Fibroids

A fibroid is an abnormal growth (a tumor) in the womb which occurs commonly in black women and can range in size from as small as 1cm to as big as 25cm. They can be big enough to make a woman look up to 8 months pregnant. One person can have only one fibroid or as many as fifty or sixty fibroids in the womb at a time. In most women, fibroids do not cause any problems and so a lot of people actually have fibroids and don’t even know it.

The definite cause of fibroids is not known, but each individual fibroid starts when a single cell starts to grow abnormally, and produce large amounts of collagen and other proteins. The female hormones estrogen and progesterone are necessary for fibroids to grow, so they usually do not occur before puberty when production of these hormones begins and shrink after menopause when hormone production drastically decreases.

Different types of fibroids develop in different locations in and on the uterus as follows:

Sub mucosal fibroids: They grow and bulge toward the inside of the uterus. They grow directly below the lining cells of the uterus and may lead to heavy or irregular bleeding.

Intramural fibroids: These stay mostly embedded within the middle of the wall of the uterus

Subserosal fibroids: They grow on the outside of the uterus and may be attached to it by a stalk

Most women with uterine fibroids have no symptoms. However, fibroids can cause a number of symptoms depending on their size, location and their closeness to nearby pelvic organs. Women may experience:

  • Heavy bleeding between or during periods that may include blood clots
  • Menstrual periods that last longer than usual or are irregular
  • Painful menstrual periods
  • Swelling or enlargement of the abdomen
  • Abdominal pain
  • Frequent urination
  • Pain during intercourse
  • Pain in the pelvis and/or lower back
  • Pressure or fullness in the lower abdomen
  • Fibroids can also be a cause of infertility, especially if they are located inside the uterine cavity where the baby should stay.

A diagnosis of fibroids is usually made by an ultrasound scan, which would show the fibroids. Sometimes, you might need to have some further tests like an MRI (a very sensitive imaging technique which is more accurate than a conventional scan). In some cases, a procedure called a diagnostic hysteroscopy is done – a thin camera is inserted into the uterus and the images are projected on a screen, to view the inside of the womb. This helps to determine whether or not the fibroid is located in either wholly or partially in the cavity of the womb.

Fibroids do not need to be removed if they are not causing any problems. The definitive treatment for fibroids is surgical, which involves removing the fibroid(s) from the womb. The procedure is called a myomectomy. There are different types of myomectomy procedures available. The decision on which type is an option for you to have is made on an individual basis. The factors that determine this decision include the type, location, number, and size of the fibroids. Your symptoms, previous medical issues, and present medical condition are also taken into consideration.

The different treatments for fibroids are as follows:

Hysteroscopic myomectomy: This is a minimally invasive procedure performed in theatre under anaesthesia. A fine instrument with a camera is introduced into the vagina and it goes through the cervix to the uterus without making an incision and the video images are projected on a screen. The fibroid is then removed in pieces through the cervix. It can only be done for fibroids located inside the womb. It is done as a day case, so you will be able to go home a few hours after the procedure. Recovery is fast and the uterus is preserved.

Laparoscopic myomectomy: In this case, small cuts about 5mm in size are made in the abdomen and the fibroid is removed in small pieces through these cuts. This is done only for fibroids that are located either completely or mostly outside the uterus, if they are a suitable size. It is also a theatre procedure performed under general anaesthesia. You will need to be on admission for two or three days.

Abdominal myomectomy: This is the traditional approach to removing fibroids; the surgery is performed through a longer cut on the lower abdomen. This technique is done when the fibroids are large or multiple, and it usually involves the removal of all visible fibroids. You will need to be on admission for four days, and the recovery period after discharge is longer than for the other types of myomectomy.

Hysterectomy: This is the complete removal of the uterus and is reserved for women who do not want children in the future and who have multiple fibroids that are not suitable for myomectomy or Uterine Artery Embolization. It can be done either by making a cut on the lower abdomen or through a laparoscopic procedure. This can be considered as a definitive treatment and ensures that the fibroids do not recur.

Some other options for treating fibroids include:

Drug treatments: There are some medications (tablets and injections) that can be used to treat fibroids. Drugs alone are usually insufficient for as they grow back once the drug is stopped. The drugs are hormonal and can have unwanted side effects if used for prolonged periods. In selected cases, drugs are used to shrink fibroids just before surgery to make the procedure less complicated

Uterine Fibroid Embolization: This non-surgical treatment is an increasingly popular alternative to hysterectomy and myomectomy. It is performed by specialists called Interventional Radiologists and involves introducing a small, thin tube through the blood vessels in the thigh and releasing microbeads which block the blood supply of the fibroid, thus causing them to die off over time.

After you have had a review with your doctor and the various appropriate tests have been done where necessary, you will be informed about your option(s) for treatment. You will also be informed about the advantages and disadvantages to you of the different procedures, the period of recovery and the possible complications. Ensure that you are clear on what is being offered, so that you can make the best decision. It is possible that only one of these treatment options is suitable for you.