FIBROID: WHAT EVERY WOMAN MUST KNOW ABOUT IT

Fibroids are non-cancerous tumours that grow in or around the womb (uterus). The growths are made up of muscle and fibrous tissue and vary in size.  Uterine fibroids are growths of the uterine muscle occurring in 30-40% of women. The tumours are sensitive mainly to oestrogen and progesterone. Most fibroids do not cause any problems and do not require treatment.

Some fibroids, however, can cause heavy periods which can lead to anaemia and debilitation, or if the fibroids grow large they can lead to 'compression syndrome' in which adjacent organs may be compressed such as the bladder leading to frequency of urination, the bowel leading to constipation and bloating. Fibroids may press on nerves causing backache and sciatica and can cause cosmetic unsightliness by bulging the abdomen.

TYPES OF FIBROIDS

Fibroids can grow anywhere in the womb and vary in size considerably. Some can be the size of a pea, whereas others can be the size of a melon.

The main types of fibroids are:

• intramural fibroids – the most common type of fibroid, they develop in the
  
  muscle wall of the womb
• subserosal fibroids – fibroids that develop outside the wall of the womb into the pelvis and can become very large
• submucosal fibroids – fibroids that develop in the muscle layer beneath the inner lining of the womb and grow into the middle of the womb

In some cases, subserosal or submucosal fibroids are attached to the womb with a narrow stalk of tissue. These are known as pedunculated fibroids.

CAUSES

Fibroids begin when cells overgrow in the muscular wall of the uterus. The exact cause of this growth is unknown. However, they are linked to the hormone oestrogen. Oestrogen is the female reproductive hormone produced by the ovaries (the female reproductive organs).

Fibroids usually develop during a woman's reproductive years (from approximately 16 to 50 years of age) when oestrogen levels are at their highest, and they tend to shrink when oestrogen levels are low, such as after the menopause (when a woman's monthly periods stop at around 50 years of age).

SYMPTOMS

Uterine fibroid symptoms and problems include:

·         Abnormal menstrual bleeding, such as:

• Heavier, prolonged periods that can cause anaemia.
• Painful periods.
• Spotting before or after periods.
• Bleeding between periods.

·         Pelvic pain and pressure, such as:

• Pain in the abdomen, pelvis, or low back.
• Pain during sexual intercourse.
• Bloating and feelings of abdominal pressure.

·         Urinary problems, such as:

• Frequent urination.
• Leakage of urine (urinary incontinence).
• Kidney blockage following ureter blockage (rare).

·         Other symptoms, such as:

• Difficulty or pain with bowel movements.
• Infertility. Sometimes, fibroids make it difficult to become pregnant.
• Problems with pregnancy, such as placental abruption and premature labor.
• Miscarriage.

RISK FACTORS

Things that increase a woman's risk for uterine fibroids include:

• ·         Age. Fibroids become more common as women age, especially from the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• 
  
• ·         Family history. Having a family member with fibroids increases your risk.
• 
  
• ·         Ethnic origin. Black women are more likely to develop fibroids than white women.
• 
  
• ·         Obesity

DIAGNOSIS

Uterine fibroids are diagnosed by pelvic exam and even more commonly by ultrasound. Often, a pelvic mass cannot be determined to be a fibroid on pelvic exam alone, and ultrasound is very helpful in differentiating it from other conditions such as ovarian tumors. MRI and CT scans can also play a role in diagnosing fibroids, but ultrasound is the simplest, cheapest, and best technique for imaging the pelvis.

Occasionally, when trying to determine if a fibroid is present in the uterine cavity (endometrial cavity), a hysterosonogram (HSG) is done. In this procedure, an ultrasound exam is done while contrast fluid is injected into the uterus through the cervix. The fluid within the endometrial cavity can help outline any masses that are inside, such as submucosal fibroids..

PREVENTION

There is no known treatment that prevents uterine fibroids. But getting regular exercise may help. According to one study, the more exercise women have, the less likely they are to get uterine fibroids.

It is common for fibroids to grow back after treatment. The only treatment that absolutely prevents regrowth of fibroids is removal of the entire uterus, called hysterectomy. After hysterectomy, you cannot get pregnant. While many women report an improved quality of life after hysterectomy, there are also possible long-term side effects to think about. For more information, see the topic Hysterectomy

TREATING FIBROIDS

There are several options for the treatment of uterine fibroids that include

·        Surgical procedure:

o   hysterectomy (REMOVAL OF UTERIUS)

o    Myomectomy(REMOVAL OF WOMB)

o    Cryosurgery (USE OF EXTREME COLD TO DISTROY TUMORS)

·        NON SURGICAL TREATMENT:

o   uterine artery embolization (UAE){ This procedure blocks the blood supply of the arteries that supply fibroids causing them to shrink}.

o   MRI-guided high-intensity focused ultrasound (MRgFUS)

Medical treatments include medications such as mifepristone (RU-486, danazol (Danocrine), raloxifene (Evista), GnRH analogs (Lupron and others), and low-dose formulations of oral contraceptives. 

WHEN TO CALL A DOCTOR

          Call to make an appointment if you have possible symptoms of a problem from a uterine fibroid, including:

·         Heavy menstrual bleeding.

·         Periods that has changed from relatively pain-free to painful over the past 3 to 6 months.

·         Frequent painful urination or an inability to control the flow of urine.

·         A change in the length of your menstrual cycle over 3 to 6 menstrual cycles.

·         New persistent pain or heaviness in the lower abdomen or pelvis.