Uterine fibroid: what is a fibroid tumor?

Sharon Stone announces on her Twitter account to suffer from a “fibroid tumor”. In other words, a fibroid in the uterus. What is that ? How is it diagnosed? What are the symptoms of fibroids?

[Updated November 4, 2022 at 10:15 a.m.] Sharon Stone announced on his account Twitter 1 November 2022 'have a large fibroid tumor' which must be removed. 'L worsening pain asked for a second opinion. (...) I will be out for 4-6 weeks for a full recovery' explained the 64-year-old actress before urging women to seek further medical advice when symptoms do not improve. what she calls 'fibroid tumor' is a uterine fibroid. Fibroid (also sometimes called fibromyome ) is a benign tumor very common muscle of the uterus and fibrous tissue of the uterus. It concerns approximately 1 in 3 women of childbearing age in Europe. It does not progress to cancer, but can cause symptoms and be bothersome ( heavy bleeding ...). That's why it's sometimes removed. What are its causes ? The symptoms to recognize it? The exams to detect them? Insights from our two gynecology experts.

What is a uterine fibroid?

Uterine fibroids are small benign tumors that grow in the uterus . They appear as small circular masses. Depending on their exact location, submucosal, interstitial and subserous fibroids are distinguished. Fibroids can be located on all types of organs, however they are most often found in the level of the uterus . These are groups of cells that do not have the same characteristics as the surrounding tissue and which form a tumor called a fibroma. These are benign tumors, but it is often best to remove them to prevent the risk of complications. Fibroids have a round shape or several lobes. They can be inside the organ (e.g. intrauterine fibroid), or outside (ectopic fibroid) by simply being attached by a foot (pedunculated fibroid) or flush with the surface of the organ. organ.

What are the symptoms of fibroids?

Fibroids, in the vast majority of cases, are asymptomatic. Some fibroids go undetected for years and are only discovered during a medical examination such as an ultrasound. Others cause symptoms that can be bothersome for the patient. When symptoms do occur, they are usually heavy bleeding during or outside of menstruation; of abdominal pain , in the lower back, or during sexual intercourse; frequent urination or constipation. A gynecological examination followed by an ultrasound can confirm the diagnosis. Some women feel a feeling of mass in the lower abdomen when the fibroid is of a large size. It is also possible that a intense and brutal pain appears when it is a pedunculated fibroma who is twisting on his foot: it is then urgent to intervene surgically to avoid necrosis of the fibroid. The presence of a fibroid can also be suspected when there are difficulties in conceiving a child, the fibroma can interfere with the implantation of the embryo. Finally, Dr Katty Ardaens, gynecologist in Lille, adds that ' 64% of women with uterine fibroids say they are tired and stressed, compared to 43% of women without fibroids '.



  Diagram of'un fibrome utérin
Diagram of a uterine fibroid

What causes fibroids?

The precise causes of the appearance of a fibroid are not known, but hormonal secretions play a role.

Which women are at risk for fibroids?

These benign tumors, which affect 20 to 40% of women, can be hereditary or favored by significant estrogen secretion and particularly affect women between 30 and 50 years old . In addition, the risk of developing fibroids increases with body mass index (BMI). In 2012, more than 42,000 cases of symptomatic uterine fibroids were recorded in France and more than 33,000 surgical interventions were performed after this diagnosis.

What are the treatments for fibroids?

In the absence of symptoms, simple regular monitoring is sufficient, because fibroids usually end up regressing, after menopause. If symptoms exist, and depending on the frequency and severity of these, several treatments can be proposed. 'It must be emphasized that solutions exist to treat fibroids. As a doctor, we must develop and explain to our patients the existing therapeutic solutions to reduce symptoms and feelings of discomfort. ' insists Dr. Ardaens. Several treatments can be offered such as anti-hemorrhagic, analgesic and anti-inflammatory drugs.

Medications

Several treatments can be proposed such as anti-haemorrhagic, analgesic and anti-inflammatory drugs. Of the hormonal drugs can also be proposed in order to reduce the intensity of the symptoms and to envisage a reduction in the size of the fibroid(s), up to around 50% but temporarily. It is not advisable to use these drugs for a long time. drug treatment, l'Ulipristal acetate , intended to improve the lives of women with uterine fibroids may also be prescribed. This treatment indicated in the preoperative treatment of the symptoms of uterine fibroids in adult women of childbearing age, could make it possible to avoid more than 30% of surgical interventions if the very strict gynecological follow-up is well respected . It is necessary to discontinue treatment 2 months after a 3 month treatment cycle. Monitoring of hepatic check is necessary.

Uterine artery embolization

Embolization consists of interrupting the vascularization of the uterine arteries supplying the fibroid and necrosing it. This non-surgical technique of interventional radiology is used in certain indications. The doctor injects particles into the vessels irrigating the fibroid in order to reduce its size and improve the symptoms.

ultrasound

The technique of ultrasound to destroy the fibroid through the abdominal wall can also be considered. Several techniques can be combined.

Endometrial thermocoagulation

The fibroid can also be destroyed via thermocoagulation thanks to the heat produced by ultrasound

What does fibroid surgery involve?

