Uterine Fibroid (Myoma)

What causes fibroids is still unclear, but the following factors may be involved:

• Genetic changes – Linked to close family members with the condition
• Hormones – Sex hormones oestrogen and progesterone may promote the growth of a fibroid. These fibroids often shrink after menopause as the body produces less oestrogen and progesterone
• Other growth factors – Substances that help the body maintain tissues, eg. insulin-like growth factor

Growth Patterns

Uterine fibroids have different growth patterns. Some grow slowly, while others grow rapidly. Some don’t grow in size at all, while some uterine fibroids go through growth spurts. There are also uterine fibroids that resolve on their own. For example, fibroids that developed during pregnancy may shrink or completely disappear as the uterus returns to its normal size after pregnancy.

Risk Factors for Uterine Fibroids

Aside from the reproductive age of a woman, other risk factors for uterine fibroids include:

• Heredity - If family members have a history of having fibroids, you have an increased risk of developing uterine fibroids.
• Other factors
• Obesity
• Early onset of menstruation
• Vitamin D deficiency
• Diet higher in red meat
• Diet that is low in dairy, green vegetables and fruits
• Drinking alcohol

Preventing or reducing the risk of a uterine fibroid

As researchers continue to study what causes fibroids, there is still no certain way to prevent the development of uterine fibroids. However, your lifestyle can affect your risk of developing fibroids. Stick to healthy lifestyle habits like maintaining an ideal weight and eating more fruits and vegetables.

Symptoms of uterine fibroids depend on the location and size of fibroids. Common symptoms of uterine fibroids include:

• A sense of pressure or discomfort in the lower abdomen (belly) or pelvis
• Acute or chronic and mild abdominal pain, but persistent and localised
• Constant back pain – a fibroid can press against the muscles and nerves of your lower back
• Difficulty passing stools – rectal pressure from a fibroid can cause a feeling of fullness
• Discomfort or pain during sexual intercourse – this should be mentioned to your doctor
• Vaginal bleeding, passing of blood clots or prolonged menstrual periods
• The need to urinate frequently or inability to urinate despite a full bladder

Some severe fibroid symptoms that require urgent medical attention include:

• Excessive vaginal bleeding
• Sudden sharp pelvic pain
• Pelvic pain that doesn't go away
• Prolonged or painful heavy menstrual periods
• Bleeding or spotting between periods
• Difficulty emptying your bladder
• Unexplained low red blood cell count

Uterine fibroids are usually detected through a pelvic examination. After the pelvic exam, your doctor will require you to undergo some tests that will confirm the initial diagnosis and serve as a guide in exploring treatment options for you.

• Ultrasound
  A safe and effective way to detect uterine fibroids, ultrasound makes use of sound waves to create an image of your uterus and ovaries. This procedure usually takes 30 - 60 minutes.
• Saline Hysterosonography
  Ideal for looking at submucosal fibroids and polyps, this test will require a small catheter to be inserted through your cervix. Through it, sterile saline will be injected into the uterus before ultrasound images are captured. This test typically takes about 30 minutes.
• Magnetic Resonance Imaging (MRI)
  MRI gives a more detailed image of what’s inside the uterus. This test, which takes about 45 - 60 minutes, identifies the exact location of the fibroids, as well as their quantity and size. If your doctor is considering a uterine artery embolization as your treatment, you will likely be required to undergo MRI.
• Hysteroscopy
  During a diagnostic hysteroscopy, a speculum is inserted in the vagina. A hysteroscope is then carefully inserted through the cervix into the uterine cavity. To inflate the uterine cavity, a sterile saline is injected through the hysteroscope. On a TV monitor, your doctor can then see images of the openings of the fallopian tubes, lining of your uterus, polyps, and fibroids. The test usually takes 30 minutes.

Fibroids treatment will be determined based on your age, general health, medical history, size of the fibroid(s), and your desire for future pregnancy. Treatments for uterine fibroids include:

Traditional Surgery for Uterine Fibroids

• Abdominal hysterectomy – surgical removal of the uterus through the abdomen (belly)
• Vaginal hysterectomy – surgical removal of the uterus through the vagina. This may be done for smaller fibroids
• Abdominal myomectomy – surgical removal of the fibroid from the uterus through the abdomen

Minimally Invasive Procedure for Uterine Fibroids

• Uterine artery embolisation to block blood supply to the fibroid so that the fibroid shrinks and dies
• Laparoscopic-assisted vaginal hysterectomy – removal of the uterus via keyhole surgery
• Endometrial (inner layer of uterus) ablation and resection to remove the lining of the uterus

Non-invasive Procedure

If you want a procedure that requires no incision and can be done on an outpatient basis, ask your doctor about MRI-guided focused ultrasound surgery (FUS). It is a non-invasive treatment option for uterine fibroids performed while the patient is lying inside an MRI scanner. Through the images seen on the scanner, your doctor can see the exact location of the uterine fibroids. Once the fibroid is found, the ultrasound transducer uses sound waves to to heat and destroy the fibroid tissue.

Medications

Your doctor may prescribe medicines to treat your uterine fibroids. These medications don’t get rid of the fibroids but may possibly help to shrink them. The medicines can treat fibroid symptoms like heavy menstrual bleeding and pelvic pain by targeting the hormones which regulate your menstrual cycle. These medications include:

• Progesterone to counteract the excess oestrogen
• Gonadotropin-releasing hormone to stop oestrogen production in the ovaries – this can delay fibroid treatment until after menopause, when symptoms are less severe or have disappeared completely. The hormone can also be used to shrink the fibroid before surgery

Your doctor may also prescribe non-steroidal anti-inflammatory drugs to relieve mild pain related to uterine fibroids.

Treatment Options for Those Trying to Get Pregnant

If you still plan to get pregnant, discuss with your doctor what treatment plan will work best for you. Find out about the benefits and risks of each fibroid treatment options. You will be required to undergo a complete fertility evaluation if you are planning to get pregnant in the future.

If fibroid treatment is necessary for your condition, myomectomy is usually the preferred treatment for those who still want to get pregnant. Hysterectomy and endometrial ablation may not be good options for you. Likewise, radiofrequency ablation and uterine artery embolisation are not ideal uterine fibroid treatments if you want to preserve your fertility.

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Although uterine fibroids are not usually dangerous, the condition can cause discomfort and may lead to complications of anaemia (low red blood cell count) from heavy blood loss.

How Do Uterine Fibroids Affect Pregnancy?

Uterine fibroids can occasionally cause infertility, miscarriage or prevent implantation and growth of an embryo. Rarely, uterine fibroids can block your fallopian tubes or affect the passage of sperm from your cervix to your fallopian tubes.