The majority of fibroids are small and cause no problems. Fibroids may be present in 50% of women so that the fact that they co-exist with a symptom such as pelvic pain does not necessarily prove cause and effect (Q4.3).
Heavy periods are often associated with fibroids. In one study, 30% of women presenting with heavy periods had fibroids seen on hysteroscopy (Q 24.8). There was, however, no difference in the incidence of fibroids in the group with heavy periods and another group who did not have heavy periods. Many women who present with heavy periods are found to have fibroids but proof that the fibroids are the cause of the problem is lacking. There have been very few studies to confirm that removing fibroids reduces heavy periods.
Bleeding between periods (intermenstrual bleeding IMB) can be related to a submucous fibroid (Figure 23.1).
Recommended Books:
Uterine Fibroids: The Complete Guide (Johns Hopkins Press Health Books)
Pelvic pain, like heavy periods, is a frequent problem and may co-exist with fibroids. They are not usually the cause of pain unless they are being squeezed out through the cervix or they are attached to the outer surface of the uterus and start twisting (torsion). If there is any doubt, it may be helpful to undertake a pelvic examination at the time that the pain is present. On occasion, a fibroid may lose part of its blood supply resulting in degeneration and acute pain. Degeneration of a fibroid is more common during pregnancy but can occur at other times.
Infertility and recurrent miscarriage investigation frequently demonstrate fibroids. It should not be assumed that the fibroids are the cause of the problem.
Submucosal fibroids had the strongest association with lower ongoing
pregnancy rates primarily through decreased implantation. Cumulative
pregnancy rates appear to be slightly lower in patients with intramural
fibroids. Patients with intramural fibroids also experience more
miscarriages, (20.4% vs 12.9%). Adverse obstetric outcomes are rare and may
reflect age or other differences in fibroid populations. Increased risk of
malpresentation (odds ratio, 2.9; 2.6-3.2), caesarean (odds ratio, 3.7;
3.5-3.9), and preterm delivery (odds ratio, 1.5; 1.3-1.7) have been
reported; however, the incidence of labor dystocia was low (7.5%). There is
no conclusive evidence that intramural or subserosal fibroids adversely
affect fecundity. More prospective, controlled trials are needed to assess
the effects of myomectomy. Good maternal and neonatal outcomes are expected
in pregnancies with uterine fibroids.0801
Bladder symptoms including increased frequency of bladder emptying may be due to large fibroids pressing on the bladder (Q 29.9)
Occasionally abdominal enlargement may be the presenting symptom of large fibroids.
The risk of malignant change of a fibroid is extremely small. The figure often quoted is one in a thousand but this is probably derived from examination of fibroids that have been removed and excludes the majority of fibroids that have not been removed. Rapid enlargement of a fibroid could indicate the possibility of malignant change.
Related Medical Abstracts - Click on the paper title:-
