Fibroids

What are uterine fibroids?

Uterine fibroids are noncancerous (benign) tumours, commonly seen in women of childbearing age. Fibroids are composed of muscle cells and other tissues and very rarely cancerous. Uterine fibroids are usually round or semi-round in shape.

Fibroids are common and only need treatment if there is a specific indication.

Types of fibroids

Based on their location within the uterus, uterine fibroids can be classified as:

• Subserosal fibroids: Sited beneath the serosa (the membrane covering the outer surface of the uterus) (Also called FIGO 5, 6 or 7)
• Submucosal fibroids: Sited inside the uterine cavity below the lining of the uterus – endometrium. (FIGO 0, 1 or 2)
• Intramural fibroids: Sited within the muscular wall of the uterus (FIGO 3 or 4)
  
  

Causes of fibroids

The exact cause for the development of fibroids remains unknown. 

Symptoms of fibroids

The majority of women with uterine fibroids are asymptomatic. Others may experience

• Prolonged menstrual periods
• Heavy periods
• Pelvic pressure or pain
• Frequent urination
• Constipation
• Backache or leg pain
• Difficulty in emptying your bladder
• Difficulty getting pregnant
• A mass in the lower abdomen

Effect on fertility

Submucosal fibroids has a significant effect on fertility and have to be removed.  Intramural fibroids could have an effect but removal of these fibroids will leave a weakened scar in the uterine muscle that may tear during labour or childbirth.  Subserosal fibroids rarely have an effect on fertility.

Large fibroid can cause pain in pregnancy and if it is low in the uterus it may also interfere with the birth.

Diagnosis of fibroids

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. Other imaging techniques such as MRI scan and CT are rarely needed.

Treatments for fibroids

Surgery is considered the best modality of treatment. The common operations performed for the management of fibroids include:

• Hysterectomy or removal of the uterus
• Myomectomy or selective removal of the fibroids within the uterus
• Other techniques employed are uterine artery embolisation (UAE). To be a suitable candidate for this procedure there are certain requirements. There are possible side effects and complications so this procedure is not performed very often. 

Fibroids and pregnancy

Because fibroids can grow back, women who are planning a pregnancy must try to conceive as early as possible after the myomectomy procedure. However, following surgery, we will advise you to wait at least 2 to 6 months until the uterus heals.

Studies indicate that the presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as breech presentation, increased chance of caesarean section, increased bleeding post-delivery of the baby, premature labour and rarely even growth restriction. Surgery to remove the fibroids on the other hand may damage the uterus and cause a uterine rupture in labour. Risk and benefits of surgery must be weighed carefully before proceeding.