Uterine Fibroids

Uterine fibroids are non-cancerous growths that develop in or on the uterus. They are common among women, especially those of reproductive age. 

In this Fast CE For Less guide, we will cover some of the most important aspects of uterine fibroids you should know, including what they are, their causes, symptoms, and treatments. With better awareness of uterine fibroids, you can be better equipped to help your patients and support them with patient education that can help them make more informed decisions about their care.

What are Uterine Fibroids?

Uterine fibroids, also known as myomas or leiomyomas, are benign tumors that originate from the smooth muscle layer of the uterus. Fibroids come in all shapes and sizes, from tiny, undetectable masses to large tumors that can distort and enlarge the uterus. There are several types of uterine fibroids:

• Pedunculated Fibroids: These fibroids are attached to the uterine wall by a thin stalk. They can grow either inside or outside the uterus and may cause pain if the stalk twists.
• Subserosal Fibroids: These fibroids form on the outer wall of the uterus. They may grow large enough to put pressure on surrounding organs, causing symptoms like frequent urination or constipation.
• Intramural Fibroids: These are the most common type of fibroid. They grow within the muscular wall of the uterus and can cause symptoms like pressure, pelvic pain, and heavy menstrual bleeding.
• Submucosal Fibroids: These fibroids develop just under the lining of the uterine cavity. They can grow into the uterus and are often associated with heavy menstrual bleeding and infertility.

Uterine fibroids are a common health condition, affecting up to 70-80% of women by the age of 50. They are most prevalent in women during their reproductive years, particularly between the ages of 30 and 40. African American women are more likely to develop the condition when they are young and have a higher chance of developing more and larger fibroids compared to women of other racial backgrounds. Family history also plays a significant role; women with a mother or sister who have fibroids are more likely to develop them.

Considering the demographics of women this condition affects, better awareness about the condition and how to treat it is crucial information.

Causes of Uterine Fibroids

Uterine fibroids are influenced by several factors, including genetics, hormones, and lifestyle. Understanding the causes can help in managing and potentially preventing fibroids.

Genetic Factors

Genetics play a significant role in the development of uterine fibroids. Women who have a family history of fibroids are more likely to develop them. If a woman’s mother or sister had fibroids, her chances of developing them are increased. Researchers have identified specific genetic mutations that are common in fibroids, suggesting a strong hereditary component.

Hormonal Influence

Hormones, particularly estrogen and progesterone, are major contributors to the growth of fibroids. These hormones are responsible for regulating the menstrual cycle and promoting the growth of the uterine lining during the menstrual cycle. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells, causing them to grow when hormone levels are high, such as during pregnancy. Conversely, they tend to shrink after menopause when hormone levels decrease.

Other Contributing Factors

Several other factors can contribute to the development of fibroids:

• Lifestyle and Diet: A diet high in red meat and low in green vegetables, fruit, and dairy can increase the risk of developing fibroids. Conversely, a balanced diet rich in fruits and vegetables may help reduce the risk.
• Obesity: Women who are overweight or obese have a higher risk of developing fibroids. Fat cells produce estrogen, which can contribute to the growth of fibroids.
• Vitamin D Deficiency: Studies suggest that women with lower levels of vitamin D are more likely to develop fibroids. Vitamin D is thought to inhibit fibroid cell growth.
• Environmental Factors: Exposure to environmental toxins such as pesticides and certain hair relaxers used by African American women may also increase the risk of developing fibroids.

Educating your patients about these contributing factors can help you encourage women to make informed lifestyle choices to manage their risk of developing fibroids.

Age of Females with Uterine Fibroids

Uterine fibroids are most commonly diagnosed in women during their reproductive years, typically between the ages of 30 and 40. However, fibroids can develop at any age after puberty. The risk of developing fibroids increases with age, peaking in the late reproductive years. After menopause, fibroids often shrink due to the decrease in hormone levels. Healthcare providers need to monitor women in these age groups closely for symptoms of fibroids, as early detection can lead to more effective management and treatment options.

Symptoms of Uterine Fibroids

Uterine fibroids can cause a range of symptoms depending on their size, location, and number. These symptoms can significantly impact a woman’s quality of life.

Pain and Discomfort

One of the most common symptoms of uterine fibroids is pain. This can manifest as pelvic pain, which may be constant or intermittent. Women with fibroids may also experience lower back pain or discomfort during sexual intercourse. Large fibroids can press on surrounding organs, causing additional pain and discomfort.

