Fibroids

Fibroids, medically known as uterine myomas or leiomyomas, are benign growths that originate in or around the womb (uterus). These tumours are made up of muscle and fibrous tissue and can range in size from a tiny seed to a large melon. While fibroids are not cancerous, they can cause a variety of symptoms and may require treatment in some cases.

What is Fibroids?

Fibroids are muscular tumours that develop within the wall of the uterus. These growths are almost always benign, meaning they are not cancerous. Fibroids can vary greatly in size, from being as small as an apple seed to as large as a melon. They can grow as a single tumour or in multiples. Fibroids are extremely common. Despite their prevalence, the exact causes of fibroids remain unknown.

However, research suggests that hormonal factors, particularly oestrogen and progesterone levels, play a significant role in their growth. Unlike some other conditions, such as cancer, fibroids do not have specific stages. However, they can grow and change over time. Fibroids tend to grow during the reproductive years when oestrogen levels are high and may shrink after menopause when oestrogen levels decrease. The size and location of fibroids can also impact the severity of symptoms and the need for treatment.

There are several types of fibroids, classified based on their location in the uterus:

• Intramural Fibroids: These are the most common type, developing in the muscle wall of the uterus.

• Subserosal Fibroids: These fibroids grow outside the wall of the uterus into the pelvis and can become very large.

• Submucosal Fibroids: These fibroids develop in the muscle layer beneath the womb's inner lining and grow into the cavity of the uterus.

• Pedunculated Fibroids: These fibroids grow on a stalk and can protrude into the abdominal cavity or the uterine cavity.

The symptoms of uterine fibroids can vary significantly from one woman to another. Some women with fibroids may not experience any symptoms at all, while others may have severe and debilitating symptoms. Common symptoms of fibroids include:

• Heavy Menstrual Bleeding: Fibroids can cause prolonged and heavy menstrual bleeding, which can lead to anaemia.

• Pelvic Discomfort or Pain: Large fibroids can cause a feeling of heaviness or pressure in the lower abdomen or pelvis. In some cases, acute and severe pain may occur due to degeneration of the fibroid.

• Bladder Problems: Fibroids that press against the bladder can cause frequent urination or difficulty emptying the bladder.

• Low Back Pain: Fibroids located on the back surface of the uterus can cause back pain.

• Rectal Pressure: Fibroids pressing against the rectum can cause a sensation of rectal fullness, difficulty with bowel movements, or pain during bowel movements.

• Discomfort or Pain During Sexual Intercourse: Fibroids can make sexual intercourse painful or uncomfortable.

• A Feeling of Fullness in the Pelvic Area: Enlargement of the lower abdomen can occur with large fibroids.

While these symptoms can be indicative of fibroids, they can also be caused by other gynaecological conditions. Therefore, it is essential to consult a healthcare professional for an accurate diagnosis.

Despite extensive research, the exact cause of uterine fibroids remains unknown. However, several factors are believed to contribute to the development and growth of these non-cancerous tumours:

• Hormonal Influence: Oestrogen and progesterone, the primary female reproductive hormones, appear to play a significant role in the growth of fibroids. These tumours tend to grow rapidly during pregnancy when hormone levels are high and shrink after menopause when hormone levels decline.

• Genetic Factors: Studies suggest that fibroids may have a genetic component, as they often run in families. Women with a family history of fibroids are more likely to develop them.

Certain factors can increase a woman's risk of developing uterine fibroids. These include:

• Age: Fibroids are most commonly diagnosed in women of reproductive age, particularly those in their 40s and early 50s.

• Family History: Having a close female relative, such as a mother or sister, with fibroids increases the likelihood of developing them.

• Obesity: Women with a high body mass index (BMI) or who are overweight are at a higher risk of developing fibroids.

• Diet: Consuming a diet high in red meat and low in green vegetables, fruits, and dairy products may increase the risk of fibroid development.

• Ethnicity: Studies have shown that women of African descent are more likely to develop fibroids compared to women of other ethnicities.

Uterine fibroids can lead to various complications, although these are relatively rare. Some of the potential complications associated with fibroids include:

• Emergency Surgery Needs: Severe pain and heavy bleeding may require immediate surgical intervention.

• Twisting of Fibroids: When fibroids twist, they can obstruct blood vessels that supply the tumour, leading to intense pain and potentially necessitating surgery.

• Anaemia Risks: Heavy bleeding caused by fibroids can result in anaemia, characterised by a deficiency of red blood cells.

• Urinary Tract Complications: Fibroids can exert pressure on the bladder, leading to urinary retention, urinary tract infections, and difficulty emptying the bladder.

• Impact on Fertility: Large fibroids, especially submucosal ones, can hinder fertility by blocking fallopian tubes. This prevents sperm from reaching the egg or interfering with embryo implantation.

• Pregnancy Complications: Fibroids can lead to various pregnancy-related issues, including premature labour, the need for cesarean delivery if the fibroid obstructs the birth canal and heavy postpartum bleeding. In rare cases, they may also contribute to miscarriage within the first 23 weeks of pregnancy.

  Although rare, acute urinary retention and renal failure can occur as serious complications during pregnancy.

• Red Degeneration: During pregnancy, fibroids may experience red degeneration, a hemorrhagic infarction that can cause significant pain.

• Rare Vascular Complications: Thrombo-embolism and other vascular issues, such as mesenteric vein thrombosis and intestinal gangrene are extremely rare but can occur.

