequently and creating a constant feeling of urgency. A woman may also find that she is suddenly unable to control her bladder. In severe cases, the fibroid may push on the urethra or urinary canal so hard that she cannot urinate at all and has to be catheterized. If the tumor extends towards the back and leans on the lower bowel, a woman is likely to develop a backache, become constipated, and find it difficult to have a bowel movement.
Infertility. Fibroids can make it difficult for a woman to become pregnant or, if she does become pregnant, to carry the baby for the full nine months. Many things can happen to interfere with conception, with the fertilized egg's implantation in the uterus, and with the baby's growth. Tumors can block the sperm's pathway to the egg by distorting the uterus or pushing the cervix, or opening of the birth canal, out of alignment with the uterus. Large tumors can pinch the fallopian tubes, interfering with the egg's journey to the uterus.
Most fibroids are found underneath the lining of the uterus. As they grow, the lining above them stretches and may not receive enough nourishment. A fertilized egg may not be able to implant itself properly on the fibroid-distorted lining; and even if the egg does manage to attach itself to the thinned out lining, it may not hold on for the full nine months. The pregnancy will then end in a miscarriage. It is also difficult for the egg to attach itself to the lining if the woman constantly suffers bleeding.
As the pregnancy progresses, fibroids may occupy space meant for the baby. The tumors may also keep the uterus from expanding to accommodate a growing baby. Either of these situations could result in miscarriage or premature labor.
Fibroids may also interfere with the baby's birth, making it necessary for delivery by cesarean section. For example, the uterus may not be able to contract sufficiently, resulting in ineffective labor. Or the baby may not have enough room to assume the proper position for a normal birth. Tumors in or near the birth canal can block the baby's progress. After the baby is born, fibroids may also increase the amount of maternal bleeding.
Fibroids do not prevent most women from conceiving and delivering healthy babies. But when fibroids do cause problems, they are likely to be serious. Indeed, when a woman has a history of miscarriages, a physician will think "fibroids" and try to establish or rule out the presence of these tumors. However, there are many causes of infertility, so only a thorough evaluation can determine whether fibroids are the culprit. If they do prove to be the reason, surgery to remove them will take care of the problem for many women.
