Tag Archives: Uterus

Pelvic Ultrasound and Transvaginal Ultrasound

Alternative  Names:Endovaginal ultrasound; Ultrasound – transvaginal; Sonohysterography; Hysterosonography; Saline infusion sonography; SIS
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Definition:
Ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures inside the body. This imaging technique works in a manner similar to radar and sonar, developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible. After coating your skin with a lubricant to reduce friction, a radiologist or ultrasound technician places an ultrasound transducer, which looks like a microphone, on your skin and may rub it back and forth to get the right view. The transducer sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor.

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Pelvic organ ultrasound is used to monitor pregnancy, find cysts on your ovaries, examine the lining of your uterus, look for causes of infertility, and find cancers or benign tumors in the pelvic region. Depending on the view needed, the ultrasound sensor is placed either on your abdomen (pelvic ultrasound) or in your vagina (transvaginal ultrasound).

Pelvic ultrasound, primarily performed on females is most frequently used for evaluation of pelvic pain, abnormal vaginal bleeding, inflammatory disease, or detection of a mass. Pelvic ultrasound may help explain findings from a manual examination and provide additional information. Pelvic ultrasound examination will generally result in good depiction of the bladder, uterus, and ovaries.

In some patients, transvaginal ultrasound, which involves the insertion of a small transducer (probe) into the vagina, may be necessary to provide a complete analysis of the ovaries and uterine endometrial lining. Early pregnancy or body habitus (obesity) can obscure adequate evaluation of some structures. The decision to use transvaginal ultrasound is determined by the radiologist following pelvic ultrasound.

Pelvic ultrasound generally requires a full bladder and is performed with the patient lying flat on a padded table. Transvaginal ultrasound testing requires the patient to empty their bladder in the restroom and return to the scanning room for a transvaginal examination. Patients are asked disrobe from the waist down with hips elevated by folded towels or a foam pad. Patients usually insert the probe themselves, but can be assisted.

How to prepare for the test.
You will be asked to undress, usually from the waist down.
Your doctor might ask you to drink a few glasses of water before the test because a full bladder lifts your intestines out of the way and provides a clearer view of your pelvic organs. If you’re having a transvaginal ultrasound and have a tampon in place, you’ll need to remove it before the test.

A full bladder is essential for adequate visualization of the pelvic region.

* Finish drinking 4 glasses (32 ounces total) of water one hour prior to your appointment. It is important to drink water only. Do not substitute other beverages.

* Do not empty your bladder prior to the exam.

* Eat as you normally would before and after the examination and return to your usual or recommended activities after the exam.

To avoid delay or rescheduling of your pelvic / transvaginal ultrasound examination, follow preparation instructions carefully.

* Arrive 15 minutes prior to your scheduled appointment time to register for your test.

* The length of time needed to complete this examination will vary depending on the information needed. Plan for up to 45 minutes to complete your exam.

How the Test is Performed
You will lie down on a table with your knees bent and feet in holders called stirrups. The health care provider will place a probe, called a transducer, into the vagina. The probe is covered with a condom and a gel. The probe sends out sound waves, which reflect off body structures. A computer receives these waves and uses them to create a picture. The doctor can immediately see the picture on a nearby TV monitor.

The health care provider will move the probe within the area to see the pelvic organs. This test can be used during pregnancy.

In some cases, a special transvaginal ultrasound method called saline infusion sonography (SIS), also called sonohysterography or hysterosonography, may be needed to more clearly view the uterus.

This test requires saline (sterile salt water) to be placed into the uterus before the ultrasound. The saline helps outline any abnormal masses, so the doctor can get a better idea of their size.

SIS is not done on pregnant women.

What happens when the test is performed.

You lie on your back on a table for the test. For a pelvic ultrasound, after squirting some clear jelly onto your lower abdomen to help the ultrasound sensor slide around easily, a doctor or technician places the sensor against your skin. For a transvaginal ultrasound, the doctor or technician covers a sensor with a condom and some jelly before inserting it into your vagina.When the sensor is in place, a picture will appear on a video screen. The technician or doctor moves the sensor on your abdomen or in your vagina to see the uterus and ovaries from many different views.