There are no known methods to completely prevent the development of fibroids, as the exact cause is still not fully understood. However, several factors are thought to influence the risk of developing these benign tumours:

• Hormonal Factors: Exposure to higher amounts of endogenous oestrogen is believed to be a significant risk factor for developing fibroids. Maintaining a healthy body weight and avoiding excessive alcohol consumption may help regulate hormonal levels.

• Genetic Factors: Fibroids may run in families, suggesting a genetic component. While you cannot change your genetic makeup, being aware of your family history can help you stay vigilant about potential symptoms.

• Dietary Factors: Some studies suggest that a diet high in red meat and low in fruits and vegetables may increase the risk of developing fibroids. Adopting a balanced diet rich in fruits, vegetables, and whole grains may be beneficial.

• Lifestyle Factors: Regular exercise and maintaining a healthy body weight may help lower the risk of developing fibroids, as obesity has been linked to an increased risk.

Diagnosing uterine fibroids usually starts with a pelvic exam. Your doctor will check for any unusual lumps or changes in the shape of your uterus. However, small fibroids can be hard to detect this way.

If fibroids are suspected, your doctor may recommend one or more of the following tests:

• Ultrasound: This is the most common tool used to diagnose fibroids. It uses sound waves to create a picture of your uterus, allowing your doctor to see its internal structure. Ultrasound can be done abdominally (over your belly) or transvaginally (with a probe inserted into your vagina).

• Magnetic Resonance Imaging (MRI): An MRI uses a strong magnetic field and radio waves to produce detailed images of the uterus and surrounding structures. This test can provide more information about the size and location of fibroids than an ultrasound.

• Hysteroscopy: This procedure involves inserting a small, lighted telescope called a hysteroscope through the cervix into the uterus. This allows your doctor to see the inside of the uterus and take a tissue sample (biopsy) if needed.

• Laparoscopy: In this surgical procedure, a small incision is made in the abdomen, and a thin, lighted telescope called a laparoscope is inserted to view the outside of the uterus and other pelvic organs. This can help identify fibroids on the outer surface of the uterus.

• Hysterosalpingography: This is an X-ray of the uterus and fallopian tubes. A dye is injected into the uterus and an X-ray is taken. This test can show if the fallopian tubes are open and if the inside of the uterus is a normal shape.

• Hysterosonography: This test involves injecting saline into the uterus before an ultrasound. The saline helps outline the uterine cavity, making it easier to see fibroids inside the uterus (submucosal fibroids).

In some cases, imaging tests may be inconclusive, and a biopsy may be necessary to confirm the diagnosis. This involves removing a small sample of tissue from the uterus for laboratory analysis.

The treatment and management of fibroids depend on several factors, including the size, location, and number of fibroids. This also depends on the patient's age, symptoms, and fertility goals. Here are some common treatment options:

1. Medical Treatment Options

Anti-inflammatory Painkillers: Over-the-counter medications such as ibuprofen or naproxen can help manage pain and reduce menstrual bleeding caused by fibroids.

2. Hormonal Treatments:

• Gonadotropin-releasing Hormone Agonists (GnRH Agonists): These medications lower oestrogen levels, triggering a temporary "medical menopause," which can shrink fibroids and stop menstrual periods. However, they are typically used for no longer than a year due to potential side effects.
• Oral Contraceptive Pills: These can help reduce bleeding associated with fibroids.
• Progesterone-containing Agents: Medications such as pills, implants, injections, or intrauterine devices (IUDs) can help control bleeding.

3. Surgical Options

• Myomectomy: This procedure removes the fibroids while preserving the uterus, making it suitable for women who wish to maintain their fertility.
• Hysterectomy: The removal of the entire uterus is often recommended for women who are not interested in future pregnancies. It is the most effective method to ensure that fibroids do not recur.

4. Other Interventions

• Radiologically Guided Interventions: Procedures such as uterine artery embolisation (UAE) and magnetic resonance-guided focused ultrasound surgery (MRgFUS) can be considered for symptomatic fibroids.

Living with uterine fibroids can be challenging, but there are ways to manage the condition and maintain a good quality of life. For women with asymptomatic fibroids, regular monitoring by a healthcare provider is often sufficient to ensure that the fibroids do not grow or cause symptoms.

Women experiencing symptomatic fibroids may need to manage symptoms such as heavy menstrual bleeding, pain, and urinary or bowel problems. Over-the-counter medications and hormonal treatments can help alleviate these symptoms, allowing women to continue their daily activities with minimal disruption.

Fertility considerations are essential for women with fibroids who wish to maintain their ability to conceive. Discussing treatment options carefully with a healthcare provider is crucial, as some treatments, such as hysterectomy, can permanently impact fertility. Myomectomy, which preserves the uterus, maybe a more suitable option for women who desire future pregnancy.

Maintaining a healthy lifestyle can also help manage fibroid symptoms and improve overall well-being. This includes:

• Eating a balanced diet rich in fruits, vegetables, and whole grains

• Exercising regularly to maintain a healthy weight and reduce stress

• Managing stress through relaxation techniques, such as meditation or yoga

• Staying hydrated and avoiding excessive alcohol and caffeine consumption

If you suspect that you may have fibroids or are experiencing symptoms that are affecting your daily life, it is essential to consult with a doctor. Here are some signs that indicate you should seek medical attention:

• Heavy or prolonged menstrual bleeding that interferes with daily activities or causes anaemia

• Pelvic pain or pressure that is not relieved by over-the-counter pain medications

• Frequent urination or difficulty emptying the bladder

• Pain during intercourse

• Enlarged abdomen or a palpable mass in the lower abdomen

• Infertility or recurrent miscarriages