Fibroids are benign (noncancerous) tumours that grow within the uterine wall. They are also known as uterine fibromas, myomas, uterine fibromyomas, fibromas or leiomyomas.
Let’s take a look at the symptoms, treatment options, causes and risk factors of fibroids.
Fibroids can range in size from very small – about as big as a pea or even smaller, and invisible to the naked eye – to quite large, up to 20 cm in diameter. With some being so small, they are often undiagnosed and do not require treatment.
However, occasionally they are associated with infertility, miscarriage and premature labour, and require treatment. They are most common in women during their childbearing years and affect roughly 30-50% of women of reproductive age. However, only about half of these actually present symptoms.
Types of Fibroids
There are three types of fibroids, which are categorised by their location on the uterus:
• Intramural: These are the most common type – growths in the wall of the uterus
• Submucosal: These are growths in the endometrium (the lining of the uterus)
• Subserosal: These are growths on the outside of the wall of the uterus (serosa), which can sometimes appear like long stalks.
• Pedunculated: These grow on a stalk either to the outside of the uterus, or inside the uterine cavity.
Symptoms of Fibroids
Some fibroids are very small and do not cause any noticeable symptoms – many women don’t even notice they are present. Sometimes they are only detected during a routine gynaecological check up, or when the uterus is being examined for another condition.
However, larger growths, or those growing on a particular part of the uterus, can present symptoms (for example, submucosal fibroids often cause heavy or painful periods).
• Pain during sex
• Heavy periods (menorrhagia) or painful periods (dysmenorrhoea)
• Spotting between periods
• Pain or pressure in the pelvic area
• Frequent urination, or constipation
• Noticeable swelling in the lower abdomen
• Headaches or fatigue
Causes and Risk Factors of Fibroids
We do not know for sure why fibroids occur, however, as they only present in women in their childbearing years, we do know that female hormones play a significant role in their development and growth. After menopause, they tend to decrease in size and slowly disappear due to decreased levels of oestrogen and progesterone.
There are some risk factors associated with fibroids. These include:
• Race – women of African or African American origin face a fourfold increase in their risk of developing fibroids
• Age – older women, prior to menopause – are at a higher risk
Treatment of Fibroids
Fibroids often do not present symptoms and will not need to be treated. In this case monitoring is the best approach for management.
Treatment of fibroids that are causing troublesome symptoms or complications will depend on their size, number and location. These include:
• Hormone medication: Can be used to shrink fibroids, making surgical treatment easier. Agents such as GnRH agonists, or selective progesterone receptor modulators are effective in this way.
• Uterine artery embolisation: A procedure to reduce the supply of blood to the fibroid, causing it to shrink.
• Transcervical Resection: A hysteroscope is used to remove a fibroid that is partially or completely inside the cavity of the uterus, and partially in the wall of the uterus.
• Laparoscopy: Keyhole surgery to remove a fibroid
• MRI and ultrasound: An MRI is used to located the fibroid, which is then destroyed using the heat from ultrasound waves. This procedure is considered experimental at this time.
• Open surgery: Keyhole surgery may not be possible for larger fibroids. In this case, open surgery may be required.
• Hysterectomy: Removal of part or all of the uterus. This may be required for very large or multiple fibroids that are causing major symptoms or complications. Pregnancy is not possible after a hysterectomy, so this should be discussed with your gynaecologist beforehand.
If you are experiencing pelvic pain, heavy periods or any symptoms indicative of fibroids, or if you have any questions regarding fibroids, please don’t hesitate to give us a call. We will strive to offer advice and compassionate care in every way possible.