FIBROIDS

WHAT ARE FIBROIDS?

Fibroids are noncancerous growths or tumors that mostly develop in the muscle of the uterus. They can also grow on the outer walls of the uterus. The size of a fibroid can vary from the size of a pea to the size of a watermelon. The number and size also varies from individual to individual. It is also called myomas.

TYPES OF FIBROIDS?

There are four types of fibroids. They are listed below.

  • Intramural Fibroid: This type of fibroid develops in the muscular wall of the uterus. It is the most common form of fibroid.
  • Subserosal Fibroid: These can extend beyond the wall of the womb and can grow to a large size.
  • Submucosal Fibroid: These develop in the muscle layer of the uterus. They are less common that the previous two.
  • Cervical Fibroid: They develop in the cervical region of the womb.

HOW CAN FIBROID BE DIAGNOSED?

Fibroids are usually diagnosed during a routine abdominal or pelvic exam. The doctor may feel an unusual abdominal or pelvic mass. However there are more ways to diagnose and even determine the size and number of this benign tumor(s).

They include the following;

  • Ultrasound (sonogram)
  • Hysteroscopy
  • Laparoscopy
  • Magnetic Resonance Imaging (MRI)
  • Saline Sonohysterogram (Hysterosalpingogram)

WHAT CAUSES FIBROIDS?

It is not certain what causes fibroids to develop but there are some factors that influence their formation.

WHO IS AT RISK OF FIBROIDS?

As women mature they are increasingly at risk of developing fibroid. The increase in the production of estrogen and progesterone (hormones produced by the ovaries) may influence the growth of the tumor.

Women with a family medical history of recurrent fibroids in relatives have a high risk of developing fibroids.

Women with high body weight are also at risk.

SYMPTOMS OF FIBROIDS?

Symptoms will depend on location, size and number of tumors. Smaller tumors may not show any symptoms and may shrink during menopause while large tumors may cause excessive bleeding and difficulty conceiving.

Symptoms may include;

  • Abdominal mass
  • Excessive/prolonged menstrual bleeding
  • Pain in abdomen
  • Lower back pain
  • Increased urination
  • Constipation
  • Pain during sexual intercourse
  • Difficulty getting pregnant.

TREATMENT FOR FIBROIDS

For fibroids without any outward display of symptoms, ‘watchful waiting’ with frequent ultrasounds in between may be prescribed as fibroids tend to shrink as she reaches menopause. However, with symptomatic fibroids the following treatment options are available;

Medical treatment.

  • Gonadotropin-Releasing Hormone agonists (GnRHa): This drug shrinks fibroids by inducing menopause like symptoms. It stops the menstrual cycle without affecting treatment.
  • Gonadotropin-Releasing Hormone antagonists (GnRH): This stops the ovaries from producing estrogen and progesterone.

Other medications are available but ineffective against larger fibroids. They include;

  • Birth-Control Pills: This help regulate the ovulation cycle and may help with bleeding during periods
  • Nonsteroidal Anti-inflammatory Drugs: such as Ibuprofen will help with the pain associated with fibroids. It does not stop the bleeding.

Very large or severe fibroids may be nonresponsive to medication. In such instances, surgeries are the next treatment option. The speed of recovery and fertility is also considered when choosing the type of surgery. The following procedures are available;

  • Myomectomy: This is one of the most common form of surgical treatment option for fibroids. It is the removal of fibroids(s) from the muscular walls of the womb. Open surgery and laparoscopy are options here.
  • Hysterectomy: This is the partial or total removal of the womb. This is only considered in extreme cases.
  • Endometrial Ablation: This is the removal of the inner lining of the womb. Only available for fibroids in specific locations as another option to hysterectomy.

Other procedures include;

  • Uterine Artery Embolization (UAE)
  • MRI-guided focused ultrasound surgery
  • MRI-guided percutaneous laser ablation.

Keeping weight down and eating healthy may help but it is not a proven treatment option.

STATISTICS (SITUATION REPORT)

  • 65% – 80% of women will develop fibroid at the age of 50.
  • 30% – 40% will be symptomatic.
  • Less than 0.5% of fibroids turn to cancer.
  • Mortality rate due to fibroid is almost insignificant in recent years.

 

 

ARE FIBROIDS A CAUSE OF INFERTILITY IN WOMEN?

WHAT ARE FIBROIDS?

Fibroids are generally benign tumours that grow inside the uterus and can be as small as a pea or as large as a baby head. Fibroids are the most common type of growth in the pelvic region; most women who have them are between the ages of 35 and 45.

Hormones such as progesterone and estrogen stimulate their growth. Since estrogen levels decline with age, fibroids usually affect women during their reproductive years and shrink after menopause.

Depending on the number, size and location of the fibroids, pregnant women may experience localized pain or more serious complications, such as miscarriage or premature delivery.

WHAT CAUSES FIBROIDS?

The cause of fibroids is unknown but recent studies show that genetics play a big part; Women with family histories of fibroid development are twice as likely to get them as those who do not.

SYMPTOMS?

Fibroids are usually asymptomatic – this means you can have them and not know. However, depending on how numerous and large they are or their position, you could experience symptoms like a

  1. Heavy menstrual flow
  2. Severe cramping,
  3. Pelvic pain
  4. Bleeding between periods,
  5. Pain in the legs,
  6. abdominal bloating,
  7. backaches,
  8. miscarriage,
  9. infertility.

If you bleed heavily during or between your periods, you might become anaemic (that is, have too little iron in the blood) — and anaemia can cause fatigue. You might also be bothered by constipation and by an urgent need to urinate, signals that a large fibroid may be squeezing the organs around your uterus.

TYPES OF FIBROIDS

There are three major types of uterine fibroids:

Intramural fibroids grow within the muscular uterine wall.

Submucosal fibroids bulge into the uterine cavity.

Subserosal fibroids project to the outside of the uterus.

Some submucosal or subserosal fibroids are pedunculated — they hang from a stalk inside or outside the uterus.

TREATMENT OPTIONS

Your age, the location of the growths, the mildness or severity of your symptoms, and the question of whether you want to retain fecundity are factors to be considered when choosing a treatment option. If you do not have symptoms, you probably will not need any treatment.

Your doctor could also place you on estrogen-reducing medications which are expected to shrink the growth but they leave you with reactions such as hot flashes, mood swings, and vaginal dryness and the fibroids begin to grow once you discontinue drug use.

There are however  two major surgeries to take out fibroids

  1. Myomectomy: This involves a surgical removal of the fibroids, leaving the uterus in place. Myomectomy can be performed via the conventional open surgery or via minimally invasive surgeries such as a hysteroscopy and laparoscopy. This surgery is usually chosen by women who chose to retain fertility.
  2. Hysterectomy: This procedure, involves the removal of the entire uterus. It can be done either vaginally or abdominally. This method of treatment is preferred for women past child-bearing age and is a more permanent form of treatment.

FIBROIDS AND FERTILITY

For the most part, only submucosal fibroids that impinge upon the endometrial cavity affect fertility, although there are exceptions where large intramural fibroids block the openings of the fallopian tubes into the uterus.

Large or multiple fibroids reduce the ability of the uterus to stretch in order to accommodate the spatial needs of a rapidly growing pregnancy, this may induce recurrent 2nd-trimester miscarriages or trigger the onset of premature labour.