概述

What are uterine fibroids? A Mayo Clinic expert explains

Learn more about uterine fibroids from Michelle Louie, M.D., a minimally invasive gynecologic surgeon at Mayo Clinic.

I'm Dr. Michelle Louie, a minimally invasive gynecologic surgeon at Mayo Clinic. In this video, we'll cover the basics of uterine fibroids. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love. We're here to give you the best information available. Uterine fibroids, also called leiomyomas or myomas, are growths that appear in the uterus. They're made of uterine muscle. They're noncancerous and extremely common. In fact, 75 to 80% of people with a uterus will be diagnosed with fibroids at some point in their lives. These growths often show up during the reproductive years, most commonly in your 20s to 30s. They can range in quantity, size and growth rate. So each case is a bit different.

Who gets it?

We believe uterine fibroids occur when one cell of muscle divides repeatedly to create a firm, rubbery mass of tissue. Scientists are not yet sure exactly what sparks this behavior, but we're looking into specific genes. We do know a couple of risk factors that may make someone more likely to get fibroids. First, race. For reasons that are unclear, fibroids are more prevalent and more severe among black patients compared to other racial groups. Second, family history. If your mother or sister had fibroids, you're at increased risk for developing them, too. And more studies look into other risk factors like obesity, lifestyle choices, and diet.

What are the symptoms?

Most people with fibroids don't have symptoms at all. That's why they're often found unintentionally during a routine checkup. If a patient does have symptoms, heavy, prolonged, or painful menstrual bleeding is a common problem. Periods that lasts more than one week or cause soaking through pads or tampons every hour or large blood clots are also considered abnormal. If fibroids get very large, they can cause your belly to bulge like a pregnancy or press on nearby organs causing constant pelvic pressure, frequent urination, or difficulty passing bowel movements. In some cases, fibroids can make it harder to get pregnant or cause problems during pregnancy or childbirth. If you're experiencing any of these symptoms, talk to your doctor.

How is it diagnosed?

Fibroids are often found during a routine pelvic exam. If your doctor feels an irregularity in the shape of the uterus or if you come in with symptoms, they'll probably order a diagnostic test like an ultrasound. Beyond that, your doctor may need more information, especially if you're trying to get pregnant or at risk for uterine cancer. They might order blood tests or imaging studies like an MRI. Sometimes other unique imaging studies that use water to see inside the uterus or dye to check the fallopian tubes are needed if you're trying to get pregnant. Even hysteroscopy, in which a small camera is guided through the vagina, is sometimes used to see inside the uterus where some fibroids can be located. All these tests are done in service of getting a better, clearer picture of what's going on or to check for other problems.

How is it treated?

There are many ways in which we treat uterine fibroids. If you have no or only mild symptoms, as many women do, the best treatment may be no treatment at all. We call this watchful waiting where we keep a careful eye on your fibroids until further action is needed. Medication or birth control is another option which can relieve symptoms like heavy, irregular or painful periods. For some more severe cases, surgery may be needed. The kind of surgery we recommend depends on the size, number, and location of fibroids, as well as your personal goals, feelings about pregnancy and surgery, and general health. A hysterectomy is where the uterus and the fibroids are removed together. And it is a great option for those who have no desire for pregnancy as it guarantees no more period bleeding and the fibroids cannot return in the future. A myomectomy is a surgery in which we remove the fibroids through the vagina or the abdominal wall. Uterine fibroid embolization is a more minor procedure in which we blocked the blood supply to the fibroids, causing them to shrink but not go away completely. A radiofrequency fibroid ablation is where a probe is inserted into the fibroid and heats the tissue, so it shrinks. Magnetic resonance-guided focused ultrasound passes energy through the abdomen to destroy the fibroid. Lastly, an endometrial ablation is a procedure in which a device is inserted through the vagina to treat the uterine lining, and stop heavy period bleeding due to fibroids. But this does not treat the fibroids themselves.

What now?

Fibroids are common, noncancerous and often don't need treatment. Whether or not you do end up needing treatment, know that there are many options that can address your concerns and give you a great quality of life. Talk to your doctor or get a referral to a fibroid specialist to ensure that you are offered all the treatment options. If you'd like to learn more about fibroids, watch our other related videos, or visit mayoclinic.org. We wish you well.