The decision to perform an intervention depends on manifestations such as bleeding and pain but also the location and the excessive volume of the fibroid(s). The myomectomy is a conservative surgical treatment that consists of removing only the fibroid(s) while preserving the uterus. This helps maintain menstruation and possibly the possibility of pregnancy. It is advisable to respect a healing period between surgery and pregnancy. On the other hand, the persistent scar at the level of the uterus may sometimes require the performance of a cesarean delivery due to an area of ​​great tenderness and fragility.

► Myomectomy can be performed during a hysteroscopy operation leaving in this case no scar. This technique is indicated when the fibroid is located in the uterine cavity and if it measures less than 4 cm.

If the fibroid is less than 8 cm and there are less than 3 fibroids, the procedure can be performed about laparoscopy , technique allowing the incision and the scars to be smaller. The fibroid will be extracted in small pieces.

When the fibroid is too large, larger than 8 cm or when there are more than 3 fibroids, it is necessary to practice laparotomy , performing an abdominal opening.

When should the uterus be removed in case of fibroids?

A hysterectomy, an operation consisting of removing the uterus, is particularly indicated when the fibroid is large, larger than 10 centimeters, when there are several fibroids or when the pressure exerted by the fibroid(s) on the neighboring organs causes too much bleeding, pain, especially during sexual intercourse, anemia or pain when pressing on the bladder. The operation can be performed vaginally or abdominally. This radical method leads to the impossibility of pregnancy because of the permanent menopause it causes.

What are the risks associated with fibroids?

The development of a fibroid can cause compression of different organs such as the bladder, veins, ureter, certain nerves and the rectum and lead to urinary retention, edema and varicose veins, hemorrhoids and constipation. Episodes of neuralgia and sciatica can sometimes be observed. A torsion of a fibroid can occur when it is pedunculated, i.e. fixed to the uterine wall by a narrow pedicle and cause violent pains. The transformation of a fibroid into a sarcoma (malignant tumor) is exceptional.

Pregnancy

A fibroid can also be the cause of infertility or difficulty in becoming pregnant or present risks during pregnancy as well as increased risk of spontaneous miscarriages. On the other hand, the fibroid can interfere with vaginal delivery, thus causing hemorrhage during delivery. Aseptic fibroid necrobiosis, the main cause of pain in fibroids, often occurs during pregnancy or after childbirth. Pelvic pain, fever and metrorrhagia can then occur.

Bleeding

The uterine mucosa is irrigated by many blood vessels: a fibroid which sits under the mucous membrane and which develops can stretch a blood vessel and cause bleeding, more or less abundant. This genital bleeding is called 'metrorrhagia'. If heavy, fibroid-related genital bleeding can lead to iron deficiency (anemia). Anemia easily results in symptoms like fatigue, dizziness, lightheadedness and syncope. Severe hypochromic anemia may require surgery. Any bleeding occurring outside the menstrual period is a warning sign and justifies consulting your doctor or gynecologist for an accurate diagnosis.

Aseptic necrobiosis

Aseptic necrobiosis is the main cause of pain in fibroids. Often related to pregnancy or following childbirth, it is triggered by the ischemia (stopping of blood flow) of the fibroid. It is manifested mainly by pelvic pain, a feverish state and metrorrhagia.

Urinary problems

If the fibroid puts pressure on the bladder, it causes the frequent urge to urinate. The mass of the fibroid will indeed compress the bladder and hinder urinary flow, or cause a feeling of bladder always full. A large uterine fibroid can cause a fragile urinary tract. By impeding urinary flow, it can promote the occurrence of cystitis (urinary tract infection). Repeated fibroid-related urinary tract infections may require intervention to prevent certain complications. Urinary or recurrent discomfort is symptomatic of many pathologies, which are more or less benign. It is therefore necessary to turn to your doctor/gynecologist if the symptom persists.

How does a fibroid develop?

An asymptomatic fibroid requires no treatment but should be monitored regularly. The fibroid can nevertheless continue to evolve and grow and cause the manifestations mentioned above such as heavy bleeding, fatigue linked to anemia or urinary disorders.

Can the formation of a fibroid be prevented?

Although it is impossible to prevent the appearance of a uterine fibroid, it has been proven that active women are less prone than women with a higher body mass. Doing regular sports activity could thus provide some protection against the formation and growth of uterine fibroids. These tumors can be detected by a healthcare professional during a routine examination.

On the health forum: discussions about fibroids Topic Answers Pregnant with Fibroids 35 Fibroma 33 fibroids and pregnancy? 58 Pregnancy, bleeding and invisible on ultrasound 12 twin pregnancy and bleeding 26 To retain

► Uterine fibroids are small benign tumors that grow in the uterus.

► Fibroids, in the vast majority of cases, are asymptomatic.

► They particularly affect women between the ages of 30 and 50.

► Fibroids usually eventually regress after menopause.

► Active women would be less prone to fibroids than women whose body mass is higher.

Thanks to Dr. Katty Ardaens and Dr. Philippe Mironneau, gynecologists.

Source journaldesfemmes.fr