Fibroids: What are they?

If you are a woman you must have come across the term fibroids. Fibroids are the most common non-cancerous (benign) tumour of a woman's uterus. Usually found on the wall of the uterus, they may develop within the uterine wall or attach to it, and may grow as a single tumour or as a cluster. Often thought to be made up of 'fibres', they are instead made of smooth muscle tissue.

There are mainly 4 types of fibroids:

• Myometrial: Found in the muscle wall of the uterus
• Sub-mucosal : These are fibroids that are formed just under the surface of the uterine lining
• Sub-serosal: This type of fibroid is formed right under the outside covering of the uterus
• Pendunculated: The unusual shape of this type of fibroid makes it very distinct. It is attached to a long stalk which in turn is attached to the outer or sometimes inner wall of the uterus.

Risk factors:

Fibroids grow fairly slowly, and are formed in response to the hormone oestrogen. They occur naturally, and sometimes shrink after menopause due to the lack of the hormone in the body. They can be absolutely insignificant and cause no symptoms. In some cases fibroids can grow to weigh several kilograms and cause severe side effects.

Here are a few factors that could predispose you to having fibroids:

• Obesity
• Never having given birth to a child (nulliparity)
• Onset of early puberty (menstruation) prior to age 10
• In some cases genetic factors are also known to cause fibroids

Symptoms

Found during a routine examination, they are usually asymptomatic, but as the size increases fibroids can produce symptoms. Here are some you should look out for:

• Irregular or heavy menstruation: In rare cases you may even notice a few clots.
• Frequent urination: Because of the size of the fibroid, the pressure on the bladder increases and causes an urgency to urinate. Rarely this may also lead to the inability to urinate, or constipation.
• Lower abdominal pain: Increase in the size of the abdomen, which you cannot attribute to weight gain.
• Infertility or the inability to get pregnant after trying for a period of one year

Diagnosis:

If you suspect that you have fibroids, your physician will be able to guide you through the process of diagnosis. Here are a few things you could expect during diagnosis. Your doctor will first ask you about the symptoms you have been experiencing then he/she will do a physical examination, in which he/she will look for a palpable mass.

If further diagnosis is required, you doctor may do the following:

• An abdominal or trans-vaginal ultrasound: This is the most common method to diagnose a fibroid. An abdominal ultrasound involves using a probe, to detect the presence of the fibroid. This is done by passing the probe over the abdomen. In a transvaginal ultrasound, the doctor will insert the probe into the vagina to get a better view of the fibroid.
• Endometrial Biopsy: This is done by taking a tissue sample from the uterus. A small instrument is passed into the uterus, through the cervix and a small sample is taken.

Treatment:

The treatment of fibroids depends on the severity of the symptoms and the age of the patient. You physician will recommend a different mode of treatment depending on the type and size of the tumour. The basic types of treatments are:

• Medication to control symptoms: Usually a doctor will prescribe NSAIDs (Non-steroidal anti-inflammatory drugs) to help with severe pain. Another option is to prescribe an intrauterine device. This is very helpful in controlling heavy bleeding.
• Medication aimed at shrinking tumours: To shrink tumors your doctor might prescribe some hormone therapy. There are a number of oral medications that can help without severe side effects.
• Ultrasound fibroid destruction: In this method the doctor will use ultrasound waves to destroy the fibroid.
• Myomectomy or radio frequency ablation: This is the newest advancement in treatment of fibroids. In this technique a small needle is inserted into the fibroid, and the cells of the fibroid are killed using heat.
• Hysterectomy: It is the complete removal of the uterus. This is done in extreme cases where the fibroid has progressed beyond repair. This is the treatment of choice when a woman does not choose to have children.
• Uterine artery embolization: This is an interventional radiological technique. In this method the doctor will reduce the size of the arteries supplying the fibroid, therefore helping in reducing its size and the amount of blood flow.
• Uterine artery ligation: This method is similar to Uterine artery embolization. It aims at reducing the blood flow to the uterus.

Complications:

In certain rare cases fibroids can cause complications. They are:

• Severe bleeding or pain may require emergency surgery to rectify the problem.
• Twisting of the fibroid may cause a blockage in the blood vessels feeding the tumour. This condition can cause a lot of pain, and may require surgery.
• Anaemia (low red blood cell count) is commonly seen because of heavy bleeding.
• In very rare cases the fibroid may show cancerous changes called leiomyosarcoma.

Unexpected bleeding or too much pain during your menses are common indicators that there is a problem. If you do find that you are experiencing anything that feels abnormal, make sure to visit your doctor to rule out the possibilities of fibroids.

Read more about causes, symptoms, diagnosis and treatment of fibroids.

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