Fibroid Facts

Fibroid Facts

What is a Fibroid (aka Myoma)?

A fibroid is a non cancerous growth of the uterus, chiefly arising from it's muscular wall.

Fibroids can grow in different parts of the uterus:

-in the wall (intramural fibroid)

-under the lining of the uterus (submucosal fibroid)

-under the outer surface of the uterus (subserosal fibroid)

-attached to the uterus by a stalk (pedunculated fibroid)

In todays world, fibroids are very common and occur mostly in women aged between 30 to 50 yrs old.

A woman may have only one fibroid or many of different sizes. They can grow slowly, rapidly or stay the same in size.

What causes uterine fibroids?

Though one cannot pin-point the exact cause, fibroids are thought to occur because of the interplay between hormonal disturbances (estrogen and progesterone) and environmental influences. Thus, fibroids tend to grow when hormone levels are higher (eg during pregnancy) and shrink when they are low (eg menopause).

What are the risk factors for uterine fibroids?

There are several risk factors that can play a role in your chances of developing fibroids. These can include:

• obesity and a higher body mass index (BMI)
• Family history of fibroids.
• Not having children.
• Early onset of menstruation (getting your period at a young age).
• Late age for menopause

What are the symptoms of uterine fibroids?

They may remain small, silent and create no problems in most women, while in others, they may grow to a considerable size to cause symptoms. Thus, the treatment of a fibroid is necessary only if it causes problems.

Larger fibroids can cause you to experience a variety of symptoms, including:

• excessive bleeding during periods
• Bleeding between periods.
• anaemia (in those with heavy menses)
• excessive pain and cramping during menses
• Increased abdominal enlargement, causing you to look pregnant.
• Inability to conceive.
• frequent trips to the washroom (this can happen when a fibroid puts pressure on the bladder).
• Inability to pee or completely empty your bladder.
• Low back pain.
• constipation or feeling pressure on your rectum.
• rarely, vaginal discharge

What tests can your doctor order to confirm the diagnosis of a fibroid?

An internal examination performed by your gynecologist may raise a suspicion of a fibroid. This may be followed by the following tests to confirm fibroids and determine their size and location.

-Ultrasonography
-MRI
-Hysteroscopy (Allows diagnosis and treatment in the same sitting)

-Hysterosalpingography (HSG) or Sonosalpingography (SSG)

How are uterine fibroids treated?

Small fibroids and those not causing any problems can often be left alone. 

If you’re experiencing symptoms from your fibroids, you’ll need help. Your treatment plan will depend on a few factors, including:

• What symptoms you’re experiencing related to the fibroids.
• How many fibroids you have.
• The size of your fibroids.
• Where your fibroids are located.
• Your desire to keep your uterus and your plans for future pregnancy.

Treatment options for uterine fibroids can include:

Medications

• Over-the-counter (OTC) pain medications: 
• Iron supplements: To help combat anemia due to excess bleeding
• Birth control pills: These also suppress symptoms of fibroids - especially heavy bleeding during and between periods and menstrual cramps. Your doctor can help you choose from a variety of birth control options such as pills, patches, injections and intrauterine devices.
• Gonadotropin releasing Hormone (GnRH) agonists: These medications work by shrinking fibroids. They’re sometimes used to shrink a fibroid before surgery, making it easier to remove the fibroid. 
• Oral therapies: In the form of progesterones, can help reduce the size of the fibroid.

 Always consult your provider before starting a new medication to discuss any possible complications.

Fibroid surgery

Not only can the size, location and number of fibroids influence the type of surgery, but your wishes for future pregnancies can also be an important factor when developing a treatment plan. Some surgical options preserve your uterus and allow you to become pregnant in the future, while other options can either damage or remove your uterus.

MYOMECTOMY is a procedure that allows your provider to remove the fibroids. There are several types of myomectomy. The type of procedure that may work best for you will depend on where your fibroids are located, how big they are and how many you have. The types of myomectomy procedures to remove fibroids can include:

• Hysteroscopy: Your provider inserts a scope (a thin, flexible, tube-like tool) through your vagina and cervix and into your uterus. Your provider uses the scope to shave and cut away and remove the fibroids.
• Laparoscopy: In this procedure, your provider will use a scope to remove the fibroids. Unlike hysteroscopy, this procedure involves placing a few small incisions in your abdomen. This is how the scope will enter and exit your body.
• Laparotomy: During this procedure, your provider makes one larger incision in your abdomen and removes the fibroids through this one cut.

If you aren’t planning future pregnancies, there are additional options your healthcare provider may recommend. These options can be very effective, but they typically prevent future pregnancies. These can include:

• Hysterectomy: Removing the uterus. If your ovaries are left in place, you won’t go into menopause after a hysterectomy. This procedure might be recommended if you’re experiencing very heavy bleeding from your fibroids or if you have large fibroids. 

     Minimally invasive hysterectomies include vaginal, laparoscopic or robotic methods.

• Uterine Artery Embolization: A small catheter is placed in the uterine artery and small particles are injected, which block the flow of blood from the artery to the fibroids. Loss of blood flow shrinks the fibroids and improves the symptoms. This procedure though very effective, is not suitable for those planning to conceive in future.

What can happen if fibroids go untreated?

 Sometimes fibroids can get larger and increase in number if left untreated. This can cause symptoms to worsen. Your doctor can determine the best treatment plan for your fibroids.

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