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Fibroids – Madhavi Manoharan

What are fibroids?

Uterine fibroids are benign (non-cancerous) tumours which develop on or within the muscular wall of the uterus. They are comprised of dense, fibrous tissue which is fed by blood vessels. Their size may vary between that of a pea and a melon. A woman may have one or more fibroids.

How common are fibroids?

Fibroids are frequent occurrences. Doctors estimate that 20% to 40% of woman over the age of 35 has fibroids.

What are the symptoms?

Many fibroids cause no symptoms but some trigger the following problems:

  • Heaving bleeding
  • anaemia
  • fatigue
  • Painful menstrual periods
  • Sensation of weight in the pelvis, back pain
  • Urinary disorders
  • Pain during intercourse
  • Subfertility

How do I know if I have fibroids?

Your doctor may diagnose fibroids during a routine gynaecologic examination. In order to confirm this diagnosis, your doctor may request that you undergo an ultrasound or MRI (magnetic resonance imaging) examination.

What are the treatments?

There are several treatments for fibroids. Your doctor will suggest that most appropriate treatment for you based on the following elements:

  • Severity of symptoms
  • Whether or not you wish to become pregnant
  • The size, type, and number of fibroids
  • Your age

MEDICAL TREATMENTS

Pain- Simple analgesics like paracetamol can help with pain.

Some hormonal treatments such as GnRH analogues (GnRHa) or Esmya may also be used, but these do not make the fibroids go away. Most often they have a temporary effect on symptoms and mostly prior to surgery. 

SURGERY 

There are two types of surgical treatment:

Hysterectomy

This means removing the uterus under general anaesthesia. This operation takes place via an abdominal incision and requires several days of hospitalization and convalescence lasting 6 to 8 weeks. A hysterectomy makes it impossible to become pregnant in the future.

Myomectomy

Fibroids are usually removed under general anaesthetic. They may be removed either hysteroscopically ("key-hole surgery"), which involves a telescope being inserted through the cervix, and the fibroid may then be cut away with no cuts in the tummy. This is only suitable for small fibroids, which bulge into the uterine cavity. Some smaller fibroids may be removed laparoscopically (also "key-hole surgery"); this involves inserting a telescope through the tummy button, and the fibroids are removed using two smaller holes in the abdomen. Large fibroids need to be removed "open" through a cut in the abdomen, which is usually below the bikini line. This results in hospitalization lasting several days and several weeks of convalescence.

Embolisation – a treatment that preserves the uterus 

Embolisation makes it possible to preserve the uterus and consists of the use of small particles injected to block the blood vessels to the fibroid. As the blood supply to the fibroid is then blocked, it dries up and the symptoms should disappear. This treatment has a quick effect on bleeding and, after a few months, results in the decreased size of the fibroids and the uterus. This technique has been used for 20 years and has treated more than 40,000 patients worldwide. Because of the exceptional risk of early menopause related to embolisation, the procedure is not recommended in the case of patients who have a strong desire for pregnancy and where there is a surgical possibility to preserve the uterus (myomectomy). However, cases of pregnancy have been reported after embolisation. Embolisation is the recognized alternative to hysterectomy for patients who wish to retain their uterus.