Fibroids

Fibroids, also known as uterine myomas, are non-cancerous growths composed of muscle and fibrous tissue that grows in or around the uterus or womb.

In Africa, many women may have fibroids without being aware of them because they are often asymptomatic. However, for those who do have symptoms (approximately 1 in 3 women), common signs may include heavy or painful periods, abdominal or lower back pain, frequent urination, constipation, and pain or discomfort during sexual intercourse.

It’s imperative to notify your medical physician if you experience these symptoms so that they can investigate the possible causes. Fibroids are sometimes discovered incidentally during routine gynecological examinations, tests, or scans.

The exact cause of fibroids is idiopathic (unknown), but they have been associated with the hormone estrogen. Estrogen, produced by the ovaries, is a key reproductive hormone in females. Fibroids typically develop during a woman’s reproductive years when estrogen levels are at their highest. They tend to shrink when estrogen levels decrease, such as after menopause, when a woman’s monthly periods stop.

Fibroids are quite common, with about two-thirds of women developing at least one fibroid during their lifetime. They are more frequently observed in women of African-Caribbean origin and are believed to occur more often in overweight or obese women due to increased estrogen levels in the body. On the other hand, women with children have a lower risk of developing fibroids.

These growths can vary in size considerably, ranging from as small as a pea to as large as a melon. The three main types of fibroids are:

• Intramural fibroids: They make up the most type of fibroid, developing within the muscle wall of the uterus.
• Subserosal fibroids: These fibroids grow outside the uterine wall into the pelvic cavity and can become quite large.
• Submucosal fibroids: These fibroids develop in the muscle layer beneath the inner lining of the uterus and extend into the uterine cavity.

In a few scenarios, subserosal or submucosal fibroids are connected to the womb by a narrow stalk of tissue known as pedunculated fibroids.

Diagnosis

If a physician suspects the presence of fibroids, they will typically conduct a pelvic examination to look for any noticeable signs. To confirm the diagnosis or rule out other potential causes of your symptoms, you may be referred to a local hospital for further tests. These tests may include:

1. Ultrasound scan: An ultrasound scan is one of the primary tests used to diagnose fibroids. It is a painless procedure that utilizes high-frequency sound waves to form images of the inner part of the body. There are two types of ultrasound scans that can help diagnose fibroids:- Abdominal ultrasound scan: In this type of scan, the ultrasound probe is moved over your abdomen to capture images.
   – Transvaginal ultrasound scan: This involves inserting a small ultrasound probe into the vagina for a closer examination.The images produced by the ultrasound scan are transmitted to a monitor, allowing the doctor to identify any signs of fibroids. If the scan suggests the presence of fibroids, you may be referred to a gynecologist for further tests.
2. Hysteroscopy: A hysteroscope, a small telescope, is inserted through the vagina and cervix into the uterus to visually inspect the uterine cavity. This procedure is particularly useful for identifying submucosal fibroids.
3. Laparoscopy: A laparoscope, a thin instrument with a camera, is inserted through a small incision in the abdomen to examine the pelvic organs and tissues. Laparoscopy is commonly used when there is a suspicion of fibroids on the outer wall of the uterus (subserosal fibroids).

In certain cases, a biopsy may be performed during a hysteroscopy to obtain a small tissue sample for microscopic analysis. This can provide additional insights into the nature of the fibroids.

It’s important to seek medical advice if you suspect you may have fibroids, as rare complications from fibroids can affect pregnancy or lead to infertility. Early diagnosis and appropriate management can help alleviate symptoms and ensure the best possible outcomes.

Complications

The likelihood of complications associated with fibroids can vary depending on factors such as the size and position of the fibroids.

• During pregnancy: The presence of fibroids can sometimes lead to issues with fetal development or labour difficulties. Pregnant women with fibroids may experience abdominal pain, and there is a risk of premature labour. In cases where large fibroids obstruct the vagina, a caesarean section may be necessary for delivery.
• Infertility: It is characterized by the inability to conceive and may occur in women with large fibroids. While it is rare, fibroids can sometimes interfere with the attachment of a fertilized egg to the lining of the womb or impede the movement of sperm towards the egg.

Submucosal fibroids, which grow from the muscle wall into the cavity of the womb, can potentially block a fallopian tube, making it more challenging to achieve pregnancy. The fallopian tubes play a crucial role in connecting the ovaries (where eggs are released) to the womb.

Please keep in mind that each individual’s situation is unique, and it is important to consult with your healthcare professionals, who can provide personalized information and advice based on your specific circumstances.

