Cysts and Fibroids

Uterine fibroids, also known as leiomyomas, fibromas, or myomas, are the most frequently seen tumors that affect the female reproductive system. Fibroids are firm, compact benign growths within the uterus. They are made of fibrous connective tissue and smooth muscle and can appear as clusters or single growths. They can form anywhere throughout the uterus; on the outer surface, within the uterine walls, or attached to the stem-like structure.

According to a study by The American Journal of Obstetrics and Gynecology, 20 to 50 percent of women of childbearing age have fibroids, most of which are not diagnosed because they often cause no symptoms. Other estimates show that 30 to 77 percent of women will develop fibroids at one point during their reproductive age, although only 1/3 of these are large enough to be incidentally detected during a physical examination. This means that most women have had these tumors but aren’t aware.

Fibroids are usually non-cancerous and only 1 in 1,000 cases is a cancerous mass detected when it was thought to be a uterine fibroid. They range in size from the size of a pea about ¾ inch to the size of a small grapefruit several inches in diameter. In most cases, fibroids decrease in size with the onset of menopause as a result of the reduced hormone production.

Types of Fibroids

Fibroids are classified based by their location in or on the uterus.

  • Intramural fibroids

    These are the most common type of fibroids that develop in the wall of the uterus. Many of these do not cause problems and can range in size. They can become quite large and can stretch your womb.

  • Submucosal fibroids

    Submucosal fibroids develop partially in the wall and partially in the cavity of the uterus, meaning they develop in the middle muscle layer of the uterus. These types of tumors aren’t as common as others.

  • Subserosal fibroids

    These types of myomas form on the serosa, which is the outside wall of the uterus. When these tumors grow, they make the womb appear bigger on one side.

  • Pedunculated fibroids

    These types of tumors tend to be supported and connected to the uterine wall by a stem.

Causes of Fibroids

It’s still unclear why fibroids develop, but research and clinical experience point to these factors:

  • Genetics

    Fibroids may run in the family and may contain genes that are different from those in normal cells. So, you may develop the tumors if your grandmother, mother, or sister has a history of this condition.

  • Hormones

    Progesterone and estrogen are the two hormones produced by the ovaries and that stimulate the regeneration of the uterine lining in preparation for pregnancy during the menstrual cycle. They also appear to stimulate the growth of fibroids. Compared to normal uterine muscle cells, fibroids contain more progesterone and estrogen. This explains why the tumors decrease in size during menopause.

  • Pregnancy

    Since the level of estrogen and progesterone production in the body increases when a woman gets pregnant, uterine fibroids may develop and grow rapidly during pregnancy.

    Insulin-like growth factors and other substance that help the body maintain tissues may also result in the growth of fibroids.

    Uterine fibroids may develop from the myometrium, which is a stem cell in the smooth muscular tissue of the uterus. The growth patterns vary – they may remain the same size, or grow slowly or rapidly. Some may shrink on their own while others go through growth spurts. Those that develop during pregnancy may shrink or disappear with the reduced hormone production and as the uterus goes back to normal size.

Risk Factors

Other than being a woman of childbearing age, there are other factors that put women at greater risk of developing uterine fibroids, including:

  • Environmental factors such as the use of birth control, early onset of menstruation, obesity, and poor diet

  • Race. African-American women are more likely to develop fibroids, especially at a younger age.

  • Age 30 or older

  • A family history of fibroids

  • Pregnancy

Symptoms of Fibroids

You may not have any symptoms if you’re going through menopause or the tumor is very small. The symptoms will depend on the size, location, and the number of tumors you have. The most common symptoms of uterine fibroids include:

  • Increased menstrual cramping

  • Changes in the menstrual cycle, including prolonged or heavy bleeding that includes blood clots

  • Increased or difficult urination

  • Pain in the pelvis or lower back

  • Pain or pressure during intercourse

  • Recurrent miscarriages

  • Swelling or enlargement of the abdomen

  • Fullness or pressure in the lower abdomen

  • Infertility

Diagnosing Fibroids

Fibroids are usually found during a routine pelvic examination. Diagnostic procedures for fibroids may include:

A transvaginal ultrasound: This involves inserting the ultrasound wand into the vagina to allow the doctor to see the internal structures of the uterus and any fibroids present.

