Associate Professor, Department of Obstetrics & Gynaecology, University Technology Mara, Malaysia
What are uterine fibroids?
Uterine fibroids are slow growing tumours made out of muscle and fibrous tissue attached to the wall of the uterus. They appear and grow in women during their childbearing years. The tumour may vary in size from a pinhead to the tip of a grapefruit. When numerous fibroids are present, the size of the uterus may increase to any size and may mimic a pregnancy. Most fibroids are non-cancerous.
How do they occur?
The exact cause of uterine fibroids is not known. They may be related to high oestrogen levels; but research suggests that pregnancy, birth control pills and hormone replacement therapy do not stimulate their increase in size. These tumours usually shrink as a woman approaches menopause.
What are the symptoms?
Often there are no symptoms. Large fibroids may cause abdominal distension or a feeling of weight in the lower abdomen. They may exert pressure on the bladder, causing increased urination, or on other organs located in the lower abdomen, which may cause discomfort. The most frequent symptom is heavy bleeding during the menstrual period that may occur when the fibroid is growing near or towards the uterine cavity. Sometimes, fibroids may cause infertility, miscarriage, or severe pain.
How are they diagnosed?
Fibroids are usually discovered during routine internal examination. An Abdominal as well as a transvaginal ultrasound examination may be done for confirmation. Hysteroscopy is done to confirm the presence of uterine fibroids only if there is a doubt of the diagnosis following transvaginal ultrasound. In this procedure, an optic instrument is inserted into the uterus through the cervix, to confirm the existence of a fibroid bulging into the uterine cavity. It can be combined with a dilatation and curretage in cases where menorrhagia is a complaint. Currently the accuracy of the ultrasound in the diagnosis of fibroids is >85%.
What is the treatment?
A majority of fibroids require no treatment. However treatment becomes necessary if there is excessive bleeding during menstruation, the tumour keeps growing or if there are other symptoms. In women older than 35years or with completed family are treated by a hysterectomy (removal of the uterus) rather than myomectomy (removal of the fibroids), to minimize the chances of recurrence. Myomectomy is generally done in cases where the patient wishes to preserve her fertility. Medicines like danazol, GnRH analogues and progesterone derivatives, to shrink the fibroid, may be given for 2-3 months before surgery.
In the present times, laparoscopic removal of the uterus with fibroids or removal of the fibroid only are also performed reqularily with excellent results. The advantage over the routine open procedures is a quicker recovery, shorter hospital stay and less complications. The only disadvantage may be a longer anasthesia duration.
What measures can be taken at home?
Bed rest and medicines like aspirin or paracetamol may help in cramps and body aches. A hot water bottle or a heating pad may also help to relieve the pain. Excessive menstrual blood loss may cause anaemia. In this case, prescribed medication (such as tranexamic acid) should be taken during the three first days of the period. The anaemia can be corrected by taking iron supplements.
Can they be prevented?
There is no known way of preventing the development or recurrence of fibroids. Pregnancy may have a protective effect, and nulliparous women are known to have a higher tendency to produce fibroids.