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Uterine Fibroids

 

Fibroids are common benign growths of the womb (uterine) muscle.  They are seen in 25% of white women and 50% of black women.  Fibroids are common towards the end of reproductive life.  Fibroids can be either single or multiple and can vary in size or position.  They arise from the muscle called intramural fibroids.  If they grow towards the uterine lining they are known as submucosal fibroids and project into the cavity of the uterus.  

Women with these type of fibroids may have a fertility problems, whereas intramural fibroids are important causes for pain and heavy periods.  Submucosal fibroids are fibroids which grow under the surface of the uterus and can sometimes be very large. They usually do not cause any problems with periods or fertility and are often associated with pressure symptoms of the bladder or bowel.

 

Common Symptoms of Fibroids

 

The common symptoms of fibroids are heavy bleeding, pain during bleeding, pressure on the bladder causing urinary frequency and backache.  Submucosal fibroids can cause irregular periods along with heavy periods.  Fibroids can be associated with endometriosis, pelvic inflammatory disease and are often the cause of fertility problems.  Fibroids are usually discovered on routine pelvic examination particularly in asymptomatic women.  An ultrasound scan is very important to diagnose fibroids in asymptomatic women. 

 

Treatment Options for Fibroids

 

If the fibroids are small and not causing any problems then often conservative treatment is the right treatment of choice.  Symptomatic fibroids should be treated by either removing the fibroid called a myomectomy or in older women a hysterectomy - the removal of the uterus along with the fibroid.  Other treatments are available namely embolisation of the fibroid.  This treatment cannot be offered in young women or women who are planning to have future pregnancies. 

Submucosal fibroids which project into the cavity of the uterus can be removed by hysteroscopic resection, where a telescope is inserted inside the womb and the fibroids are removed in pieces.  This is often performed as a daycase procedure, thus avoiding major surgery.  Completion of this procedure may require more than one operation.  Another option to prevent surgery is uterine artery emobolisation.   This is carried out by a radiologist where a fine catheter is passed into the artery responsible for feeding the uterus.   The artery is blocked and this in due course will shrink the fibroid.

Medical treatment has a very limited role in the management of fibroids.  These are drugs which can be used to reduce symptoms, such as painkillers, those which reduce the amount of blood loss each cycle.  Blood loss can also be reduced by oral contraceptive pills. 

There are some treatments which can shrink the fibroids, but these have several side affects and therefore should not be continued for more than six months.  However, for women who do not want to go for major surgery or want to wait for the menopause, this kind of treatment should only be considered as an alternative. 

 

Cancerous changes in Fibroids

 

Cancerous changes in fibroids are extremely rare, but can happen in 0.05% to 0.1% cases of fibroids that are diagnosed.

 

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