Uterine fibroid is the most common benign (not cancerous)
tumour of a woman uterus (womb). Fibroids are tumours of the smooth
muscle that is normally found in the wall of the uterus.
They can develop within the uterine wall or attaché to it. They may grow as single tumours or in clusters.
Uterine fibroids can cause excessive menstrual bleeding,
pelvic pain and frequent urination. Even though they are called benign
(not cancerous) tumours, fibroids potentially can cause many health
problems.
Fibroid growth occurs in up to 50% of all women and they are a
leading cause of hysterectomy (removal of uterus) in Europe and
America.
Fibroids starts in muscle tissues of the uterus they can grow
into uterine cavity (submucosal) into the thickness of the uterine
wall (intramural) or on the surface of the uterus (subserosal) into the
abdominal cavity. Some may occur as pedunculated masses.
Uterine Fibroid Causes.
The exact reasons why some women develop fibroids are
unknown. Fibroids tend to run in families. Women of Africa descent
(blacks) are 2 0r 3 times more likely to develop fibroids than women of
other races.
Fibroids grow in response to stimulation by the female
hormone (oestrogen) produced naturally in the body. These growths can
show up as early as 20 and shrink after menopause when the body stops
producing large amount of oestrogen.
Fibroids can be small and cause no problems, but they can
also grow to weigh several kilograms. Fibroids generally grow slowly.
The following factors have been associated with the presence of fibroids:
- Being overweight (obesity).
-
Never having given birth to a child.
-
Onset of menstruation period before age 10.
- African and African heritage (3 – 9 times often than in Caucasian women).
- Uterine Fibroid Symptoms.
Most fibroids, even large ones, produce no symptoms. These
masses are often found incidentally during a normal pelvic examination.
When women do experience symptoms, the most common are the following:
Irregular vaginal bleeding or an increase in menstrual bleeding known as menorrhagia, sometimes with blood clots.
Pressure on the bladder which may cause frequency in
urination and a sense or urgency to urinate and very rarely inability
to urinate.
Pressure in the rectum, resulting in constipation.
Pelvic pressure, resulting in lower abdominal pain.
Increase in size around the waist and abdominal swelling.
Some women need to increase their cloth size but not because of
significant weight gain.
Infertility
Pelvic mass during a physical examination.
When to Seek Medical Help
If a woman has any of the following, she should see her gynaecologist.
Irregular heavy menstrual bleeding. Menstrual bleeding
soaking though more than 3 pads per hour requires your gynaecologist
attention.
Severe or prolonged pelvic or abdominal pain.
Dizziness, light headedness, shortness of breath or chest pain associated with excessive vaginal bleeding.
Vaginal bleeding associated with pregnancy.
Infertility with long standing fibroid.
Uterine Fibroid Diagnosis
When uterine fibroid is suspected, your gynaecologist can arrive at a diagnosis by various methods:
A physical examination including a pelvic examination can reveal an irregularly shaped uterus when fibroids are present.
An abdominal, or transvaginal ultrasound san can help indentify the numbers, size and shape of most fibroid.
A hysteroscopic look at the uterus by passing a small fibreoptic camera through the cervix can confirm a submucous fibroid.
Hystero salpingogram (HSG) during infertility working
sometimes gives an indication about the presence of a fibroid. It helps
in distinguishing those fibroids that cause tubal blockage from those
that do not.
Laparscopy is a minor surgical procedure to have a direct
view of the pelvic. It is procedure done during routine infertility
work up to confirm tubal patency. It can detect subserous and intra
mural fibroids sometimes incidentally.
Uterine Fibroid Treatment
Uterine fibroid treatment depends on the symptoms, the size,
and the location of the fibroids, the age (How close to menopause) and
the patients desire to have children and the patients’ general health.
Medical Treatment
In most cases of fibroid, treatment is not necessary
particularly if the woman has no symptoms, has small tumours, or has
gone through menopause.
Abnormal vagina bleeding caused by fibroids may require
surgical scrapping of the uterine cavity by D&C (Dilatation &
Curettage). If no malignancy found, the bleeding can be controlled by
hormonal medications. Observation every 6 months to check for changes
in the size and symptoms is advisable.
Medication
Women with heavy bleeding, pains and fibroids may be given
non-steroidal anti inflammatory drugs (NSAIDs) oral contraceptive
(birth control pills) gonadotrophin releasing hormone agonists and anti
hormonal drug mifepristone.
Non steroidal drugs such as ibuprofen have been shown to relieve pelvic pain associated with fibroids.
Oral contraceptive pills are also commonly used in women with
fibroids. They often decrease perceived menstrual blood flow and help
with pelvic pain.
Gonodotrophin releasing hormone agonists are medications that
act on the pituitary gland to decrease oestrogen produced by the body.
A decrease in oestrogen causes fibroids to decrease in size. These
medications are usually used prior to surgery to shrink the fibroid, to
decrease the amount of blood loss during surgery to improve
pre-operative blood count. The size of fibroid can be reduced up to 50%
in 3 months, but the fibroids can re-grow once treatment is stopped.
Long term treatment with these drugs is limited by the side
effects of low oestrogen (much like menopause) which includes decreased
bone density (osteoporosis) hot flushes and vaginal dryness.
Mifepristone has also been shown to reduce fibroid size by
about half. It has also been shown to reduce pelvic pain, bladder
pressure and lower back pain. Mifepristone can induce miscarriage so it
should be used with caution if a woman is trying to conceive.
Danazol has been used to reduce bleeding in women with
fibroids. It causes the menstruation to stop but does not shrink the
size of the fibroid. Danazol is an androgenic (male hormone) drug that
can cause side effects such as weight gain and muscular cramps
decreased breast size, acne (oily skin) mood changes depression etc.
Surgery
Myomectomy is the surgical removal of the fibroid only. It
can be accomplished by open surgery, hysteroscopy or laparoscopically
depending on the size and location of the fibroid.
The uterus is left intact and the patient may be able to
become pregnant. It is the most common surgical procedure in the
treatment of fibroid in Nigeria.
Hysterectomy is the surgical removal of the uterus (and
fibroids). It is the most common performed surgical procedure in the
treatment of fibroid in the UK and USA and it is considered a cure, but
at the expense of fertility. Depending on the size and location of the
fibroid, it can be performed abdominally, vaginally or
laparoscopically.
Uterine artery embolization or clotting of the arterial blood
supply to the fibroid is an innovative approach that has shown
promising results. This procedure is done by inserting a catheter (small
tube) into an artery of the leg (femoral artery) using special X-ray
video to trace the arterial blood supply to the uterus, then clotting
the artery with tiny plastic or gelatine sponge particles the size of
grains of sand. This material blocks blood flow to the fibroid and
shrinks it. Interventional radiologist performs their procedures.
Uterine Fibroid Prevention
Women should avoid weight gain after age 18 and maintain a
normal body weight compared to height. Body weight tends to increase
oestrogen production thus aggravating fibroid growth.
Exercise can help women control weight and additionally decrease hormone production that stimulates fibroid growth.
In conclusion, treatment success and future outcome in
fibroid depends on the severity of the fibroid prior to treatment and
the chosen treatment. Fibroids may affect fertility, but it depends on
the size and location of the fibroids.
Many women with fibroids are older than 35 years. This and
other factors such as decreased egg quality and decreased ovulation
contribute to their inability to become pregnant.
Fibroids rarely turn into cancer.
