The commonest benign tumour in the body
Uterine fibroids are benign (non cancerous) growth that develop on the womb. Fibroids are very common, thought to occur in over 50% in women above 30. They present in various ways and sizes.
Diagnosis of fibroids
1. Symptoms of fibroids – they are many and varied.
Although thought to be extremely common, most women with uterine fibroids are not aware of their presence.
Women come to know they have uterine fibroids when they develop symptoms. Most women with fibroids present with heavy menstrual bleeding. The following are just a few common symptoms.
- Heavy periods which may also be painful
- Swollen or distended abdomen
- Enlarged uterus, found on examination for other reasons.
- Urinary symptoms such as frequency of micturition and incontinence
- Sometimes, pregnancy problems or infertility
- Painful sex
There are many other symptoms
2. Examination – an abdominal and pelvic examination usually clinches it.
Pelvic examination will identify an enlarged uterus also being palpable in the abdomen. Sometimes the uterus with fibroids may be quite large, comparable to a 6 months pregnant woman!
3. Investigations – Including ultrasound scan, MRI and hysteroscopy.
It is during the investigations that uterine fibroids are confirmed.
To confirm the diagnosis of fibroids, an ultrasound scan, and increasingly MRI are performed.
- Trans-vaginal ultrasound scan is usually combined with an abdominal scan in large fibroids. The scan is a simple test usually performed at the first visit to the clinic to confirm the diagnosis.
- Hysteroscopy, a painless procedure to inspect the inside of the womb is vital. This simple office, outpatient test is performed with a tiny 3 mm camera to see whether fibroids are protruding into the cavity of the womb. Presence of any fibroids into the cavity of the womb, endometrial fibroid polyp, would explain many of the symptoms women present with, particularly very heavy periods. Hysteroscopy also provides an opportunity to assess the state of the endometrium, to see if there are other potential problems including cancer.
- For a more detailed study, an MRI is advisable. This investigation may help identify the type of fibroids that a woman has. This has a bearing on planning treatment.
- Pelvic ultrasound and MRI are important to rule out other uterine and ovarian diseases particularly to exclude ovarian cysts, endometriosis and adenomyosis. Ovarian cysts are also extremely common but fortunately are transient.
Planning treatment of fibroids is straight forward, but depends on the presenting symptoms.
- When a woman with heavy periods is found to have fibroids, treatment depends on where the fibroids are. If any are in the cavity of the womb, endometrial fibroids or polyps, they can be removed by a procedure called trans-cervical resection of fibroids.
- This procedure is extremely effective but demands high level of skill. Recently, a simpler technique called morcellation has been introduced.
- Women suffering from heavy menstrual bleeding and fibroids but normal endometrial cavity can benefit from a simple yet effective treatment method called endometrial ablation. This form of treatment destroys the endometrial lining, reduces or stops periods but renders the woman totally infertile.
- If the fibroids are within the wall of the womb, otherwise known as intramural fibroids, they can treated by surgery. This major surgery, known as myomectomy involves opening the abdomen to remove the fibroids.
- An alternative to major open or keyhole myomectomy surgery is uterine artery embolisation. This form of treatment cuts off the blood supply to the womb. By reducing the blood supply, fibroids are starved of their nutritional needs and wither! They shrink in size by up to 50% in about half the cases. A major operation can be avoided this way.
- Hysterectomy may be the only or desirable option if all treatment options have been tried and have failed. Abdominal hysterectomy is the preferred option if the fibroids are very large and other treatment options such as uterine artery embolisation are unlikely to work. Occasionally cancer, which is found in less than 1% of fibroids is suspected.
Medical treatment is being mentioned for completeness but is not usually a long term solution.
Are you suffering with heavy periods, pain and think may have fibroids?
Pick up the phone and arrange an appointment. We’ll be happy to resolve your problems as quickly as is practicable.
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