Pelvic MRI: This is a non-invasive, in-depth imaging test that produces two-dimensional images of your pelvic organs. These scans can also tell the difference between fibroids and other types of conditions that affect the uterus.

Hysteroscopy: A quick office procedure that involves inserting a hysteroscope through the vagina to examine the canal of the cervix and the interior of the uterus.

Treatment Options for Fibroids

Determining the appropriate treatment option for fibroids is based on several factors including your overall health and medical history, severity and type of symptoms, the extent of the disease, expectations for the course of the disease, tolerance for specific procedures and medication, and a woman’s desire to get pregnant in the future.

  • Watchful Waiting

    Since most fibroids shrink or stop growing as a woman approaches menopause, your healthcare provider may suggest “watchful waiting,” which involves monitoring your symptoms carefully to ensure the fibroids are not growing or there are no significant developments.

  • Medications

    Medications for fibroids may be prescribed to target hormones that regulate your menstrual cycle. This consequently treats pelvic pressure and heavy menstrual bleeding. Gonadotropin-releasing hormone (GnRH) agonists will cause your progesterone and estrogen levels to drop, eventually shrinking fibroids. Other options that can help control pain and prolonged bleeding but won’t eliminate or shrink fibroids include over-the-counter anti-inflammatory pain relievers, birth control pills, and an intrauterine device (IUD) that releases progestin. If hormone therapy is not accompanied by another treatment, the fibroids tend to grow back once the treatment has been stopped.

  • Minimally Invasive Procedures

    The uterine artery embolization procedure is a minimally invasive procedure that begins with incisions in the groin area and involves the use of specialized x-ray equipment and catheter to inject embolic material into the uterus. This deprives the fibroids of oxygenated blood, causing them to shrink. The material remains permanently at the fibroid site.

    Forced ultrasound surgery is a new and noninvasive procedure where you lie down inside an MRI machine then the doctor directs high-energy, high-frequency sound waves at the tumors to destroy or ablate them.

    Similarly, cryomyolysis freezes the fibroids while myolysis uses laser or an electric current to shrink the fibroids. Another option is endometrial ablation, which involves inserting a special instrument into the uterus and uses hot water, heat, or electric current to destroy the uterine lining as well as the fibroids.

  • Surgical Treatments

    Surgery may be performed to remove multiple or very large growths. This is referred to as myomectomy or hysterectomy. The different types of surgery to remove fibroids include:

    • Abdominal myomectomy

    • Robotic-assisted myomectomy

    • Hysteroscopic myomectomy

    • Laparoscopic myomectomy

    • Vaginal hysterectomy

    • Laparoscope-assisted vaginal hysterectomy

    • Robotic-assisted laparoscopic hysterectomy

    • Abdominal hysterectomy

    All of these involve the use of special instruments to access the uterus and remove it.

Ovarian Cysts

Ovarian cysts are sacs or pouches filled with fluid or other tissue and may develop on one or both ovaries. Each month during your menstrual cycle, the ovaries grow normal follicles that produce estrogen and rupture to release an egg during ovulation. The most common types of cysts usually form during ovulation when a normal follicle continues to grow and fails to open. The remaining follicle can fill up with blood or fluid.

Ovarian cysts are very common in women of reproductive age. In most cases, cysts will go away within 1 to 2 menstrual cycles without causing symptoms and without treatment. Ovarian cysts are also far less common in women who’ve gone through their menopause because they usually occur during ovulation. Other types of ovarian cysts can represent ovarian tumors, some malignant and other benign. Benign examples include dermoids and endometriomas. Malignant tumors include epithelial ovarian cancers and germ cell tumors.