How the Test Will Feel
The test is usually painless, although some women may have mild discomfort from the pressure of the probe. Only a small part of the probe is placed into the vagina.

Risk Factors:
There are no known harmful effects of transvaginal ultrasound on humans.

Unlike traditional x-rays, there is no radiation exposure with this test.

How long is it before the result of the test is known.

If a doctor does the test, you might be able to get preliminary results immediately; this will not be possible if a technician performs the test.Whether a doctor or technician performs the test, he or she records it on a videotape so that it can be formally reviewed by a radiologist. Your doctor should receive the radiologist’s report in a day or two.

Results:
Normal Results

The pelvic structures or fetus are normal.

What Abnormal Results Mean

An abnormal result may be due to many conditions. Some problems that may be seen include:

* Cancers of the uterus, ovaries, vagina, and other pelvic structures
* Non-cancerous growths of the uterus and ovaries (such as cysts or fibroids)
* Twisting of the ovaries
* Infection, including pelvic inflammatory disease
* Birth defects

Some problems that may be found specifically in pregnant women include:

* Ectopic pregnancy
* More than one fetus (twins, triplets, etc.)
* Miscarriage
* Placenta previa
* Placental abruption
* Tumors of pregnancy including gestational trophoblastic disease

Resources:
https://www.health.harvard.edu/fhg/diagnostics/pelvic-ultrasound-and-transvaginal-ultrasound.shtml
http://www.tacomarad.com/exams/ultrasound/pelvic.html
http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm

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Hysteroscopy

Definition:
Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
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The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.

Method:-
The hysteroscope is an optical instrument connected to a video unit with a fiber optic light source, and to the channels for delivery and removal of a distention medium. The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus during hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure and the patient’s condition. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally depending on the quality of the high-resolution video images in front of surgeon’s eyes, CO2 gas is not commonly used as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they are conducting electricity, these fluids should not be used with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol and a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. Each of these distention fluids is associated with unique physiological changes that should be considered when selecting a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose in the liver and is contraindicated if patients has fructose intolerance. High-viscous Dextran also has potential complications which can be physiological and mechanical. It may crystallize on instruments and obstruct the valves and channels. Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and can cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% has a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) should be avoided in fructose intolerant patients.

A hysteroscope is in fact a modification of the traditional resectoscope, which is used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for less outflow through the smaller channel. This results in the distention of the uterine cavity. With modern optical technologies, hysteroscopes are getting smaller in diameter yet able to provide larger and brighter images for surgeons’ convenience.

After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy. Typically hysteroscopic intervention is done under general endotracheal anesthesia or Monitored Anesthesia Care (MAC), but a short diagnostic procedure can be performed in a gynecologist‘s office with just a paracervical block using the Lidocaine injection in the upper part of the cervix.

Why it is Done:
Hysteroscopy is useful in a number of uterine conditions:

Asherman’s syndrome (ie. intrauterine adhesions). Hysteroscopic adhesiolysis is the technique of lysing adhesions in the
*uterus using either microscissors (recommended) or thermal energy modalities. Hysteroscopy can be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure.
*Endometrial polyp. Polypectomy.
*Gynecologic bleeding
*Uterine fibroids. Myomectomy.
*Congenital Uterine malformations (also known as Mullerian malformations). Eg.septum,
*Evacuation of retained products of conception in selected cases.

Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman’s syndrome.
How do you prepare for the test
The time that you schedule this test can be important. Your gynecologist is able to get the best view of the uterine lining during the week that follows your period. If you have regular cycles, it is helpful for you to anticipate the timing of your next period and plan to have the hysteroscopy done in the following week.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Discuss different options for anesthesia with your doctor in advance.

If your doctor plans on giving you any anti-anxiety medicines before the procedure, or if you are going to have other tests done at the same time as hysteroscopy, you might be told not to eat or drink for eighthours or more before the test. Just before the test, you should empty your bladder.

Risk Factors:

After the procedure, you may have slight vaginal bleeding and cramps for one or two days. Sometimes a small amount of the gas used to expand the uterus can float up to the top of the abdomen and remain there for a day or two before it dissolves away. This can cause some shoulder pain. Some patients experience nausea from medicines used for anesthesia or anxiety.

