FIBROID TREATMENT

GYNAECOLOGY

Fibroids are non-cancerous tumours of the uterus that appear during your childbearing years. They can appear on the inside or outside lining of your uterus, or within its muscular wall. Fibroids usually develop from a single smooth muscle cell that continues to grow.

Condition

fibroids img
What are the common names for fibroids?

Fibroids are also called myomas, fibromyomas or leiomyomas.

What is the percentage of population affected by fibroids?

Uterine fibroids are the most common type of benign growth that affects the uterus. It affects about 70% white women and more than 80% black women.

Which part of the body is affected?

The female reproductive system is made up of the following parts:

  • Vagina: opening of the reproductive system, which allows the entry of sperm
  • Cervix: narrow region that connects the vagina to the uterus
  • Uterus: womb, where a fertilised egg implants and grows to develop into a baby
  • Ovaries: organs on either side of the uterus, which release an egg each month in the prospect of a pregnancy
  • Fallopian tubes: narrow tubes that open out at the ovaries to pick up the released egg for fertilisation

The uterus is made up of three layers – The innermost layer is called the endometrium, the second layer, myometrium and the third layer, the serosa. Every month, the endometrial layer is built, and thickens in preparation to accept the fertilised egg for implantation and provide nourishment to the growing embryo, until birth. If the egg does not get fertilised, the layer of tissue that is formed sloughs off and passes out in the form of your monthly period.

How do fibroids affect you?

Uterine fibroids usually cause problems during your periods. They can be very painful, affect your fertility and cause complications during your pregnancy.

What are the different types of fibroids?

Fibroids are categorised by their location, which include:

  • Intramural: most common variety that grows in the uterine wall
  • Submucosal: grows in the uterine lining (endometrium), causing excessive menstrual bleeding and period pain
  • Subserosal: grows on the exterior wall of the uterus and sometimes appears as long stalks
What are the causes of fibroids?

Uterine fibroids may be caused by:

  • Genetic changes
  • Presence of high levels of oestrogen and progesterone hormones
  • Growth factors
Who is at risk of developing fibroids?

The risk factors for uterine fibroids are:

  • Increasing age
  • High BMI
  • High alcohol consumption
  • History of infertility

Gynaecologist Navigation

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What are the signs and symptoms of fibroids?

In many cases, fibroids are asymptomatic. Symptoms may include:

  • Heavy periods
  • Lengthy periods that last more than a week
  • Painful periods
  • Spotting between periods
  • Painful intercourse
  • A sense of heaviness or pressure in the back, bowel and bladder
  • Frequent urination
  • A lump or swelling in the lower abdomen
What are the related disorders that occur with fibroids?

Uterine fibroids can be associated with anaemia, urinary problems, miscarriage, premature labour and infertility. Fibroids can prompt the growth of polyps in the uterine lining (endometrium). A polyp is a small protrusion that looks like a tiny ball on the end of a slim stalk. Endometrial polyps can also contribute to menstrual problems, such as excessive bleeding and pain.

How are fibroids diagnosed?

Fibroids can be detected using an ultrasound, where sound waves create a two-dimensional picture. The inside of the uterus can be examined with a hysteroscope, which is a thin tube passed through the cervix. A small camera may be placed at the tip of the hysteroscope, so that the interior of the uterus can be viewed on a monitor.

Treatment

What are the consequences of not treating fibroids?

Most uterine fibroids that do not cause any problem can be left untreated. They are benign, and may remain the same size or grow very slowly, causing no symptoms to mild signs and symptoms. As the levels of reproductive hormones drop with menopause, the fibroids usually shrink in size.

When should I consider watchful waiting of fibroids?

Close monitoring is required when your fibroids are not causing any problems and treatment is stalled for further development. In rare cases, it can rapidly grow into a tumour or to sizes that can cause significant problems, and make surgical removal difficult and risky.

What are the treatment options for fibroids?

Treatment depends on the location, size and number of fibroids and may include:

Non-surgical treatments
  • Medication: such as hormones, are used in combination to shrink the fibroids prior to surgery
  • Uterine artery embolisation (UAE): blocking the blood supply to the fibroids and in turn causing them to shrink
  • Endometrial ablation: removing the uterine lining containing the fibroid with the help of laser, heated wire loop or hot liquid in a balloon
  • MRI-guided procedures: ultrasound or laser energy passed through small needles that are inserted under the guidance of MRI

Symptoms caused by uterine fibroids usually resolve by the time you reach menopause. Hence, if you are nearing menopause you can consider controlling symptoms with home treatment and medicine.

Surgeries
  • Open surgery: required for the removal of larger fibroids
  • Laparoscopy: keyhole surgery is performed where a thin tube is inserted through the abdomen to remove the fibroids
  • Myomectomy: uterine fibroids are excised, retaining the ovaries
  • Hysterectomy: a part or all of the uterus is removed
  • Hysteroscopy: fibroids are removed via the cervix, using a hysteroscope
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