Types of Ovarian Cysts

The most common types of ovarian cysts are functional cysts, including corpus luteum and follicular cysts. Follicular cysts form when the follicle sac inside the ovaries doesn’t break open, eventually forming a cyst on the ovary. If a follicle does not dissolve after releasing an egg and the opening of the follicle seals, the fluid that accumulates in the sac causes a corpus luteum cyst.

Other types include:

Cystadenomas: These are benign tumors that develop on the outside of the ovaries, affecting fertility and causing pain.

Dermoid cysts/Teratomas: These are cysts that can contain tissue types from other parts of the body, including fat, hair, or skin.

Endometriomas: Tissues that normally grow inside the uterus grow outside and attach to the ovaries.

Some women may end up developing a condition known as polycystic ovary syndrome in which the ovaries contain multiple cysts. This can result in the enlargement of the ovaries and if not treated, the condition can cause infertility.

Risk Factors

While cysts may affect any woman at her reproductive age or going through menopause, you’re at higher risk if you’ve had a severe pelvic infection, are taking fertility drugs, or have had ovarian cysts in the past.

Symptoms of Ovarian Cysts

Ovarian cysts in most cases do not cause any symptoms. However, you may experience symptoms as the cyst grows. Symptoms may include:

  • Pelvic pain before or during the menstrual cycle

  • Pain in the lower back or thighs

  • Painful intercourse

  • Abdominal bloating or swelling

  • Nausea and vomiting

  • Painful bowel movements

  • Frequent urination

  • Breast tenderness

Severe symptoms that require immediate attention include:

  • Faintness of dizziness

  • Fever

  • Severe or sharp pelvic pain

  • Rapid breathing

You should seek immediate medical attention if you experience sudden and sharp pain, especially if it’s accompanied by fever or vomiting. When we suspect an ovarian cyst during an exam, we will determine whether there’s a need for further testing.

Complications of Ovarian Cysts

Ovarian cysts in most cases are benign, cause little to no symptoms, and naturally go away without treatment. A cancerous cystic ovarian mass may also be detected, though this is usually rare.

One rare complication of ovarian cysts is ovarian torsion. This is a condition where the ovary twists or moves from its position, cutting off blood supply to the ovary. If left untreated, this condition can cause damage or death to the ovarian tissue. A ruptured cyst is another complication that can cause internal bleeding and intense pain. If not treated, this complication can be life-threatening as it increases your risk of infection.

Diagnosing Ovarian Cysts

An ovarian cyst can be detected during a routine pelvic examination. Swelling on one of your ovaries may be noticed but others will be examined if you experience pelvic during menstruation or sex. An ultrasonography test (ultrasound) can be carried out to confirm the presence of a cyst. It also helps determine the location, shape, size, and composition of a cyst. Other tools used to diagnose ovarian cysts include:

  • MRI: This produces in-depth images of internal organs by using magnetic fields

  • CT scan: Used to create cross-sectional images of your pelvic organs

  • Ultrasound Device: Imaging device used to get a view of the ovary

A treatment plan is not recommended immediately because the majority of cysts naturally go away on their own. If there aren’t any changes to the conditions or the cysts have increased, additional tests may be requested. These include hormone level test, pregnancy test, and CA-125 blood test.

Treatment for Ovarian Cysts

A period of watchful waiting may be recommended and repeat ultrasound tests done to monitor the growth and development of the ovarian cyst.

A hysterectomy may be performed to remove your ovaries and uterus if the cysts are determined to be cancerous. In more severe cases both ovaries may be removed through an oophorectomy.

Finding a Cysts and Fibroids OB-GYN Near Me

If you’re exhibiting symptoms of either uterine fibroids or ovarian cysts, consult with a Los Angeles OB-GYN at GYNLA to discuss the treatment plan that’s best for you. Contact our Los Angeles OBYN today at 310-375-8446 to schedule a consultation.