Some of the procedures that are done along with hysteroscopy have risks of their own. You should ask your doctor about special risks that might come along with additional procedures planned for you.

A common problem is the uterine perforation when the instrument breaches the wall of the uterus. This can lead to bleeding and damage to other organs. A life-threatening condition is the bowel perforation by the instruments after the uterine perforation, resulting in acute peritonitis which can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media described above are also not uncommon. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less then 1% of cases.

How long is it before the result of the test is known
Your doctor can tell you what was seen through the hysteroscope right away. If a biopsy sample is removed, the analysis might take several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/hysteroscopy.shtml
http://en.wikipedia.org/wiki/Hysteroscopy

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Endometrial Biopsy

Introduction:An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body’s hormone levels that affect the endometrium are in balance.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

The lining of the uterus changes throughout a woman’s menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

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There are several ways to do an endometrial biopsy. Your doctor may use:

*A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.

*A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.

*An electronic suction device (Vabra aspiration). This method can be uncomfortable.

*A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done
An endometrial biopsy is done to:

*Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
*Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.

*See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare
Tell your doctor if you:

*Are or might be pregnant. An endometrial biopsy is not done during pregnancy.

*Are taking any medicines.

*Are allergic to any medicines.

*Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).

*Have been treated for a vaginal, cervical, or pelvic infection.

*Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done
An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor’s office.

Your cervix may be numbed with a spray or injection of local anesthetic.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.

If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.

You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels
If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks Factors:
You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.There is also a small risk of disturbing a very early pregnancy. To guard against this, your doctor might order a pregnancy test before performing the biopsy.

After the test:
You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

*Heavy vaginal bleeding (more than a normal menstrual period).

*A fever.

*Belly pain.

*Bad-smelling vaginal discharge.

Results:
Time to know the results:
An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.


Endometrial biopsy  Normal
: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Endometrial biopsy  Abnormal:

*A noncancerous (benign) growth, called a polyp, is present.

*Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

*Cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endometrial-biopsy.shtml
http://women.webmd.com/endometrial-biopsy

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Fibroma

Soft Fibroma (fibroma molle).

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Definition:
A tumour that is comprised mainly of fibrous connective tissue.

Fibromas (or fibroid tumors or fibroids) are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchyme tissue.

The term “fibroblastic” or “fibromatous” is used to describe tumors of the fibrous connective tissue. When the term fibroma is used without modifier, it is usually considered benign, with the term fibrosarcoma reserved for malignant tumors.

The term fibroid can also refer to tumors of smooth muscle, as in uterine fibroids.

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Hard Fibroma
The hard fibroma (fibroma durum) consists of many fibres and few cells, e.g. in skin it is called dermatofibroma (fibroma simplex or nodulus cutaneous), might A special form is the keloid, which derives from hyperplastic growth of scars.

Soft Fibroma
The soft fibroma (fibroma molle) or fibroma with a shaft (acrochordon, skin tag, fibroma pendulans) consist of many loosely connected cells and less fibroid tissue. It mostly appears at the neck, armpits or groins. The photo shows a soft fibroma of the eyelid.

Other Types of Fibroma
The fibroma cavernosum or angiofibroma, consists of many often dilated vessels, it is a vasoactive tumor occurring almost exclusively in adolescent males.

The cystic fibroma (fibroma cysticum) has central softening or dilated lymphatic vessels.

The myxofibroma (fibroma myxomatodes) is produced by liquefaction of the underlying soft tissue.

The cemento-ossifying fibroma is hard and fibrous, most frequently seen in the jaw or mouth, sometimes in connection with a fracture or another type of injury.

Other fibromas: chondromyxoid fibroma, desmoplasmic fibroma, nonossifying fibroma, ossifying fibroma, perifollicular fibroma, pleomorphic fibroma etc.

Ovarian fibroma
It appears in the sex cord-stromal tumour group of ovarian neoplasms. Ovary fibromas are most frequent during middle age, and rare in children. Upon gross pathological inspection, ovary fibromas are firm and white or tan. Variants with edema are especially likely to be associated with Meig’s syndrome. On microscopic examination, there are intersecting bundles of spindle cells producing collagen. There may be thecomatous areas (fibrothecoma).

