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Uterine Fibroid

  • What is a Uterine Fibroid?

    Uterine fibroid is a non-cancerous growth in the uterus (womb). It can grow on the inside of the uterus, within the muscle wall of the uterus or on the outer surface of the uterus. Uterine fibroids can make it difficult for women to conceive and can cause repeated miscarriages.

    Uterine fibroids are classified according to their location in the uterus:

    • Intracavitary – Almost completely within the womb cavity
    • Intramural or intramyommetrial – Completely within the womb muscle
    • Pedunculated – Attached to the womb surface by a stalk
    • Submucous – Partially in the womb cavity, starting from the wall of the womb cavity
    • Subserous – Protruding outside the womb, with the base on the outer surface of the womb
  • The causes of uterine fibroids are not clear 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
    • 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
    • Excessive vaginal bleeding, passing of blood clots or prolonged menstrual periods
    • The need to urinate frequently or inability to urinate despite a full bladder
  • Treatment will be determined based on your age, general health, medical history, size of the fibroid(s) and your desire for future pregnancy. Treatments include:

    • 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
    • Laparoscopic-assisted vaginal hysterectomy – removal of the uterus via keyhole surgery
    • Abdominal myomectomy – surgical removal of the fibroid from the uterus through the abdomen
    • Endometrial (inner layer of uterus) ablation and resection to remove the lining of the uterus
    • Hormone treatment:
      1. Progesterone to counteract the excess oestrogen
      2. 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
    • Non-steroidal anti-inflammatory drugs for mild pain
    • Uterine artery embolisation to block blood supply to the fibroid so that the fibroid shrinks and dies
  • 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. They can occasionally cause infertility or miscarriage or prevent implantation and growth of an embryo. Rarely, uterine fibroid can block your fallopian tubes or affect the passage of sperm from your cervix to your fallopian tubes.

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