What are Fibroids ?
A uterine fibroid is the most common benign (not cancerous) tumour of a woman’s uterus (womb). Fibroids are tumours of the smooth muscle that are normally found in the wall of the uterus... They may grow as a single tumour or in clusters. They can grow:-
- Into the uterine cavity (sub mucosal)
- Into the muscle of the uterine wall (intramuscular)
- Or on the surface of the uterus (subserosal)
- Or may occur as pedunculated masses. (fibroids growing on a stalk on the uterus)
The term FIBROIDS is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma.
How common are they among women ?
The prevalence rate worldwide for fibroids among women is 10-20% (Natural women’s health info centre NICD.NIH). Fibroids are number one reason for hysterectomy in USA (CDC). They result in 150,000-175,000 hysterectomies in the US. The prevalence of fibroids identified by USG imaging ranges from:
- 4 per cent in women between ages 20 and 30
- 11-18 per cent in women between ages 30 and 40
- 33 per cent in women 40-60 yrs of age
What symptoms should one look out for ?
Most fibroids even large ones produce no symptoms. These masses are often found during a regular pelvic examination. The most common symptoms that a woman with fibroids may experience:-
- Excessive menstrual bleeding known as menorrhagia, sometimes with blood clots
- Irregular vaginal bleeding
- Pelvic pain
- Pressure on the bladder, which may cause frequent urination, and a sense of urgency to urinate and rarely, inability to urinate.
- Pressure on the rectum, resulting in constipation
- Pelvic pressure, “feeling full” in the lower tummy
- Increase in size around the waist and change in abdominal contour
- Infertility, which is defined as an inability to become pregnant after 1 year of unprotected intercourse. .
How are they diagnosed ?
Fibroids are present. The doctor normally prescribes the following tests to help decide if the patient has fibroids and to exclude other and potentially more serious causes of ongoing symptoms.
- An abdominal, transvaginal or pelvic ultrasound (SONOGRAPHY) can help identify the site, shape, number of fibroids.
- An endometrial biopsy, which is a tissue taken from the womb lining.
- A hysteroscopy to rule out submucosal fibroids, by passing a small fibreoptic scope through the opening of the cervix.
- Hysterosalpingography can be done, which involves injection of dye into the uterus and fallopian tubes, which is then X-rayed, to identify the anatomy of these structures.
- Laparoscopy, in whcih a small telescope is put into the abdomen through belly button to examine the inside of the abdomen, the uterus, tubes and ovaries.
What is the treatment for fibroids ?
Treatment for fibroids depends on the following:
- Size and location of the fibroids
- Symptoms and general health of the patient
- Age (how close the patient is to menopause)
- The patient's desire to have children.
In most cases, treatment is not necessary, like:
- If a woman has no symptoms
- If the size of fibroids is small
- If woman is menopausal
These patients may require a check up maybe every 6 months to a year, to check on changes with the fibroid.
How are fibroids treated ?
Patient may be given oral medications to control the pain and excessive bleeding.
- NSAID’s – Non steroidal anti- inflammatory agents are good for pelvic pain relief
- OCP’s – Oral contraceptive pills help by decreasing the blood flow & pain during periods.
- Gonadotrophin Releasing Hormone (GnRH) Agonists - These are medications that act on the pituitary gland to decrease the estrogen produced by the body. A decrease in estrogen causes fibroids to decrease in size. This is often used prior to surgery to shrink the fibroid, to decrease the amount of blood loss during surgery, or to improve pre-operative haemoglobin count.
- Danazol : This drug has been used to reduce bleeding in women, but it does not shrink the size of fibroids and has many unwanted side effects.
- The anti-hormonal drug RU-486 has been shown to reduce fibroid size by half. This drug has also been shown to reduce pelvic pain, bladder pressure and lower back pain.
- Ullipristal Acetate- A new drug which is a progesterone receptor modulator has been found to shrink fibroids and reduce bleeding associated with fibroids. It is awaiting US FDA approval.
- Patients who are unresponsive to oral medications or in whom oral hormonal medicines are contra-indicated due to some reason can opt for a surgical procedure.
The various types of surgeries which are best suited as per individual case are:-
- Myomectomy – is the surgical removal of fibroids only. This can be accomplished by hysteroscopy, laparoscopy or an open procedure (an incision on lower abdomen)
- Hysterectomy - is the surgical removal of the uterus with fibroids.
Hysterectomy with removal of the fallopian tubes and ovaries (called salpingo - oophorectomy) may be indicated if there is a suspicion of cancer or if ovarian masses are present along with fibroids.
- Uterine Artery Embolization (UAE)- This involves blocking of the blood supply to the fibroid. It is an innovative approach that has shown promising results. This method may prove to be a good option for woman if other methods have not worked, patient is not willing for surgery, or may not be a good candidate for surgery.