Menstrual Irregularities

Fibroids can lead to menstrual irregularities, such as prolonged and heavy menstrual cycles. Some women may experience bleeding between periods. The heavy bleeding can lead to significant blood loss over time, affecting overall health and well-being. It is crucial for nurses to educate patients on tracking their menstrual cycles and reporting any changes or excessive bleeding.

Anemia

Due to heavy menstrual bleeding, women with fibroids are at risk of developing anemia. Anemia occurs when the body does not have enough healthy red blood cells to carry oxygen to tissues, leading to symptoms like fatigue, weakness, and shortness of breath. Nurses should be vigilant in monitoring patients for signs of anemia and ensure they receive appropriate treatment, such as iron supplements or dietary changes.

Infertility

Fibroids can also impact fertility and pregnancy. They can distort the shape of the uterus, block fallopian tubes, and interfere with the implantation of an embryo. Women with fibroids may have difficulty conceiving or may experience recurrent miscarriages. It is important to discuss potential complications with your patients who are trying to conceive or are currently pregnant.

Understanding the symptoms will help you identify whether a patient is suffering from uterine fibroids and provide timely intervention.

Treatment for Uterine Fibroids

Treatment for uterine fibroids varies depending on the size, location, and symptoms of the fibroids. Some women may not need treatment if their symptoms are mild or absent, but for those experiencing significant discomfort, there are several options available, both surgical and non-surgical.

Surgical Options

• Laparoscopic Surgeries: Laparoscopic surgeries, such as laparoscopic myomectomy, involve small incisions and the use of a camera and specialized instruments to remove fibroids. These procedures are less invasive, have shorter recovery times, and cause less postoperative pain compared to open surgeries. They are suitable for smaller fibroids and those located on the outer surface of the uterus.
• Uterine Myomectomy: This surgery involves the removal of fibroids while preserving the uterus. It is an option for women who wish to maintain their fertility. Myomectomy can be performed through several approaches, including abdominal (open), laparoscopic (minimally invasive), or hysteroscopic (through the vagina and cervix). The choice of method depends on the size and location of the fibroids.
• Hysterectomy: A hysterectomy is the complete removal of the uterus and is the only treatment that guarantees fibroids will not return. This option is usually considered for women who have severe symptoms and do not wish to preserve fertility. There are different types of hysterectomies, including total, partial, and radical, depending on the extent of removal needed.

Non-Surgical Treatments

• Medication Management: Medications can help manage symptoms and shrink fibroids but do not eliminate them. Options include:
  • Anti-inflammatory drugs (NSAIDs): These can reduce pain but do not affect bleeding or fibroid size.
  • Oral contraceptives and progestins: These can help control heavy menstrual bleeding but do not shrink fibroids.
  • Gonadotropin-releasing hormone (GnRH) agonists: The medicine reduces progesterone and estrogen levels, making the fibroids shrink. That said, they are usually used short-term due to side effects like bone thinning.
• Radiation Treatment: Uterine artery embolization (UAE) is a procedure that blocks the blood supply to fibroids, causing them to shrink. This is done by injecting small particles into the uterine arteries. UAE is minimally invasive and preserves the uterus, making it a suitable option for women who want to avoid surgery.
• IUD Devices: A hormone-releasing intrauterine device (IUD) can reduce heavy bleeding and provide relief from pain. It does not shrink fibroids but is a good option for women seeking non-surgical management.

Emerging Treatments and Future Directions

Research is ongoing to find new and improved treatments for uterine fibroids. Some of the emerging treatments include:

• New minimally invasive techniques: Advances in surgical technology continue to improve the effectiveness and recovery times of minimally invasive fibroid treatments.
• Selective progesterone receptor modulators (SPRMs): These medications can help shrink fibroids and reduce symptoms with fewer side effects compared to GnRH agonists.
• MRI-guided focused ultrasound surgery (FUS): This non-invasive procedure uses high-frequency sound waves to heat and destroy fibroid tissue. It is performed under MRI guidance, allowing precise targeting of fibroids.

Emerging treatments offer hope for better management of uterine fibroids in the future, providing more options for women seeking relief from their symptoms.

Final Thoughts

Understanding the condition of uterine fibroids, their causes, symptoms, and treatment options is crucial to help you provide better care and support to patients.

If you have not completed your nursing continuing education requirements to renew your license and want to learn more, online nursing CEUs offered by Fast CE For Less can help.

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