Transcript Women High Risk For uterine fibroids

Philadelphia University
Faculty of Nursing
Uterine Fibroids
 By
:- Yasmin Ali Musleh
 Num :- 200811140
 Dr :- Aida Abd- ALrazeq
OUT LINE:Introduction
Uterine Fibroid Causes
Pathology and histology
Women high risk for uterine fibroid
What are the symptoms of fibroids?
Complications
Diagnosis
Treatment
References
Objective:
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After studying this lectures the student should be
able to:Learn what is the uterine fibroid
Causes of the uterine fibroid
Pathology and Histology uterine fibroid
Women high risk for uterine fibroid
Sign and symptom of the uterine fibroid
Complication of the uterine fibroid
Diagnosis
Treatment
Uterine Fibroids Overview
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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.
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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.
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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.
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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).
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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
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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.
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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 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
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
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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.
Micrograph of a lipoleiomyoma, a type of leiomyoma. H&E stain.
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Microscopically, tumor cells resemble normal
cells (elongated, spindle-shaped, with a cigarshaped 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
Women High Risk For uterine fibroids
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About 20–40% of women will be diagnosed
with leiomyoma but only a fraction of those
will cause problems or require treatment.
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The condition is about twice as common in
black women as white women.
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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
What are the symptoms of fibroids?
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Most fibroids do not cause any symptoms,
but some women with fibroids can have:
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heavy bleeding or painful periods
bleeding between periods
feeling of fullness in the pelvic area (lower
abdomen)
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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
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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.
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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.
Diagnosis
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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
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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.
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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.
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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.
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Other imaging techniques that may be helpful
specifically in the evaluation of lesions that
affect the uterine cavity are
hysterosalpingography or sonohysterography.
Treatment
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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:
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medication to control symptoms
medication aimed at shrinking tumours
ultrasound fibroid destruction
various surgically aided methods to reduce
blood supply of fibroids
myomectomy or radio frequency ablation
hysterectomy
References
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^ uterine leiomyoma at Dorland'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 17039693. 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.
^ 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): 563-568
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