Philadelphia University Faculty of Nursing

Uterine Fibroids By :- Yasmin Ali Musleh By :- Yasmin Ali Musleh Num : Num : Dr :- Aida Abd- ALrazeq Dr :- Aida Abd- ALrazeq

OUT LINE:- OUT LINE:- Introduction Uterine Fibroid Causes Pathology and histology Women high risk for uterine fibroid What are the symptoms of fibroids? ComplicationsDiagnosisTreatmentReferences

Objective:- After studying this lectures the student should be able to:- After studying this lectures the student should be able to:- Learn what is the uterine fibroid Learn what is the uterine fibroid Causes of the uterine fibroid Causes of the uterine fibroid Pathology and Histology uterine fibroid Pathology and Histology uterine fibroid Women high risk for uterine fibroid Women high risk for uterine fibroid Sign and symptom of the uterine fibroid Sign and symptom of the uterine fibroid Complication of the uterine fibroid Complication of the uterine fibroid Diagnosis Diagnosis Treatment Treatment

Uterine Fibroids Overview A uterine fibroid is the most common benign (not cancerous) tumor of a woman's uterus (womb). Fibroids are tumors of the smooth muscle that is normally found in the wall of the uterus. They can develop within the uterine wall itself or attach to it. They may grow as a single tumor or in clusters. A uterine fibroid is the most common benign (not cancerous) tumor of a woman's uterus (womb). Fibroids are tumors of the smooth muscle that is normally found in the wall of the uterus. They can develop within the uterine wall itself or attach to it. They may grow as a single tumor or in clusters.

Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination; so even though they are termed "benign (not cancerous) tumors," fibroids potentially can cause many health problems. Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination; so even though they are termed "benign (not cancerous) tumors," fibroids potentially can cause many health problems. These growths occur in up to 50% of all women and are one leading cause of hysterectomy (removal of the uterus) in the United States. These growths occur in up to 50% of all women and are one leading cause of hysterectomy (removal of the uterus) in the United States. hysterectomy

An estimated 600,000 hysterectomies are performed in the US annually, and at least one-third of these procedures are for fibroids. Medications and newer, less invasive surgical treatments are now available to help control the growth of fibroids. An estimated 600,000 hysterectomies are performed in the US annually, and at least one-third of these procedures are for fibroids. Medications and newer, less invasive surgical treatments are now available to help control the growth of fibroids. Fibroids start in the muscle tissues of the uterus. They can grow into the uterine cavity (sub mucosal), into the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subsersoal) into the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stalk off of the uterus). Fibroids start in the muscle tissues of the uterus. They can grow into the uterine cavity (sub mucosal), into the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subsersoal) into the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stalk off of the uterus).

Although these tumors are called fibroids, this term is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma, a type of myoma or mesenchymal tumor. Although these tumors are called fibroids, this term is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma, a type of myoma or mesenchymal tumor.

Uterine Fibroid Causes The exact reasons why some women develop fibroids are unknown. Fibroids tend to run in families, and affected women often have a family history of fibroids. Women of African descent are two to three times more likely to develop fibroids than women of other races. The exact reasons why some women develop fibroids are unknown. Fibroids tend to run in families, and affected women often have a family history of fibroids. Women of African descent are two to three times more likely to develop fibroids than women of other races.

Fibroids grow in response to stimulation by the hormone estrogen, produced naturally in the body. These growths can show up as early as age 20 and shrink after menopause when the body stops producing large amounts of estrogen. Fibroids grow in response to stimulation by the hormone estrogen, produced naturally in the body. These growths can show up as early as age 20 and shrink after menopause when the body stops producing large amounts of estrogen.menopause Fibroids can be tiny and cause no problems, but they also can grow to weigh several pounds. Fibroids grow slowly. Fibroids can be tiny and cause no problems, but they also can grow to weigh several pounds. Fibroids grow slowly.

The following factors have been associated with the presence of fibroids: Being overweight, obesity obesity Never having given birth to a child (called nulliparity) Onset of the menstrual period prior to age 10 African American heritage (occurring 3-9 times more often than in Caucasian women)

Pathology and histology Leiomyomas grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance on histological section. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall. Leiomyomas grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance on histological section. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall.

MicrographMicrograph of a lipoleiomyoma, a type of leiomyoma. H&E stain.H&E stain

Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar- shaped nucleus) and form bundles with different directions (whorled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and mitotically active Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar- shaped nucleus) and form bundles with different directions (whorled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and mitotically activemitotically

Women High Risk For uterine fibroids About 20–40% of women will be diagnosed with leiomyoma but only a fraction of those will cause problems or require treatment. About 20–40% of women will be diagnosed with leiomyoma but only a fraction of those will cause problems or require treatment. The condition is about twice as common in black women as white women. The condition is about twice as common in black women as white women.

Leiomyoma are more common in overweight women (perhaps because of increased estrogen from adipose aromatase activity). Fibroids are dependent on estrogen and progesterone to grow and therefore relevant only during the reproductive years, they are expected to shrink after menopause Leiomyoma are more common in overweight women (perhaps because of increased estrogen from adipose aromatase activity). Fibroids are dependent on estrogen and progesterone to grow and therefore relevant only during the reproductive years, they are expected to shrink after menopausearomatase

What are the symptoms of fibroids? Most fibroids do not cause any symptoms, but some women with fibroids can have: Most fibroids do not cause any symptoms, but some women with fibroids can have: heavy bleeding or painful periods heavy bleeding or painful periods bleeding between periods bleeding between periods feeling of fullness in the pelvic area (lower abdomen) feeling of fullness in the pelvic area (lower abdomen)

pain during sexual intercourse lower back pain reproductive problems, such as infertility, having more than one miscarriage, or having early onset of labor during pregnancy.