Treatment
Benign fibromas can be removed or left alone. A physician should examine the fibroma and determine whether it may be malignant. If there is any question as to whether it may be cancer-related, it should be removed. This is usually a brief outpatient procedure.

Herbal Treatment:Useful herbs to treat Fibroma :->.Evening primrose, kelp, mullein, pau d’arco, echinacea, red clover.

Homeopathic treatment of Fibroma.>………..(1)…..(2)….(3).

Resources:
http://en.wikipedia.org/wiki/Fibroma

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Uterine Fibroids

Definition:
Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.

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As many as three out of four women have uterine fibroids, but most are unaware of them because they often cause no symptoms. Your doctor may discover them incidentally during a pelvic exam or prenatal ultrasound.

In general, uterine fibroids cause no problems and seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain.

Uterine fibroids (singular Uterine Fibroma) (leiomyomata, singular leiomyoma) are benign tumors which grow from the muscle layers of the uterus. They are the most common benign neoplasm in females, and may affect about 25% of white and 50% of black women during the reproductive years. Uterine fibroids often do not require treatment, but when they are problematic, they may be treated surgically or with medication — possible interventions include a hysterectomy, hormonal therapy, a myomectomy, or uterine artery embolization. Uterine fibroids shrink dramatically in size after a woman passes through menopause.

Fibroids are named according to where they are found. There are four types: Intramural fibroids are found in the wall of the womb and are the most common type of fibroids. Subserosal fibroids are found growing outside the wall of the womb and can become very large. They can also grow on stalks (called pedunculated fibroids). Submucosal fibroids are found in the muscle beneath the inner lining of the womb wall. Cervical fibroids are found in the wall of the cervix (neck of the womb). In very rare cases, malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb.

Symptoms:

Many women with uterine fibroids have no symptoms. If you have symptoms, they may include:

*Heavy or painful periods or bleeding between periods
*Feeling “full” in the lower abdomen
*Pain during sex
*Lower back pain
*Reproductive problems, such as infertility, multiple miscarriages or early labor
*Heavy menstrual bleeding
*Prolonged menstrual periods or bleeding between periods
*Pelvic pressure or pain
*Urinary incontinence or frequent urination
*Constipation
*Backache or leg pains

The names of fibroids reflect their orientation to the uterine wall. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus, and pedunculated fibroids hang from a stalk inside or outside the uterus.

.Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and fever. A fibroid that hangs by a stalk inside or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk and cutting off its blood supply.

Fibroid location influences your signs and symptoms:

*Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are thought to be primarily responsible for prolonged, heavy menstrual bleeding.

*Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing constipation, or on your spinal nerves, causing backache.
Causes:
Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.

Doctors don’t know the cause of uterine fibroids, but research and clinical experience point to several factors:

*Genetic alterations. Many fibroids contain alterations in genes that code for uterine muscle cells.

*Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and estrogen receptors than do normal uterine muscle cells.

Other chemicals. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Location
Fibroids may be single or multiple. Most fibroids start in an intramural location, that is the layer of the muscle of the uterus. With further growth, some lesions may develop towards the outside of the uterus (subserosal or pedunculated), some towards the cavity (submucosal or intracavitary). Lesions affecting the cavity tend to bleed more and interfere with pregnancy. Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes. Less frequently, leiomyomas may occur at the lower uterine segment, cervix, or uterine ligaments.

Risk factors
There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors include:

*Heredity. If your mother or sister had fibroids, you’re at increased risk of also developing them.

*Race. Black women are more likely to have fibroids than are women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids.
Inconclusive research

Research examining other potential risk factors has been inconclusive. Although some studies have suggested that obese women are at higher risk of fibroids, other studies have not shown a link.

In addition, limited studies once suggested that women who take oral contraceptives and athletic women may have a lower risk of fibroids, but later research failed to establish this connection. Researchers have also looked at whether pregnancy and giving birth may have a protective effect, but results remain unclear.

Diagnosis:
Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus through your abdomen, suggesting the presence of fibroids.

