grow in positions, especially near the openings of
the FALLOPIAN TUBES, that prevent the implantation
of a fertilized egg (ZYGOTE). Large fibroids may
interfere with the growth of the FETUS, causing
spontaneous ABORTION(miscarriage).
The diagnostic path includes pelvic examina-
tion and imaging procedures such as ultrasound,
COMPUTED TOMOGRAPHY(CT) SCAN, orMAGNETIC RESO-
NANCE IMAGING(MRI). The doctor may also perform
HYSTEROSCOPY to view the inner uterus or
laparoscopy to view the abdominal cavity. These
procedures, performed with ANESTHESIA, also allow
the doctor to also take small samples of the
growths for further laboratory analysis.
Treatment Options and OutlookUterine fibroids that do not cause symptoms do
not require treatment. Often, uterine fibroids
shrink on their own with MENOPAUSE and then
cease to cause symptoms. Medical treatments
include
- NONSTEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS),
which effectively relieve the discomfort of uter-
ine fibroids when symptoms are mild - hormones such as GONADOTROPIN-RELEASING HOR-
MONE(GNRH) agonists (such as leuprolide) and
ANDROGENS(such as Danocrine) that alter the
hormonal balance in the body, causing the
fibroids to shrink - oral contraceptives (birth control pills), particu-
larly progestin-only products, which may
reduce symptoms with fewer risks and side
effects than other HORMONEtherapies
These drugs all have significant side effects and
affect fertility during the course of treatment.
Though these medications are effective, a woman
can take them for only a limited time and the
fibroids rapidly return when she stops taking the
medication.
Surgical treatment options include removal of
the fibroids (myomectomy), which preserves fer-
tility, and removal of the uterus (HYSTERECTOMY),
which ends fertility. Uterine fibroid embolization
(UFE) is an option for some fibroids. For this pro-
cedure an interventional radiologist injects sterile
polyvinyl alcohol (PVA) particles through a
catheter inserted into the femoral ARTERYin the
groin and threaded into the arteries that supply
the fibroids. The particles block the arteries, cut-
ting off the fibroid’s BLOODsupply and causing it to
die.Risk Factors and Preventive Measures
Uterine fibroids are most common in women who
are between ages 30 and 40. Though the cells that
form uterine fibroids have more estrogen recep-
tors (molecules that accept, or bind with, ESTRO-
GENS) than normal myometrial cells and most
fibroids recede with menopause, the correlation
between estrogen and fibroids remains unclear.
There are no measures to prevent uterine fibroids
from developing.
See also ADENOMYOSIS; ENDOMETRIOSIS; SURGERY
BENEFIT AND RISK ASSESSMENT.uterine prolapse A circumstance in which the
ligaments and muscles that support the UTERUS
within the abdomen weaken, allowing the uterus
to sag into the VAGINA. The weakness generally
occurs as a consequence of multiple pregnancies
that stress them or traumatic CHILDBIRTH that
causes damage to them. OBESITYincreases the risk
for uterine prolapse. Less commonly, uterine pro-
lapse may develop in a woman who has long-term
chronic COUGHsuch as may occur with chronic
BRONCHITISor CHRONIC OBSTRUCTIVE PULMONARY DIS-
EASE(COPD).
The symptoms of uterine prolapse may include- sensation of heaviness or pressure in the lower
pelvis - PAINduring SEXUAL INTERCOURSE
- lower BACK PAIN
Depending on the severity of the prolapse, the
uterus and cervix may protrude into the vagina or
through the entrance of the vagina (vaginal introi-
tus). The diagnostic path includes PELVIC EXAMINA-
TION, which is typically sufficient for the doctor to
diagnose uterine prolapse.
Treatment for mild to moderate uterine pro-
lapse is most often a vaginal pessary, a fitted
device the woman inserts into her vagina to hold
the uterus in position. Treatment for moderate to
severe uterine prolapse is surgery either to repair
the muscles and ligaments (sacral colpopexy) or to350 The Reproductive System