子宫肌瘤是子宫的良性生长物,常出现在育龄期。子宫肌瘤也叫做平滑肌瘤或肌瘤,它与患子宫癌的风险增加无关,而且几乎不会发展成癌症。

肌瘤大小不一,从肉眼无法检测到的幼苗样大小,到能扭曲和扩大子宫的大块头都有可能。您可能有一个肌瘤,也可能有多个。在极端情况下,多个子宫肌瘤可能使子宫扩张到足以到达胸腔,导致体重增加。

许多女性会在一生中某个时间段出现子宫肌瘤。但是您可能并不知道自己有子宫肌瘤,因为它们往往没有症状。医生可能在盆腔检查或产前超声波检查中偶然发现肌瘤。

症状

许多患有子宫肌瘤的女性没有出现任何症状。在出现症状的患者中,其症状受子宫肌瘤的位置、大小和数量的影响。

在出现症状的女性中,子宫肌瘤的最常见体征和症状包括:

  • 经期大量出血
  • 经期持续一周以上
  • 盆腔压迫感或疼痛
  • 尿频
  • 难以排空膀胱
  • 便秘
  • 背痛或腿痛

极少数情况下,子宫肌瘤血液供应不足并开始坏死时,会引起急性疼痛。

子宫肌瘤通常按其位置分类。肌壁间肌瘤生长在子宫肌壁。黏膜下肌瘤突向子宫腔内生长。浆膜下肌瘤向子宫外突出生长。

何时就诊

一旦您出现以下症状,请就诊:

  • 盆腔痛持续不退
  • 月经量过大、时间延长或痛经
  • 非经期点滴出血或出血
  • 膀胱排空困难
  • 不明原因的低红细胞计数(贫血)

如果您出现严重的阴道出血或突然出现剧烈盆腔痛,请及时就医。

病因

尽管医生尚未完全理解子宫肌瘤的病因,但研究和临床经验指向以下因素:

  • 基因改变。许多肌瘤出现了基因变化,导致它们与典型子宫肌细胞不同。
  • 激素。雌激素和黄体酮似乎会促进子宫肌瘤生长。这两种激素会在每个月经周期刺激子宫内膜发育,为怀孕做准备。

    与典型子宫肌细胞相比,子宫肌瘤包含更多的雌激素和黄体酮受体。由于绝经后激素分泌减少,肌瘤往往会收缩。

  • 其他生长因子。帮助身体维持组织生长的物质(例如胰岛素样生长因子)可能会影响肌瘤生长。
  • 细胞外基质(ECM)。ECM 是一种可使细胞粘在一起的物质,其作用就像建筑砖块之间的砂浆。ECM 在肌瘤内有所增加,使肌瘤呈纤维状。ECM 还负责储备生长因子,引起细胞自身的生物学变化。

医生认为子宫肌瘤是由子宫平滑肌组织(子宫肌层)中的干细胞引起的。这种单个细胞反复分裂,最终形成不同于邻近组织的弹性硬肿块。

子宫肌瘤的生长模式各有不同,生长速度可慢可快,肌瘤大小也可能一直保持不变。有些肌瘤会快速生长,而有些肌瘤可能会自行收缩。

孕期存在的许多肌瘤会在产后随着子宫恢复而收缩或消失。

风险因素

除了是育龄女性以外,几乎没有已知的子宫肌瘤相关风险因素。可能影响肌瘤形成的因素包括:

  • 种族。尽管所有育龄女性都可能得子宫肌瘤,但黑人女性相比其他种族的女性患病率更高。此外,黑人女性患子宫肌瘤时的年龄更小,肿瘤的数量或大小也可能更惊人,同时伴随有更严重的症状。
  • 遗传。如果您的母亲或姐妹患有子宫肌瘤,则您患子宫肌瘤的风险会增加。
  • 其他因素。来月经过早;肥胖症;维生素 D 缺乏症;饮食结构中红肉多绿色蔬菜、水果和奶制品少;另外,喝酒(包括啤酒)似乎也会增加患病的风险。

并发症

尽管子宫肌瘤通常并不危险,但它们会引起不适并可能导致并发症,如失血过多导致红细胞下降(贫血),从而导致疲劳。少数情况下,会因失血而需要输血。

怀孕和纤维瘤

纤维瘤通常不会影响怀孕。但是,纤维瘤(尤其是黏膜下纤维瘤)有可能会导致不孕不育症或妊娠丢失。

纤维瘤还可能会导致某些妊娠并发症风险增加,如胎盘早剥、胎儿生长受限和早产。

预防

尽管研究人员在持续研究子宫肌瘤的病因,但与预防有关的科学证据却很少。子宫肌瘤难以预防,但这种肿瘤仅有一小部分需要治疗。

不过您可以通过选择健康的生活方式(如维持健康的体重和多食用水果和蔬菜)来降低患子宫肌瘤的风险。

此外,一些研究表明,使用激素类避孕药可能会降低患子宫肌瘤的风险。

在 Mayo Clinic 治疗

Sept. 21, 2022
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