Fibroids

Fibroids are benign lumps or (non-cancerous tumours) that can appear on the inside or outside lining of your uterus. They often grow on the  muscle layer or uterine wall, uterine lining or the exterior wall of the uterus.

Fibroids are composed of muscle cells and other tissues. Uterine fibroids are usually round and are found in 30-50% of all women.

TYPES OF FIBROIDS

Based on their location within the uterus, uterine fibroids can be classified as:

  • Subserosal fibroids: found beneath the serosa (the outer surface of the uterus)
  • Submucosal fibroids: found in the uterine cavity
  • Intramural: found in the muscle wall of the uterus
  • Pedunculated fibroids: Develop on a stalk attached to the outer wall (serosa) of the uterus

CAUSES FOR FIBROIDS

The exact cause for the development of fibroids remains unknown, but some of the proposed causes include:

  • Genetic abnormalities
  • Alterations in expression of growth factor (protein involved in rate and extent of cell proliferation)
  • Abnormalities in the vascular system
  • Tissue response to injury
  • Family history of fibroids

SYMPTOMS OF FIBROIDS

The majority of women with uterine fibroids may be asymptomatic. However, the basic symptoms associated with fibroids include:

  • Heavy menstrual bleeding
  • Prolonged menstrual periods
  • Pelvic pressure or pain, awareness of a pelvic or abdominal mass
  • A lump or swelling in the lower abdomen
  • Frequent urination, difficulty passing urine
  • Constipation
  • Backache or leg pain
  • Bleeding between periods,
  • Pelvic pain, pain during intercourse
  • Infertility and recurrent miscarriages
  • Anaemia due to heavy menstrual bleeding

Some women do not have any symptoms (smaller fibroids)

FIBROIDS IMPACT ON YOUR HEALTH

In some cases, fibroids can cause complications including:

  • Excessive menstrual blood loss which can cause anaemia. Symptoms of anaemia include breathlessness, fatigue and paleness.
  • Large fibroids can press against the bladder, causing a sensation of fullness or discomfort and the need to urinate.
  • The presence of fibroids can interfere with implantation of a fertilised egg, cause infertility or difficulty in conceiving.
  • During pregnancy, fibroids can reduce blood flow to the placenta, or compete for space with the developing baby. This may result in a miscarriage or premature delivery.

DIAGNOSIS OF FIBROIDS

The diagnosis of uterine fibroids involves

  • a pelvic examination,
  • followed by ultrasound evaluation.

MRI can provide very detailed information on size, and location of fibroids.

TREATMENTS OF FIBROIDS

Different methods are used for managing uterine fibroids.

Surgery is considered the best modality of treatment. The common surgeries performed for the management of fibroids include:

Hysteroscopic Myomectomy

The removal of fibroid growing in the cavity of the uterus

  • Laparoscopic myomectomy (Myosure) - removal of fibroid in the muscle of the uterus via keyhole surgery. The defect in the uterus is closed with laparoscopic sutures
  • Open multiple myomectomy - removal of 4 or more fibroids followed by reconstruction of the uterus. This is performed as an open (laparotomy) procedure.

Hysterectomy

Removal of the uterus

Cryosurgery

Destructive techniques that involve boring holes into the fibroids with a laser or freezing probes - not widely used

Uterine Artery Embolisation (UAE)

Uterine Artery Occlusion (UAO)

RISKS DURING PREGNANCY

The presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as first trimester bleeding, breech presentation, placental abruption, increased chance of Caesarean section and problems during labor.