All You Need to Know about Fibroids

Fibroids are the most common benign tumours affecting the uterus of women. Medically, fibroids are also known by the terms leiomyoma, myoma, or leiomyofibroma. Fibroids have been shown to be more common in people of African descent compared to other races and the frequency of occurrence increases with age until about 50 years of age when the frequency declines.

Fibroids may be located on any part of the uterus, from the body to the cervix and may also be located within the uterus where it interferes with pregnancy or can be located outside the uterus. It may be single but most times they are multiple. On rare occasions, fibroids may lose its uterine attachment and gain new blood supply from another organ (wandering/parasitic fibroid).

Protective Factors

The following can protect or prevent a woman from having fibroids:

• Child bearing during the mid-reproductive years (25-29yrs) provides the greatest protection against fibroid development.
• Menopause which results in a reduction in the female reproductive hormones the fibroid feeds on.
• Consistent consumption of vegetables.
• Smoking. Although, this is not to be encouraged as it increases the risk of cancers which are far more deadly compared to fibroids which are not cancerous.

Risk Factors

Below are some factors that can put one at a risk of developing fibroids:

• Family history.  Risk increases by 2-3times normal population
• Obesity
• Consumption of red meat
• People of African decent
• Long interval between child birth
• Hypertension. Risk related to degree and duration of hypertension.
• Pelvic inflammatory disease. Repeated occurrences increase the risk further.

Symptoms of Fibroids

• Asymptomatic. Fibroids may be found incidentally when a client goes to hospital for an unrelated illness.
• Abnormal vaginal bleeding. Menorrhagia is the commonest presentation.
• Dizziness/collapse. Resulting from anaemia as a result of excessive bleeding.
• Abdominal pain which may result from infection of the fibroid, torsion (when the fibroid twists on its pedicle) or from degenerative changes.
• Abdominal distension
• Infertility/subfertility
• Low back pain
• Constipation especially when it compresses on the rectum.

Fibroid in Pregnancy

The effect of fibroid on pregnancy is dependent on the location of the fibroid. The submucous type of fibroid is usually the most common culprit.

It may result in the following:

• Miscarriage(s)
• Premature rupture of membranes
• Preterm labour
• Intra-uterine growth restriction
• Placental abruption
• Malpresentation
• Obstructed labour
• Caesarean section & caesarean hysterectomy
• Post-partum haemorrhage

Complications

In addition to complications resulting during pregnancy, other complications include:

• Anaemia
• Cancer. The risk of this happening is about 0.1%, majority of these are symptomatic. Rapid growths of the fibroid and post-menopausal enlargement are warning signs of this kind of transformation.

READ: Why you should go for Cervical Cancer Screening

Investigations for Fibroid

To identify its location, number and size, various modalities are employed. The choice of which depends on whether the patient is pregnant or not. They include:

• Ultrasound. The cheapest and widely available modality.
• Hysterosalpingography (HSG)
• Magnetic Resonance Imaging (MRI)
• Laparoscopy
• Hysteroscopy

Other investigations (i.e., blood tests) that may be ordered would depend on the effects of the fibroid on the person and the mode of treatment to be employed.

Treatment Options for Women with Fibroids

With better understanding and advancement in healthcare, the treatment of fibroid has evolved and is dependent on several factors. They include expectant management, medical therapy and surgical treatment.

1. Expectant Management

Expectant management means observing the fibroid and only intervening when there are symptoms. It entails regular evaluation at the hospital (at least at intervals of between 6-12 months) and treatment of symptoms when present. It is employed in patients who are asymptomatic (especially those who are found incidentally) and in patients who decline medical or surgical treatment.

2. Medical Therapy

Fibroids depend on the female reproductive hormones to survive. Medications which alter this have been employed with great success. Also, medications employed in the treatment of cancers have been employed. Medical management is aimed at the following:

• Adjunct to expectant management with alleviation of symptoms
• Improve the haemodynamic status of the client prior to surgery
• Reduce the size and vascularity of the fibroid to facilitate surgery
• An alternative to surgery in peri-menopausal women with high risk factors.
• In order to postpone surgery
  
  3. Surgical Treatment

Where expectant management and medical therapy are unsuccessful, surgery is employed. The commonest symptoms for which surgery is employed include:

• Excessive uterine bleeding
• Pelvic pressure (resulting in obstruction of the urinary tract or constipation) & pain
• Repeated pregnancy loss
• Infertility
• Suspicion of malignant change.

Surgical treatment may be open or laparoscopic depending on the size of the fibroid. Surgical removal of a fibroid is called myomectomy. On rare occasions, a hysterectomy (surgical removal of the uterus) may be employed.

Conclusion

Knowing that fibroid is essentially benign, patients and physicians are in no rush to make therapeutic decisions. There is a wide array of treatment now available including not doing anything. You should not be fooled by so called miracle drugs which are said to cure fibroid. Once you are in doubt about what to do, please Speak a Doctor or visit a hospital close to you to get expert advice on the next steps to take.