Uterine fibroids sound scary but they’re actually common, completely benign (non-cancerous) growths of the womb. We believe they affect more than 50% of all women at some stage in life.
They are more common in older women and those who have never had children. Fibroids are also more common in certain ethnic groups particularly women of African descent. They also tend run in some families, suggesting a genetic influence.
PROBLEMS OF UTERINE FIBROIDS:
- Heavy menstrual periods
- Pelvic pain
- Abdominal swelling
- Pressure on other organs, including the bladder, ureter and rectum
Infertility: As fibroids are more common in women who have not had children and in those with difficulty conceiving, this suggests they might interfere with the process of conception. Some might cause a blockage of the fallopian tubes or distortion of the lining of the womb that interferes with implantation.
Cancer (rare): In very rare cases, fibroids can undergo malignant change to become cancers. The scenarios that favour this occurrence are those found in older women (usually after the menopause), the presence of persistent non-cyclical pain and rapid growth of the fibroid over a short space of time.
HOW DO WE INVESTIGATE UTERINE FIBROIDS?
The symptoms of fibroids can vary quite significantly, depending on a number of factors. Some women have no symptoms, others may experience heavy periods, bleeding between periods, painful sex, and/or lower back pain. Taking a detailed history and abdominal/pelvic examination coupled with pelvic ultrasound scan is the main way of diagnosing fibroids. We check blood count to exclude anaemia. It is occasionally necessary to perform an MRI scan in situations where an ultrasound is not clear. Occasionally, additional investigations are warranted, to rule out other conditions.
HOW DO WE TREAT UTERINE FIBROIDS?
There are several options for treating fibroids depending on the woman’s age, symptoms, reproductive expectations and state of health, but also the number, size and locations of the fibroids.
the pain associated with fibroids can be managed with painkillers and heavy menstrual bleeding can be reduced by other drugs. The size of (and symptoms of fibroids) can be reduced by drugs that temporarily suppress ovarian function. All these measures provide temporary relief but all interfere with fertility.
Myomectomy: removing fibroids without removing the womb and thereby preserving fertility. The most common treatment can be hysteroscopic (vaginal), laparoscopic (keyhole surgery) or laparotomy (open surgery).
Every myomectomy operation carries the small risk of hysterectomy but the surgery is managed efficiently to minimise that risk.
Hysterectomy: removal of the womb. Suitable for older women who have completed their families and/or have no further need to retain their uterus. The procedure usually entails a three to five day hospital stay and six-week recuperation period.
Uterine artery embolisation (UAE): the arteries that carry blood to fibroids are blocked off leading to shrinkage of the fibroids. This is successful in reducing symptoms in many women and can reduce the size of the womb by about half. The currently available evidence suggests it is not the best option for women contemplating pregnancies in future.
Radiofrequency ablation of fibroids and Focused ultrasound ablation of fibroids are currently being evaluated and may be available in certain situations.
There is no evidence that complimentary therapies are effective in treating fibroids, but they may be useful for controlling some of its symptoms (such as painful periods).