Fibroids or myomas are benign tumours or growths found in the uterus. They are not cancer. About 40% of women above the age of 40 will have fibroids. They can vary in their size, shape and location. They can also grow over a period of time.
Fibroids are generally categorised by their location, which includes:
- Intramural – found in the uterine wall. Intramural fibroids are the most common variety.
- Submucosal – found in the uterine lining (endometrium). Excessive bleeding and period pain are associated with this type.
- Subserosal –found on the exterior wall of the uterus. These sometimes appear like long stalks
Most women with fibroids have no symptoms. When present, symptoms may include:
- Heavy or long periods
- Pain during periods
- Spotting between periods
- Painful intercourse
- A sensation of heaviness or pressure in the back, bowel and bladder
- Frequent urination
- A lump or swelling in the lower abdomen
A number of complications can be caused by Uterine Fibroids, including:
Anaemia – anaemia due to excessive menstrual blood loss can occur and it can make women feel fatigue, breathlessness and paleness of skin.
Urination problems – large fibroids can push the uterus against the bladder, resulting in a sensation discomfort or fullness and the need to urinate often.
Infertility – the fibroids can interfere with the implantation process of the fertilised egg causing infertility in women.
Miscarriage and premature delivery – fibroids can reduce blood flow to the placenta or may compete for space with the developing baby.
Fibroids can be detected using an ultrasound, where sound waves create a two-dimensional picture to help the doctor identify the size, shape and location. The inside of the uterus can be examined with a hysteroscope, which is a thin tube passed through the cervix (neck of the womb). A small camera may be placed at the tip of the hysteroscope, so that the interior of the uterus can be viewed on a monitor. The pelvic cavity can also be visualised using laparoscopy to visualise the fibroids, both intramural and subserosal fibroids.
Treatment depends on the location, size and number of the fibroids, but may include:
Monitoring – if the fibroids are causing no symptoms and are not large, a ‘wait and see’ approach is usually adopted.
Drugs – such as birth control pills, Gonadotropin-releasing hormones and progestin can be used in combination to shrink the fibroids prior to surgery.
Arterial embolisation – under local anaesthetic, a fine tube is passed via an artery in the arm or leg into the main artery supplying the fibroid with blood. The whole process is monitored by x-ray. Fine particles (like sand) are then injected into the artery to block the blood supply to the fibroid. The fibroid slowly dies and symptoms should settle over a few months.
Hysteroscopy – the fibroids are removed via the cervix, using a hysteroscope.
Laparoscopy – or ‘keyhole surgery’ is where a thin tube with a camera is inserted through the abdomen to remove the fibroids using minimally invasive methods.
Open surgery – larger fibroids need to be removed via an abdominal incision. This procedure weakens the uterine wall and makes Caesarean sections for subsequent pregnancies more likely.
Hysterectomy – the surgical removal of some, or all, of the uterus. Pregnancy is no longer possible after a hysterectomy.