2 November 2018
Uterine fibroids are benign tumours that that grow along or within the walls of the uterus. They are found in approximately 20% – 50% of women. Also known as leiomyomas, it is important to note that your chances of developing a cancerous growth do not increase because you have uterine fibroids, nor does having them increase your chances of getting other uterine cancers.
Most women with uterine fibroids experience little or no symptoms, except for an estimate 25 – 30% of women, where symptoms may occur. Fibroids are commonly discovered during pelvic examinations or ultrasounds.
Uterine fibroids are identified based upon where they appear in the uterus:
– Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the uterus. These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle.
– Submucosal fibroids are located inside the uterine cavity beneath the inner lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus.
– Intramural fibroids are located within the muscular wall of the uterus.
– Edunculated fibroids grow on a stalk of tissue known as a pedical (like a mushroom), extending
either inside the cavity of the uterus or outside the uterus from its outer surface.
Symptoms are rare with cases of uterine fibroids, and most women are usually unaware of it’s presence.
However, when symptoms occur, they are generally influenced by the location and size of the fibroids.
The most common symptoms are:
– Heavy menstrual bleeding
– Menstrual periods lasting more than a week
– Pelvic pressure or pain
– Frequent urination
– Difficulty emptying the bladder
– Backache or leg pains
Uterine fibroids are diagnosed by pelvic exam or ultrasound.
Ultrasounds are more accurate as they allow the physician to differentiate it from other conditions such as ovarian tumors.
In some cases, your doctor may order MRI and CT scans, but ultrasound is the simplest, cheapest, and best technique for imaging the pelvis.
Occasionally, when trying to determine if a fibroid is present in the uterine cavity (endometrial cavity), a hysterosonogram (HSG) is done.
Depending on the nature of the symptoms, there are several options for the treatment of uterine fibroids, that include surgery and medication.
Surgical methods are the preferred methods of treatment, if your doctor sees that treatment is necessary.
Possible surgical interventions include Hysterectomy (removal of the uterus) or Myomectomy (the selective removal of just the fibroids within the uterus).
Myomectomy can be done through a hysteroscope, laparoscope or with the standard open incision on the abdominal wall.
High-intensity focused ultrasound (HIFU) is a relatively new treatment for fibroids and other abnormalities. It is also known as MRgFUS (MRI-guided focused ultrasound) and FUS (focused ultrasound surgery). HIFU uses an ultrasound transducer with higher energy than those used for diagnostic examinations. The device focuses the sound waves, generating heat to destroy the fibroid. MRI imaging may be used for planning and monitoring of treatment.
These treatments are typically hormonal in nature and utilize the use of drugs that turn off estrogen production from your ovaries. These medications are meant to induce a hypoestrogenic (low estrogen) state. When treatment is successful, they can shrink the fibroids by as much as 50%.
Side effects of these drugs are similar to the symptoms of menopause and can include hot flashes, sleep disturbance, vaginal dryness, and mood changes.
Bone loss leading to osteoporosis after long-term treatment (6 to 12+ months) use is one complication. This is generally reversed once the treatment ends.
These treatments may also be used preoperatively, for larger leiomyomas to shrink them in order to make the operation less difficult and reduce surgical risk.
There have been studies displaying an increased risk of pregnancy complications in the presence of uterine fibroids, such as first trimester bleeding, breech presentation, placental abruption, and problems during labor.
Patients with uterine fibroids are six times more likely to give birth via caesarian section due to the increase in labour complications.
The size of the fibroid and its precise location within the uterus are important factors in determining whether a fibroid causes obstetric complications.
It is strongly advisable to see your gynaecologist if you’re experiencing any of the following:
– Consistent and abnormal Pelvic pain
– Heavy bleeding during menstruation
– Bleeding in between periods
– Difficulty controlling your urination, or urinating more frequently
Also, seek immediate medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.