WHAT ARE FIBROIDS?
Fibroids are non-cancerous growths that develop in or around the womb (uterus). They are muscular tumors that grow in the wall of the womb. Another medical term for fibroids is leiomyoma or “uterine myoma“. They are almost always benign (not cancerous).
They can grow as a single tumor, or there can be many of them in the womb. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large. The growths are made up of muscle and fibrous tissue, and vary in size.
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. They are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find it hard to live with. Some have pain and heavy menstrual bleeding.
It also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.
WHAT ARE THE TYPES?
They can grow anywhere in the womb and vary in size considerably. Some can be the size of a pea, whereas others can be the size of a melon. The main types of fibroids are:
- Intramural : The most common type of fibroid, which develop in the muscle wall of the womb.
- Subserosal : Fibroids that develop outside the wall of the womb into the pelvis and can become very large.
- Submucosal : they develop in the muscle layer beneath the womb’s inner lining and grow into the cavity of the womb.
In some cases, subserosal or submucosal fibroids are attached to the womb with a narrow stalk of tissue. These are known as pedunculated fibroids.
WHAT ARE THE SYMPTOMS?
Most fibroids do not cause any symptoms, but some women who do have symptoms (around 1 in 3) may experience:
- Heavy periods or painful periods
- Tummy (abdominal) pain
- Lower back pain
- Frequent need to urinate
- Pain or discomfort during sex
- Heavy bleeding (which can be heavy enough to cause anemia)
- Feeling of fullness in the pelvic area (lower stomach area)
- Enlargement of the lower abdomen.
CAUSES OF FIBROIDS?
The exact cause is unknown, but they have been linked to the hormone oestrogen. Oestrogen is the female reproductive hormone produced by the ovaries (the female reproductive organs). Fibroids usually develop during a woman’s reproductive years (from around the age of 16 to 50) when oestrogen levels are at their highest. They tend to shrink when oestrogen levels are low, such as after the menopause when a woman’s monthly periods stop.
Women who have had children have a lower risk of developing it, and the risk decreases further the more children you have. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. Fibroids also stop growing or shrink once a woman reaches menopause.
FACTORS THAT INCREASE RISK OF FIBROIDS
There are factors that can increase a woman’s risk of developing fibroids. They include
- Age: Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, they usually shrink.
- Family history: Having a family member with fibroids increases your risk. If a woman’s mother had it, her risk of having them is about three times higher than average.
- Ethnic origin: African-American women are more likely to develop fibroids than white women.
- Obesity: Women who are overweight are at higher risk for leiomyoma . For very heavy women, the risk is two to three times greater than average.
- Eating habits: Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing it.Many women are unaware they have fibroids because they do not have any symptoms.
FIBROIDS AND PREGNANCY
Women who have fibroids are more likely to have problems during pregnancy and delivery. This does not mean there will be problems. Most women with it have normal pregnancies. The most common problems seen in women with fibroids are:
- Cesarean section: The risk of needing a c-section is six times greater for women with fibroids.
- Baby is breech: The baby is not positioned well for vaginal delivery.
- Labor fails to progress.
- Placental abruption: The placenta breaks away from the wall of the ute hirus before delivery. When this happens, the fetus does not get enough oxygen.
- Preterm delivery.
HOW ARE FIBROIDS DIAGNOSED?
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your womb, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the womb.
Your doctor can do imaging tests to confirm that you have fibroids. These are tests that create a “picture” of the inside of your body without surgery. These tests might include:
- Magnetic resonance imaging (MRI)
- CAT scan (CT)
- Hysterosalpingogram (HSG) or sonohysterogram: An HSG involves injecting x-ray dye into the womb and taking x-ray pictures. A sonohysterogram involves injecting water into the womb and making ultrasound pictures.
- Laparoscopy: The doctor inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the womb and other organs on a monitor during the procedure. Pictures also can be made.
- Hysteroscopy: The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.
TREATMEMT OF FIBROIDS
Most women with it do not have any symptoms. For women who do have symptoms, there are treatments that can help. Factors to consider before you choose a treatment. Some of these factors include:
- Whether or not you are having symptoms from the fibroids
- If you might want to become pregnant in the future
- The size
- The location of the fibroid
- Your age and how close to menopause you might be
If you have fibroid but do not have any symptoms, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.
Fibroids with mild symptoms, may require taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.
Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroid. Low-dose birth control pills do not make fibroid grow and can help control heavy bleeding. The same is true of progesterone-like injections.
Other drugs used for treatments are “gonadotropin releasing hormone agonists” (GnRHa). These drugs, given by injection, nasal spray, or implanted, can shrink the fibroids. Sometimes they are used before surgery to make it easier to remove.
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
Myomectomy: Surgery to remove fibroids without taking out the healthy tissue of the womb. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their womb for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the womb, you might need a cesarean section to deliver.
Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.
Hysterectomy: This is surgery to remove the womb. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when:
- A woman’s fibroids are large.
- If she has heavy bleeding.
- She’s either near or past menopause.
- Does not want children.
If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope.
Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.
Endometrial ablation: The lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor’s office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About 3 in ten women have much lighter bleeding. But, a woman cannot have children after this surgery.
Myolysis: A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE): A thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. Complications, including early menopause, are uncommon but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed. Not all fibroids can be treated with UFE. The best candidates for UFE are women who:
- Have fibroids that are causing heavy bleeding.
- Have fibroids that are causing pain or pressing on the bladder or rectum.
- Don’t want to have a hysterectomy.
- Don’t want to have children in the future.
If you have fibroids without symptoms, treatment may not be needed.
If you have fibroids, they may grow if you become pregnant. This is due to the increased blood flow and higher estrogen levels. The fibroids usually return to their original size after your baby is born.