Treatment options

Treatment options for uterine fibroids vary, and the choice of treatment depends on factors such as the severity of symptoms and the individual’s preferences. It’s important to discuss treatment options with a healthcare provider to determine the most suitable approach. Here are some common treatment options for uterine fibroids:

• Monitoring: If fibroids are not causing significant symptoms, some women may choose to monitor the fibroids without immediate treatment. Fibroids often grow slowly or may even shrink after menopause.
• Medications: Medications can help manage symptoms associated with uterine fibroids, but they do not eliminate the fibroids themselves. Examples of medications include:
• Gonadotropin-releasing hormone (GnRH) agonists: These medications induce a temporary menopause-like state by reducing estrogen and progesterone levels, which can shrink fibroids and alleviate symptoms. They are typically used for a limited duration due to side effects and the potential for bone loss.
• Progestin-releasing intrauterine device (IUD): This type of IUD can help reduce heavy menstrual bleeding caused by fibroids. It does not shrink or eliminate fibroids and also serves as contraception.
• Tranexamic acid: This non-hormonal medication is taken to manage heavy menstrual bleeding by promoting blood clotting.

Noninvasive procedures

• MRI-guided focused ultrasound surgery (FUS): This noninvasive procedure uses high-energy ultrasound waves to heat and destroys small areas of fibroid tissue. It is performed inside an MRI scanner and preserves the uterus.
• Radiofrequency ablation: Radiofrequency energy is used to destroy fibroids and shrink their blood vessels. This procedure can be done laparoscopically or transcervical, offering a less invasive alternative to hysterectomy and myomectomy.

Minimally invasive procedures

• Uterine artery embolization: Small particles are injected into the uterine arteries to block blood flow to the fibroids, causing them to shrink. This procedure can relieve symptoms but may have associated risks.
• Laparoscopic or robotic myomectomy: Fibroids are surgically removed using small incisions and specialized instruments. This approach preserves the uterus and is suitable for removing a limited number of fibroids.
• Hysteroscopic myomectomy: Fibroids contained within the uterus (submucosal) can be accessed and removed using instruments inserted through the vagina and cervix into the uterus.
• Endometrial ablation: This technique destroys the lining of the uterus to reduce menstrual flow or stop menstruation altogether. It does not remove fibroids outside the interior lining of the uterus.

Traditional surgical procedures

• Abdominal myomectomy: In cases of large or deep fibroids, an open abdominal surgical procedure may be necessary to remove the fibroids.
• Hysterectomy: This is a surgical excision of the female uterus and is a permanent solution for fibroids. It eliminates the possibility of future fibroid growth but also ends the ability to bear children.

It’s important to note that each treatment option has its own benefits, risks, and considerations. The treatment option should be consulted with a healthcare provider based on individual circumstances and preferences.

References

• Overview of fibroids. NHS.
• Diagnosis of fibroids. NHS.
• Complications of fibroids. NHS.
• Uterine fibroid. MAYO CLINIC.

FAQs

• Can lifestyle changes help manage fibroid symptoms?
  Answer: While lifestyle changes cannot eliminate fibroids, they can help manage symptoms and improve overall well-being. Maintaining a healthy weight, exercising regularly, managing stress levels, and adopting a balanced diet may provide symptom relief for some individuals.
• Do all fibroids require treatment?
  Answer: Not all fibroids require treatment. If fibroids are small, asymptomatic, or not causing any complications, a healthcare provider may recommend a “watchful waiting” approach with regular monitoring to ensure they are not growing or causing significant symptoms.
• Can fibroids turn cancerous?
  Answer: Although fibroids are typically non-cancerous (benign), there is a rare type called leiomyosarcoma that can develop in the muscle tissue of the uterus. However, leiomyosarcoma is extremely uncommon, accounting for less than 1% of all uterine cancers. (Tec)
• Can fibroids shrink on their own?
  Answer: In some cases, fibroids may shrink on their own, particularly after menopause when hormone levels decline. However, this is not the case for all women, and the size and growth of fibroids can vary.
• Can fibroids recur after treatment?
  Answer: It is possible for fibroids to recur after treatment, especially if the initial treatment did not remove all the fibroids or if new fibroids develop over time. Regular monitoring and follow-up with a healthcare professional are important to assess for any recurrence.
• Can herbal remedies or alternative therapies treat fibroids?
  Answer: There is limited scientific evidence to support the effectiveness of herbal remedies or alternative therapies in treating fibroids. It is essential to consult with a healthcare professional before attempting any alternative treatments to ensure safety and effectiveness.
• Can fibroids cause cancer in the future?
  Answer: Fibroids themselves do not increase the risk of developing cancer. However, it’s important to monitor fibroids for any suspicious changes or growth patterns and promptly report any concerning symptoms to a healthcare provider.