Uterine fibroid is a non-cancerous growth of the smooth muscles of the
uterus. They occur during the reproductive years of a woman and usually
will begin to shrink after menopause. They usually do not cause any
challenge in most women and are usually incidental findings during an
ultrasound scan.
Fibroids usually do not pose any long-term dangers to a woman. However,
they could cause the following:
Heavy menstrual flow could lead to blood loss and low blood levels.
In some cases, the lady may need a blood transfusion.
Dysmenorrhea. Painful menses could affect the quality of life of the
client by causing severe pains during menses.
RISK FACTORS
As many as 4 in 10 women may have fibroids in any population, and by
age 50 years about 70 – 80 % of women will be found to have fibroids.
Several factors may increase a woman's risk of developing fibroids. They
include:
Genetic factors
Fibroids tend to run in families and are common in families where a
mother or aunt is found to have fibroids. It is also commoner in black
women.
Obesity
Fibroids are more common in obese women because of the conversion
of fat to estrogen. Fibroids feed on estrogen for their growth.
SYMPTOMS
Most persons with fibroids have no symptoms. When symptoms occur, the
client complains of:
Shifting abdominal mass. Most women describe it as regular
movements within the abdomen.
Heavy menses with the use of additional pads
Abdominal pains during menses.
Difficulty urinating [if the fibroid is compressing on the lower part of
the urinary bladder].
LOCATION OF FIBROIDS
The location of a fibroid could determine if a fibroid would cause symptoms.
The different locations include:
Intramural fibroids
They are located in the muscular walls of the fibroid and may enlarge
inwards or outwards. Small intramural fibroids generally do not cause
symptoms.
Subserosal fibroids
They are located on the external surface of the uterus.
Pedunculated fibroids
These are fibroids that grow outside the surface of the uterus and
develop a stalk.
Cervical fibroids
They are located in the wall of the cervix (neck of the uterus).
Parasitic fibroids
These fibroids are usually pedunculated and then develop blood vessels
from other structures
Submucosal fibroids
These are protrusions of fibroid into the uterine cavity thus distorting it
and increasing its surface area for bleeding. They usually cause heavy
bleeds.
FIBROID AND INFERTILITY
Fibroids rarely are a cause of infertility except in rare cases when it
occludes both fallopian tubes.
They could lead to pregnancy losses if a pregnancy implants on a
submucous fibroid. it could lead to pregnancy loss.
Women who get pregnant with fibroids could be at risk of:
Pains during the 2 nd trimester of pregnancy [when the fibroid
undergoes degeneration]
Poor growth of the developing baby, a term called intrauterine growth
restriction
Preterm delivery
Heavy bleeding after delivery
PREVENTION
There are no ways of preventing uterine fibroids as most cases have a
genetic potential. However, you may be able to reduce your risk slightly by
maintaining a normal weight.
Regular check-ups with your gynecologist are necessary if you have been
diagnosed with uterine fibroids to monitor their growth.
DIAGNOSIS
Diagnosis of uterine fibroid usually begins with a history of abdominal
swelling or heavy menses. However, in many cases, it is picked up during a
routine pelvic examination or an ultrasound scan for another medical
condition.
Laboratory tests may be required and examination done may include:
Full blood count. This checks for the presence of anemia [low blood
level], and the platelet count. It could assist in detecting blood
disorders.
Clotting profile. It helps to check for problems with blood clotting.
A 3D ultrasound scan will help confirm the diagnosis including the
numbers of fibroids and their location.
In some cases, an MRI may be indicated when planning for treatment or
surgery for women with large fibroids to get more details about the sizes
and locations of the fibroids, to ascertain that they are not cancerous.
TREATMENT
When a doctor makes a diagnosis of uterine fibroid, the plan to treat will be
determined by the symptoms. Modalities of treatment include:
1. Expectant management
Women without symptoms usually do not require any treatment. They are
counseled to have regular checkups.
2. Medical Treatment
Medications are used for the treatment of some of the symptoms of fibroids
or to temporarily reduce the size of the fibroids. They include:
NSAIDs. These drugs are used to relieve painful menses. Examples
are Ibuprofen, Brustan, Cataflam.
Mefenamic acid. Used to reduce the amount of bleeding during
menses.
Oral contraceptive pills. They are used to reduce the amount of
menstrual flow.
Mirena [progesterone IUD]. This is an insert implanted into the
uterus to reduce menstrual blood flow.
GnRH agonist. They are injections used to induce a state of
reversible menopause in a woman thus temporarily shrinking the
fibroids and reducing blood flow. They are used for a maximum of 6
months. They are also used to make fibroids smaller before a
planned surgery.
Uterine Artery Embolization [UAE]
This procedure is used for women who do not desire to get pregnant. UAE
involves inserting some gel into the uterine artery through a catheter to
block the uterine artery blood flow to the uterus. The fibroids will shrink over
months following the procedure.
3. Surgery
Myomectomy
This involves the removal of fibroids in women who still desire to
have babies in the future. Fibroids could be removed through:
Laparoscopic myomectomy
Laparoscopy is the preferred method for fibroid removal. It is done by
inserting a camera through a pinhole and the instruments for surgery are
inserted through small holes in the abdomen. The fibroids are removed
by morcellation [a procedure which cuts it into smaller pieces so it can
be pulled out of the small incisions]
Hysteroscopic myomectomy
For submucous fibroids, removal can be carried out successfully through
the vaginal route without making any incisions on the abdomen.
Laparotomy or abdominal myomectomy
This is the traditional method of removing fibroids. It is used for large
fibroids or multiple fibroids when laparoscopic removal is not feasible.
