Fibroids

A fibroid is a non-cancerous tumour that develops from the layer of the uterus. These growths are smooth muscles and fibrous tissues that vary in size ranging from small pea up to the size of a watermelon. Many women live with fibroids without their knowledge because there is no visible symptom. It is advised that women without symptoms should opt for observation rather than treatment

Types of fibroid

There are four types of fibroid classified based on its location in the womb, and they include:

• Intramural fibroid: this fibroid is the most common type embedded in the muscular wall of the womb.
• Submucosal fibroids: This type of fibroid is found in the muscle under the inner lining of the wall which can protrude into the cavity of the womb.
• Cervical fibroids: Cervical fibroids grow in the cervix.
• Subserosal fibroids: a subserosal fibroid extends beyond the wall of the womb. It grows within the surrounding outer uterine tissue layer. It might have the potential of growing into pedunculated fibroids when it develops a stock and becomes very large.

Symptoms

Fibroid doesn’t often cause symptoms in some cases. One out of every three women having fibroid is likely to experience the following symptomswhich include:

• Heavy or painful periods, also known as menorrhagia
• lower backache
• frequent urination
• constipation
• abdominal pain, especially in the case of large fibroids
• pain during sex, known as dyspareunia

Other possible symptoms that may be experienced include:

• fertility problems
• repeated miscarriages

When to see your GP

Fibroids are sometimes diagnosed since they don’t often cause symptoms; they can be diagnosed by chance on one of your routine gynaecological examination, test or scan. Seeing your GP is important if you have persistent symptoms of fibroids so they can investigate the possible cause. You may be referred for an ultrasound scan to diagnose if he or she suspects a fibroid case.

Treatment

It is only recommended that women who are experiencing symptoms of fibroid go through fibroid treatment. Treatment may not be necessary in cases where the fibroid does not affect the quality of life. Medication and surgery are the two main treatments of fibroid and the choice of treatment to be used can be affected by factors such as the location of fibroids, the severity of symptoms, and plans of childbearing.

Medication

A drug called gonadotropin-releasing hormone agonist (GnRHa) is used which causes the body to produce less estrogen and progesterone making fibroid to shrink. GnRHa is only for short-term fibroid treatment. When used, it stops the menstrual cycle without affecting fertility. It also causes menopause-like symptoms such as a tendency to sweat more, vaginal dryness, hot flashes, and, in some cases, increase the risk of osteoporosis. GnRHa can be given before surgery to shrink the fibroids.

Other drugs can be used in the treatment of fibroid but may be less effective when treating larger fibroids; they include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): these drugs include ibuprofen and mefenamic.  They reduce the production of prostaglandins which is a hormone-like lipid compound that causes crampy periods with heavy menstrual flow. NSAID is effective at reducing fibroid pain,  but does not reduce bleeding from fibroids or neither does it affect fertility.
• Birth control pills: You can regulate the ovulation cycle using Oral contraceptives, and they may help reduce the amount of pain or bleeding during periods.
• Levonorgestrel intrauterine system (LNG-IUS): This is a plastic device placed inside the womb to releases a hormone called levonorgestrel over an extended timeframe. Levonorgestrel hormone stops the inside lining of the womb from rapid growth and hence reducing menstrual bleeding. Adverse effects of LNG-IUS may cause irregular bleeding for some time, headaches, breast tenderness, and acne.

Surgery

Surgery may be needed for severe fibroid cases. The following are some of the procedures your GP might suggest in treating fibroids:

• Hysterectomy: this is the procedure used for treating extremely large fibroid which may involve partial or total removal of the womb. A total hysterectomy prevents the reoccurrence of fibroids, and it may reduce libido or cause early menopause if the ovaries and fallopian tubes were removed.
• MRI-guided percutaneous laser ablation: an MRI scan can locate fibroid. After locating fibroid with an MRI scan, then fine needles are inserted through the skin and body tissues to the targeted fibroids. A laser fibre device is inserted through the needles, and laser light is sent through the device to shrink the fibroid.
• Myomectomy: this is the best remedy for women who still want to have children. In this surgery procedure, the fibroid is removed from the muscular wall of the womb.
• Endometrial ablation: this is an alternative procedure for hysterectomy in some women which involves the removal of the lining inside the womb if the fibroid is near the inner womb surface.
• Uterine artery embolisation (UAE), more specifically uterine fibroid embolisation (UFE): this procedure cuts off the blood supply in the area of the fibroid which makes it shrink. It is guided by fluoroscopic X-ray imaging.  A chemical is injected through a catheter into the arteries supplying blood to any fibroid. This procedure is the best remedy for women who are pregnant or those who still want to have children because it can help to reduce symptoms up to 90%.
• MRI-guided focused ultrasound surgery: An MRI scan locates the fibroids, and high energy ultrasound waves are delivered to shrink them.