Uterine fibroids are benign tumours of fibrous and muscular tissue origin which grow from the muscle layers of the uterus. Benign means they are non-cancerous and so do not spread to other tissues. Uterine fibroids are also referred to as uterine myomas, fibromas or leiomyomas. They are firm masses of smooth muscles encapsulated in compressed muscle fibres and they vary in size.

 

INCIDENCE

Fibroids affect 1 in every 5 women meaning 20% of women will be affected by fibroids in their life time. Of course not every woman affected will experience the symptoms.

 

CAUSES

The cause of fibroid is not known but it is believed that oestrogen influences the enlargement of fibroids. They develop during the reproductive period and may be hormone dependent, enlarging during pregnancy and when oral contraceptives are used. They tend to regress after menopause.

Heredity also plays a role because a woman whose close relative has had fibroids has an increased chance of developing fibroids. Consumption of red meat, alcohol and Caffeine tend to increase the chances of a woman having by fibroids. Obesity is also believed to predispose to fibroids.

 

TYPES OF FIBROIDS

Fibroids are classified based on their location on the uterus. Based on this classification, we have three major types which are:

  • Intramural fibroids: these are the most common type. They grow in between the muscles of the uterus and can stretch the womb as they grow larger.
  • Subserosal fibroids: these fibroids grow on the outside of the uterus. This type does not directly affect conception.
  • Submucosal fibroids: these fibroids grow just underneath the uterine lining and into the endometrial cavity. This type is less common but more troublesome. When they occur, there is excessive menstrual bleeding and difficulty in conceiving.

 

 

SIGNS AND SYMPTOMS

The size, number and location of fibroids will determine whether a woman will experience symptoms or not.  Generally symptoms include:

  • Heavy menstrual bleeding and bleeding between periods.
  • Painful and prolonged periods.
  • Feeling of fullness in the lower abdomen.
  • Enlargement of abdomen
  • Frequent urination
  • Pain during sex.
  • Pain in the pelvis and lower back.
  • Reproductive problems, such as infertility, multiple miscarriages, or early labor.

 

DIAGNOSIS

History taking and physical examination (palpation) are important in the diagnosis of fibroids. The woman may complain of excessive menstrual bleeding, pain during sex,  feeling of fullness and so on.  On palpation, a compact mass may be felt at the middle of the pelvis. More specific diagnostic test for fibroids may include

 

Ultrasound: Both abdominal and trans-vaginal Ultrasound can be used with the latter being clearer and more accurate.

 

Magnetic resonance imaging: This imaging test is prescribed when Ultrasound has not provided enough information. It reveals the location and size of the fibroids.

 

Hysteroscopy: Visualization of the wall of uterus and fallopian tubes through the vagina  using lighted telescope.

 

TREATMENT

 Usually since not all women with fibroids will experience symptoms which will require treatment and the fibroids is expected to shrink after menopause, “watchful waiting” is adopted.  This method involves monitoring the growth of the growth of fibroid to ensure it is under control. Treatment of fibroids could be medical or surgical.

Medical treatment involves prescribing medication that will either prevent the growth of the fibroid or shrink it. Medical treatment includes:

Gonadotropin-releasing hormone agonists (GnRH agonists): GnRH inhibits oestrogen release from the ovaries thereby lowering oestrogen level.  This triggers a “medical menopause”. This method can also be used prior to surgical treatment to shrink the fibroids to make surgeries easier.

 

Antihormonal agents: Certain drugs that inhibit oestrogen can be prescribed.  These drugs shrink the fibroids. An example is danazol.

 

Pain killer:  For women who experience pelvic pain and lower back pain, anti-inflammatory pain killers are prescribed.

 

Surgical treatment includes:

Myomectomy

This is the surgical removal of the fibroids.  The concern about this method is that for women in the reproductive period, the fibroids may grow back.

 

Hysterectomy

This is the surgical removal of the entire uterus. Hysterectomy is advised if other methods have failed and the woman is not planning to get pregnant again

 

Uterine artery embolization

The arteries supplying blood to the fibroids are identified and then blocked off, thus shrinking them.

 

COMPLICATIONS

Fibroids are quite a discomforting abnormal growth that may develop anywhere around the uterus. They are however not dangerous but can cause the development of certain complications such as:

Pregnancy loss: Fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids — especially submucosal fibroids — could cause infertility or pregnancy loss. Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction and preterm delivery.

Anaemia: fibroids may cause loss of a large volume of blood and this may result in the condition known as anaemia.

 

SOURCES

  • Ferri FF. Uterine fibroids. In: Ferri’s Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed May 11, 2016.
  • Segars JH, et al. Proceedings from the third National Institutes of Health International Congress on advances in uterine leiomyoma research: Comprehensive review, conference summary and future recommendations. Human Reproduction Update. 2014;20:309.
  • Stewart EA. Epidemiology, clinical manifestations, diagnosis, and natural history of uterine leiomyomas (fibroids). http://www.uptodate.com/home. Accessed May 11, 2016.
  • Stewart EA. Uterine fibroids. New England Journal of Medicine. 2015;372:1646.
  • Cunningham FG, et al. Pelvic mass. In: Williams Obstetrics. 24th ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://www.accessmedicine.com. Accessed May 11, 2016.
  • Papadakis MA, et al., eds. Gynecologic disorders. In: Current Medical Diagnosis & Treatment 2016. 55th ed. New York, N.Y.: The McGraw-Hill Companies; 2016 http://www.accessmedicine.com. Accessed May 11, 2016.
  • Stewart EA. Overview of treatment of uterine leiomyomas (fibroids). http://www.uptodate.com/home. Accessed May 11, 2016.