Ultrasound
If confirmation is needed, your doctor may obtain an ultrasound — a painless exam that uses sound waves to obtain a picture of your uterus — to confirm the diagnosis and to map and measure fibroids. A doctor or technician moves the ultrasound device (transducer) over your abdomen (transabdominal) or places it inside your vagina (transvaginal) to obtain images of your uterus.

Transvaginal ultrasound provides more detail because the probe is closer to the uterus. Transabdominal ultrasound visualizes a larger anatomic area. Sometimes, fibroids are discovered during an ultrasound conducted for a different purpose, such as during a prenatal ultrasound.

Other imaging tests
If traditional ultrasound doesn’t provide enough information, your doctor may order other imaging studies, such as:

*Hysterosonography. This ultrasound variation uses sterile saline to expand the uterine cavity, making it easier to obtain interior images of the uterus. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound….click to see

*Hysterosalpingography. This technique uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. In addition to revealing fibroids, it can help your doctor determine if your fallopian tubes are open.  ...click to see

*Hysteroscopy. Your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. The tube releases a gas or liquid to expand your uterus, allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes. A hysteroscopy can be performed in your doctor’s office.
Imaging techniques that may occasionally be necessary include computerized tomography (CT) and magnetic resonance imaging (MRI).

Other tests
If you’re experiencing abnormal vaginal bleeding, your doctor may want to conduct other tests to investigate potential causes. He or she may order a complete blood count (CBC) to determine if you have iron deficiency anemia because of chronic blood loss. Your doctor may also order blood tests to rule out bleeding disorders and to determine the levels of reproductive hormones produced by your ovaries.
Complications
Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek medical care right away. You may need surgery.

Malignancy
Very few lesions are or become malignant. Signs that a fibroid may be malignant are rapid growth or growth after menopause. Such lesions are typically a leiomyosarcoma on histology. There is no consensus among pathologists regarding the transformation of Leiomyoma into a sarcoma. Most pathologists believe that a Leiomyosarcoma is a de novo disease.

Pregnancy and fibroids
Because uterine fibroids typically develop during the childbearing years, women with fibroids are often concerned about their chances of a successful pregnancy.

Fibroids usually don’t interfere with conception and pregnancy, but they can occasionally affect fertility. They may distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo.

Research indicates that pregnant women with fibroids are at slightly increased risk of miscarriage, premature labor and delivery, abnormal fetal position, and separation of the placenta from the uterine wall. But not all studies confirm these associations. Furthermore, complications vary based on the number, size and location of fibroids. Multiple fibroids and large submucosal fibroids that distort the uterine cavity are the type most likely to cause problems. A more common complication of fibroids in pregnancy is localized pain, typically between the first and second trimesters. This is usually easily treated with pain relievers.

In most cases, fibroids don’t interfere with pregnancy and treatment isn’t necessary. It was once believed that fibroids grew faster during pregnancy, but multiple studies suggest otherwise. Most fibroids remain stable in size, although some increase or decrease slightly, usually in the first trimester.

If you have fibroids and you’ve experienced repeated pregnancy losses, your doctor may recommend removing one or more fibroids to improve your chances of carrying a baby to term, especially if no other causes of miscarriage can be found and your fibroids distort the shape of your uterine cavity.

Doctors usually don’t remove fibroids in conjunction with a Caesarean section because of the high risk of excessive bleeding.

Treatment & Modern Drugs
There’s no single best approach to uterine fibroid treatment. Many treatment options exist. In most cases, the best action to take after discovering fibroids is simply to be aware they are there.

Watchful waiting
If you’re like most women with uterine fibroids, you have no signs or symptoms. In your case, watchful waiting (expectant management) could be the best course. Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly and tend to shrink after menopause when levels of reproductive hormones drop. This is the best treatment option for a large majority of women with uterine fibroids.

Medications
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. Medications include:

*Gonadotropin-releasing hormone (Gn-RH) agonists. To trigger a new menstrual cycle, a control center in your brain called the hypothalamus manufactures gonadotropin-releasing hormone (Gn-RH). The substance travels to your pituitary gland, a tiny gland also located at the base of your brain, and sets in motion events that stimulate your ovaries to produce estrogen and progesterone.

