Fibroids

Posted on January 2, 2018 by - Gynaecology

What are fibroids?

A fibroid is a growth of the muscle of the womb. Commonly found in women, fibroids can grow to large sizes. Usually they grow over time under the influence of the female hormone, estrogen.  Depending on their size and position in the womb, they can lead to differring symptoms.

Some of the common symptoms are:

  1. Heavy periods
  2. Painful periods
  3. Prolonged periods or bleeding
  4. Pelvic pain
  5. Pressure symptoms like the feeling of a lump in the tummy
  6. Pressure on the bladder causing urinary frequency. Sometimes this can also lead to retention of urine especially in pregnancy
  7. Infertility

Many fibroids are however asymtomatic. They are a frequent finding on routine ultrasound scans of the womb performed for other reasons. Even when present, they may not be cause of the symptoms described above. There are many other gynaecological conditions sharing the same symptoms. Some of these include endometriosis and adenomyosis. The presence of the fibroids may potentiate the symptoms.

It is thus important to determine is the fibroid is the main cause of symptoms experienced or if they are incidental to the problem. In trying to do so, I take into account a number of factors including:

  • Size of the fibroid
  • Position in the womb of the fibroid
  • Ultrasound features of the fibroid
  • Blood tests looking at tumor markers of the fibroid
  • Presence or absence of other potential gynaecological conditions

If the fibroid is determined to be the likely cause of the problem , there are a number of avenues for managing this including:

  1. Medications to shrink the fibroid. Usually this effect is temporary as the fibroid is likely to grow back after cessation of the mediction. However, it may be useful to use prior to a operating on the fibroid or to temporarily control the growth to monitor for improvement in the symptoms.
  2. Surgical removal of the fibroid – called a myomectomy. Usually I would undertake this by keyhole surgery.
  3. Hysterectomy for women who have completed their family.
  4. Ultrasound ablation of the fibroid. Using directed ultrasound waves, it can reduce the fibroid size.
  5. Vascular occlusion of the fibroid. This involves blocking off the blood supply to the fibroid and can be effective in causing shrinkage of the fibroid. It is done by radiological techniques.

With techniques 4 and 5, the fibroid is not removed. So it cannot be sent for pathology and the nature of the fibroid cannot be determined.  Whilst the vast majority of fibroids found are benign, a small proportion may be cancerous, but this is a diffcult diagnosis to make. There is no good test that can exclude cancer in a fibroid. Whilst we can look for changes on ultrasound, MRI and blood markers, the only real way of excluding cancer is with its removal and assessment by a Pathologist who can look at the fibroid under a microscope. Even then it can be difficult to tell in some cases. Fibroids that grow rapidly or after the menopause, in the absence of hormone therapy, deserve special attention.

For many women, it may be possible to control the symptoms by other means without resorting to the above techniques. This may be to buy time till menopause intervenes. With menopause, the ovaries stop making estrogen, and so the fibroids will eventually shrink. However, if a woman requires hormone replacement therapy for menopausal symptoms, the estrogen used in the treatment, may potentiate the growth of the fibroid.

The treatment of fibroids thus needs to be individualised for each person. Some of the factors that will need to be taken into account include:

  1. Her age
  2. Desire for pregnancy
  3. Severity of symptoms
  4. Size and size of fibroid
  5. Likelihood of cancer being present

Should you have concerns, speak with your family doctor first as they are well placed to advise you and initiate investigations. If simple measures fail to control symptoms, then I would be happy to provide further advice.

These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation.