What is a uterine fibroid?

Qu'est-ce que le fibrome utérin ?

What is a uterine fibroid?

Uterine fibroid is a benign (non-cancerous) tumor that grows on the lining of the uterus, i.e. on the muscle of the uterus, either singly or in groups. It is the most common solid non-cancerous tumor in women of childbearing age.

In fact, these tumors generally appear in women over 30 years of age (30 to 50% of women over 30 are affected, and this percentage increases with age) and particularly in women of African origin, who are 3 to 4 times more likely to develop a uterine fibroid. The risk of developing a uterine fibroid is also increased if the mother has developed one herself.

The number, location and size of fibroids vary from one woman to another.

Different types of fibroids

There are 3 types of uterine fibroids, distinguished by their location:

  • Intramural or interstitial fibroids (the most common type of fibroids: about 70%): they form in the muscular layer of the uterine wall
  • subserous fibroids: they develop towards the outside of the uterus
  • submucosal or endocavitary fibroids (the rarest): they grow under theendometriumand can occupy a large space in the uterine cavity

Causes of uterine fibroids

The causes of uterine fibroids are still not well known. For the moment, it seems that the fibroid originates from a single cell in the uterine wall that undergoes a genetic mutation and begins to multiply uncontrollably. Estrogen would then act on this fibroid to allow it to grow.

A number of factors favor their development, such as

  • a history of fibroids in the family on the 1stst degree (mother, sister)
  • ethnic origin: fibroids are more frequent in African-American women
  • hormonal fluctuations: the hormones as we have just said, play a role in the growth of fibroids. This is why they do not appear until puberty and often stop growing at menopause. Finally, during pregnancy, it is not uncommon to see the appearance and/or growth of fibroids
  • overweight and obesity, because body fat produces estrogens that contribute to the development of fibroids
  • excessive alcohol consumption

The symptoms

Most of the time, fibroids do not cause any symptoms and are therefore often discovered by chance during a check-up with a specialized physician.

Nevertheless, a fibroid can cause pain in the lower abdomen, frequent urination, constipation, painful sexual intercourse, etc. painful sexual intercourse abnormally long and heavy periods and/or bleeding between periods, and sometimes even fertility problems, a risk of miscarriage or premature delivery.

Moreover, it is often the size, location and number of fibroids that influence the occurrence and intensity of symptoms.

Examinations

As we have just said, it is very often the clinical examination that makes it possible, somewhat by chance, to discover a uterine syndrome.

Once there is a suspicion of a fibroid, an ultrasound scan will be performed to highlight it, its size and location.

Next, a hysterography will show the appearance of the uterine cavity and its possible deformation. Then a hysteroscopy will show the inside of the uterine cavity.

Finally, a blood test may reveal anemia in case of heavy bleeding.

What treatment for a uterine fibroid

As a general rule, a fibroid that does not cause any symptoms does not require treatment. However, there are treatments if symptoms do occur. These differ according to the size, location, number of fibroids, and age of the patient.

  • Regular physical activity reduces the risk of developing a uterine fibroid.
  • Applying warm compresses (or ice) to the painful areas can help relieve the pain.
  • To counter constipation: have a good intake of fruits and vegetables and dietary fiber. It is also possible to take laxatives.
  • Medicinal treatments: medicines can reduce the symptoms (pain, cramps, regulation of the menstrual cycle, etc.). Medication may also be prescribed to reduce the size of the fibroids. They are often prescribed in anticipation of an operation to facilitate the surgical procedure. If patients have heavy blood loss, iron supplements or an IUD insertion may be prescribed to help reduce the amount of menstrual flow and its duration.
  • Surgery:
    • Myomectomy to remove one or more fibroids while preserving the uterus for future pregnancies. However, fibroids may reappear afterwards.
    • Endometrial ablation for women who no longer want children and to reduce heavy bleeding.
    • Hysterectomy to remove the uterus, the only solution that offers a definitive result
  • Uterine artery embolization: to deprive the fibroid of oxygen and nutrients by blocking the blood vessels that irrigate it. Thus, the fibroids dry up and gradually lose about 50% of their volume. However, this method is not recommended for all types of fibroids.
  • Ligation of the uterine arteries by laparoscopy: placing a clip on the arteries. But this method is less effective than embolization.

Other techniques are also available, depending on the type of fibroid and the symptoms it generates, and these can be proposed by a specialized doctor.

Thus, the choice of treatment depends on the age and the desire to become pregnancythe importance of symptoms and possible complications, the type of fibroid and the patient's general condition.

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