Dr TARIQ JAGNARINE
Fam Medicine, Endocrinology and Diabetes
Uterine fibroids are the most common benign tumour of the female genital tract however; their true prevalence is probably under-estimated. A Recent study have estimated that the lifetime risk of fibroids in a woman over the age of 45 years is more than 70% and 25% in women of reproductive age, with incidence higher in blacks than in whites. It has an incidence of 217-3745 cases per 100 000 women/years and prevalence 4.5-68.6%.
Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these growths (tumours) become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous.
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role including the following:
• Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• Ethnic origin. African-American women are more likely to develop fibroids than white women.
• Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
• Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
• Hormones: oestrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.
• Family history: Having a family member with fibroids increases the risk of fibroids. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
• Pregnancy: Pregnancy increases the production of oestrogen and progesterone in the body resulting in rapid growth of this tumour.
TYPES OF FIBROIDS
The type of fibroid a woman develops depends on its location in or on the uterus.
• Intramural fibroids: Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch the uterus.
• Submucosal: fibroids grow into the uterine cavity. Submucosal tumours are not as common as the other types.
• Subserosal fibroids: Subserosal fibroids form on the outside of the uterus, which is called the serosa. They may grow large enough to make the uterus appear bigger on one side.
• Pedunculated fibroids: Subserosal tumours can develop a stem, a slender base that supports the tumour. They might look like mushrooms or a pendulum.
SYMPTOMS OF FIBROIDS
The symptoms experience will depend on the number of tumours present as well as their location and size. For instance, submucosal fibroids may cause heavy menstrual bleeding and trouble conceiving.
Symptoms of fibroids may include:
• Heavy bleeding between or during your periods that includes blood clots
• Pain in the pelvis or lower back
• Increased menstrual cramping
• Increased urination
• Pain during intercourse
• Menstruation that lasts longer than usual
• Pressure or fullness in the lower abdomen
• Swelling or enlargement of the abdomen
• Complications during pregnancy and labour, including a six-time greater risk of caesarean section.
• Reproductive problems, such as infertility, which is very rare
If the tumour is very small or the woman is going through menopause, they may not have any symptoms. Fibroids may shrink during and after menopause. This is because women undergoing menopause are experiencing a drop in their levels of oestrogen and progesterone, hormones that stimulate fibroid growth.
DIAGNOSIS OF UTERINE FIBROIDS
For a proper diagnosis, persons would consult a family physician or a gynaecologist to get a thorough history and physical examination including a pelvic exam done. This exam is used to check the condition, size, and shape of the uterus. Other tests are indicated, which include:
• Ultrasound: An ultrasound uses high-frequency sound waves to produce images of the uterus on a screen. This will allow doctors to see its internal structures and any fibroids present. A transvaginal ultrasound, in which the ultrasound wand is inserted into the vagina, may provide clearer pictures since its closer to the uterus during this procedure.
• Pelvic MRI: This in-depth imaging test produces pictures of the uterus, ovaries, and other pelvic organs.
A treatment plan is developed based on a person’s age, the size of the fibroids, and the overall health. A combination of treatments may be applied.
• Medications: Medications to regulate the hormone levels may be prescribed to shrink fibroids. These medications will either cause the oestrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids or stopping the body from producing follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Examples include:
• Other options that can help control bleeding and pain, but won’t shrink or eliminate fibroids, include:
• An intrauterine device (IUD) that releases the hormone progestin
• Over-the-counter (OTC) anti-inflammatory pain relievers, such as ibuprofen
• Birth control pills
• Surgery: Surgery to remove very large or multiple growths may be performed. This is known as a myomectomy. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopically, using a few small incisions into which surgical tools and a camera are inserted. Fibroids might grow back after surgery.
• If person’s condition worsens, or if no other treatments work, hysterectomy is performed. However, this means that they would be unable to bear children in the future.
• Non-invasive or minimally invasive procedures: A newer and completely non-invasive surgical procedure is forced ultrasound surgery (FUS). High-energy, high-frequency sound waves are directed at the fibroids to ablate, or destroy, them.
• Myolysis procedures shrink fibroids using heat sources like an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial ablation involves inserting a special instrument into the uterus to destroy the uterine lining using heat, electric current, hot water, or extreme cold.
• Another non surgical option is uterine artery embolization. In this procedure, small particles are injected into the uterus in order to cut off the fibroids’ blood supply.
HOME REMEDIES AND NATURAL TREATMENTS
Certain home remedies and natural treatments can have a positive effect on fibroids, including:
• Massage therapy
• Applying heat for cramps (avoid heat if experiencing heavy bleeding)
• Dietary changes can help as well. Avoid meats and high-calorie foods. Instead, opt for foods high in flavonoids, green vegetables, green tea, and fish such as tuna or salmon.
• Managing stress levels can also benefit women with fibroids.
• Weight loss
The prognosis will depend on the size and location of the fibroids. Fibroids may not need treatment if they are small or do not produce symptoms. If pregnant with fibroids, or become pregnant and have fibroids, doctors will need to carefully monitor your condition. In most cases, fibroids do not cause problems during pregnancy.
Uterine fibroids are highly prevalent in reproductive-aged women, and as women continue to delay childbearing, an increasing number of patients will require fertility-preserving treatment options.