Complications Although most fibroids do not cause problems, there can be complications. Fibroids that are attached to the uterus by a stem may twist and can cause pain, nausea, or fever. Fibroids that grow rapidly, or those that start breaking down, also may cause pain. Rarely, they can be associated with cancer. Although most fibroids do not cause problems, there can be complications. Fibroids that are attached to the uterus by a stem may twist and can cause pain, nausea, or fever. Fibroids that grow rapidly, or those that start breaking down, also may cause pain. Rarely, they can be associated with cancer.

A very large fibroid may cause swelling of the abdomen. This swelling can make it hard to do a thorough pelvic exam. A very large fibroid may cause swelling of the abdomen. This swelling can make it hard to do a thorough pelvic exam. Fibroids also may cause infertility, although other causes are more common. Other factors should be explored before fibroids are considered the cause of a couple’s infertility. When fibroids are thought to be a cause, many women are able to become pregnant after they are treated. Fibroids also may cause infertility, although other causes are more common. Other factors should be explored before fibroids are considered the cause of a couple’s infertility. When fibroids are thought to be a cause, many women are able to become pregnant after they are treated.

Diagnosis While a bimanual examination typically can identify the presence of larger fibroids, gynecologic ultrasonography (ultrasound) has evolved as the standard tool to evaluate the uterus for fibroids. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam While a bimanual examination typically can identify the presence of larger fibroids, gynecologic ultrasonography (ultrasound) has evolved as the standard tool to evaluate the uterus for fibroids. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam gynecologic ultrasonography gynecologic ultrasonography

The location can be determined and dimensions of the lesion measured. Also magnetic resonance imaging (MRI) can be used to define the depiction of the size and location of the fibroids within the uterus. Imaging modalities cannot clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, however, the latter is quite rare. The location can be determined and dimensions of the lesion measured. Also magnetic resonance imaging (MRI) can be used to define the depiction of the size and location of the fibroids within the uterus. Imaging modalities cannot clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, however, the latter is quite rare.MRI

However fast growth or unexpected growth such as enlargement of a lesion after the menopause raise the level of suspicion that the lesion might be a sarcoma. Also, with advanced malignant lesions there may be evidence of local invasion. A more recent study has suggested that diagnostic capabilities using MRI have improved the ability to detect sarcomatous lesions. However fast growth or unexpected growth such as enlargement of a lesion after the menopause raise the level of suspicion that the lesion might be a sarcoma. Also, with advanced malignant lesions there may be evidence of local invasion. A more recent study has suggested that diagnostic capabilities using MRI have improved the ability to detect sarcomatous lesions.

Biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, surgery is generally indicated. Biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, surgery is generally indicated. Other imaging techniques that may be helpful specifically in the evaluation of lesions that affect the uterine cavity are hysterosalpingography or sonohysterography. Other imaging techniques that may be helpful specifically in the evaluation of lesions that affect the uterine cavity are hysterosalpingography or sonohysterography. hysterosalpingographysonohysterography hysterosalpingographysonohysterography

Treatment Most fibroids do not require treatment unless they are causing symptoms. After menopause fibroids shrink and it is unusual for fibroids to cause problems. Most fibroids do not require treatment unless they are causing symptoms. After menopause fibroids shrink and it is unusual for fibroids to cause problems.

Symptomatic uterine fibroids can be treated by: medication to control symptoms medication to control symptoms medication aimed at shrinking tumours medication aimed at shrinking tumours ultrasound fibroid destruction ultrasound fibroid destruction various surgically aided methods to reduce blood supply of fibroids various surgically aided methods to reduce blood supply of fibroids myomectomy or radio frequency ablation myomectomy or radio frequency ablation hysterectomy hysterectomy

^ uterine leiomyoma at Dorland's Medical Dictionary ^ uterine leiomyoma at Dorland's Medical Dictionary ^uterine leiomyomaDorland's Medical Dictionary ^uterine leiomyomaDorland's Medical Dictionary ^ a b Neiger, R; Sonek, JD; Croom, CS; Ventolini, G (2006). "Pregnancy-related changes in the size of uterine leiomyomas". The Journal of reproductive medicine 51 (9): 671–4. PMID edit ^ a b Neiger, R; Sonek, JD; Croom, CS; Ventolini, G (2006). "Pregnancy-related changes in the size of uterine leiomyomas". The Journal of reproductive medicine 51 (9): 671–4. PMID editabPMID editabPMID edit ^ a b c Wallach EE, Vlahos NF. "Uterine myomas: an overview of development, clinical features, and management". Obstet Gynecol 104 (2004), pp. 393– 406. ^ a b c Wallach EE, Vlahos NF. "Uterine myomas: an overview of development, clinical features, and management". Obstet Gynecol 104 (2004), pp. 393– 406.abcabc References

^ Uterine Fibroids – The Merck Manuals Online Medical Library ^ Uterine Fibroids – The Merck Manuals Online Medical Library ^Uterine Fibroids – The Merck Manuals Online Medical Library ^Uterine Fibroids – The Merck Manuals Online Medical Library ^ Wise, L., Palmer, J., Bernard, H., Stewart, E., Rosenberg, L., (2005) Age-Specific Incidence rates for Self-Reported Uterine Leiomyomata in the Black Women’s Health Study Obstet Gynecol 105(3): ^ Wise, L., Palmer, J., Bernard, H., Stewart, E., Rosenberg, L., (2005) Age-Specific Incidence rates for Self-Reported Uterine Leiomyomata in the Black Women’s Health Study Obstet Gynecol 105(3): ^