Medications called Gn-RH agonists (Lupron, Synarel, others) act at the same sites that Gn-RH does. But when taken as therapy, a Gn-RH agonist produces the opposite effect to that of your natural hormone. Estrogen and progesterone levels fall, menstruation stops, fibroids shrink and anemia often improves.

*Androgens. Your ovaries and your adrenal glands, located above your kidneys, produce androgens, the so-called male hormones. Given as medical therapy, androgens can relieve fibroid symptoms.

Danazol, a synthetic drug similar to testosterone, has been shown to shrink fibroid tumors, reduce uterine size, stop menstruation and correct anemia. However, occasional unpleasant side effects such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.

Other medications. Oral contraceptives or progestins can help control menstrual bleeding, but they don’t reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, are effective for heavy vaginal bleeding unrelated to fibroids, but they don’t reduce bleeding caused by fibroids.
Hysterectomy
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you elect to have your ovaries removed also, it brings on menopause and the question of whether you’ll take hormone replacement therapy.

Myomectomy
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. If you want to bear children, you might choose this option. With myomectomy, as opposed to a hysterectomy, there is a risk of fibroid recurrence. There are several ways a myomectomy can be done:

Abdominal myomectomy. If you have multiple fibroids, very large or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.
Laparoscopic myomectomy. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a remote monitor via a small camera attached to one of the instruments.
Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). A long, slender scope (hysteroscope) is passed through your vagina and cervix and into your uterus. Your doctor can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.
Variations of myomectomy — in which uterine fibroids are destroyed without actually removing them — include:

*Myolysis. In this laparoscopic procedure, an electric current destroys the fibroids and shrinks the blood vessels that feed them.
*Cryomyolysis. In a procedure similar to myolysis, cryomyolysis uses liquid nitrogen to freeze the fibroids.

The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.

*Endometrial ablation. This treatment, performed with a hysteroscope, uses heat to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Endometrial ablation is effective in stopping abnormal bleeding, but doesn’t affect fibroids outside the interior lining of the uterus.
Uterine artery embolization
Small particles injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include:

*No incision
*Shorter recovery time
Complications may occur if the blood supply to your ovaries or other organs is compromised.

Focused ultrasound surgery.>..click to see

In focused ultrasound surgery, treatment is conducted within a specialized magnetic resonance imaging (MRI) scanner. High-frequency, high-energy sound waves are directed through a source (gel pad) to destroy uterine fibroids.
MRI-guided focused ultrasound surgery (FUS), approved by the Food and Drug Administration in October 2004, is a newer treatment option for women with fibroids. Unlike other fibroid treatment options, FUS is noninvasive and preserves your uterus.

This procedure is performed while you’re inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. A single treatment session is done in an on- and off-again fashion, sometimes spanning several hours. Initial results with this technology are promising, but its long-term effectiveness is not yet known.

Before you decide
Because fibroids aren’t cancerous and usually grow slowly, you have time to gather information before making a decision about if and how to proceed with treatment. The option that’s right for you depends on a number of factors, including the severity of your signs and symptoms, your plans for childbearing, how close you are to menopause, and your feelings about surgery.

Before making a decision, consider the pros and cons of all available treatment options in relation to your particular situation. Remember, most women don’t need any treatment for uterine fibroids.
Alternative medicine:
You may have seen on the Internet, or in books focusing on women’s health, alternative treatments, such as certain dietary recommendations or homeopathy, which combines stress reduction techniques and herbal preparations.

More research is necessary to determine whether dietary practices or other methods can help prevent or treat fibroids. So far, there’s no scientific evidence to support the effectiveness of these techniques.

Herbal Treatment:
YOU can fight benign lumps With these herbs:

Evening primrose, kelp, mullein, pau d’arco, echinacea, red clover.

You may click to see Homeopathic medications for Uterine fibroids>..(1)….(2)….(3)

Prevention
Although researchers continue to study the causes of fibroid tumors, little scientific advice is available on how to prevent them. Preventing uterine fibroids may not be possible, but you can take comfort in the fact that only a small percentage of these tumors require treatment.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/uterine-fibroids/DS00078
http://en.wikipedia.org/wiki/Uterine_fibroids
http://www.nlm.nih.gov/medlineplus/uterinefibroids.html

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