UTERINE FIBROIDS – Every woman’s worry

To understand fibroids, one needs to know a few facts about tumours. A tumour is a swelling of a part of the body. It is caused by an abnormal growth of body tissue, the material out of which body organs are made. In general a tumour does not cause or lead to any inflammation (soreness, sensitivity or pain) and can exist and grow in size without being detected. Tumours are either benign, that is they are not harmful, or are malignant, that is they are harmful or tend to invade normal tissue and recur after treatment. Malignant tumours are cancerous; they cause cancer- a condition in which the affected body cells have uncontrolled division and destroy the affected body part.

The word fibroid is derived from the word fibre-a thread-like object from which animal tissue is formed. A fibroid is a benign growth on the uterus.

Uterine fibroids are composed of muscle tissue from the uterus and threadlike fibres of connective tissue.

In some cases a fibroid may occur in the cervix-the lower opening (neck) of the uterus which leads to the vagina. This is called a cervical fibroid.

A uterine fibroid develops within or attaches itself to the wall of the uterus. It can be as small as the head of a pin, a pea or as large as a grape fruit and in some cases a basketball. It usually appears as a round, semi-round or oval swelling resembling the shape of an egg. A fibroid can occur either as a single swelling or several in a cluster (many swellings occurring close together).

What are the various types?
Uterine fibroids are classified into types based on their location. These categories (illustrated on the opposite page) are:

Submucous fibroids – They grow inward from the uterine wall.

Subserous fibroids – They develop outward from the wall of the uterus into the abdominal cavity.

Intramural fibroids -They grow inside the wall of the uterus. They are the most common type of uterine fibroids.

Pedunculated fibroids – They do not lie within or on the surface of the uterus, but are attached to it by a slim stalk.

Uterine fibroids mayor may not exhibit symptoms. Those without symptoms can be managed conservatively or left alone while those with symptoms have to be managed actively.

What causes uterine fibroids?
The cause of uterine fibroids is not known and they have no known prevention. A uterine fibroid originates as a single muscle cell, which later converts into a fibroid tumour cell that develops,
grows and multiplies.

Cases of women getting fibroids were relatively uncommon several years ago and it is uncertain what factors may have led to the increased prevalence. It is possible that they still occurred but went undiagnosed. Medical advancements in diagnostic techniques and radiology, for instance the use of ultrasound scans, may partly explain the increase in the number of cases.

Female reproductive hormones may have stimulating effects. Fibroids do not develop before puberty or after menopause. After menopause the level of female reproductive hormones declines and any existing uterine fibroids shrink.

What is the probability of having fibroids?
Studies have shown that uterine fibroids occur in 50 to 80 percent of women over 35 years old, although some women in their 20s have also experienced them. Uterine fibroids occur only in one to two per cent of pregnant women. Uterine fibroids are more common in black women than in other races.

Who is at risk of getting fibroids?
Any woman of reproductive age between 15 and 49 years is at risk, but fibroids are more common in women in their 30s and 40s. Fibroids tend to recur after removal within this age bracket.

How would I know I have fibroids?
The surest way to find out if you have uterine fibroids is to be examined medically. Women should strive to have a medical check-up at least once annually. Most times fibroids are diagnosed
during a routine abdominal examination. The doctor examines you internally to feel the size of your uterus and positioning of the ovaries and fallopian tubes. If the uterus feels more enlarged than usual the doctor may suspect fibroids. A common investigative procedure for fibroids is an ultrasound scan, which is a harmless procedure (does not have any X-rays) in which the internal organs are shown on a television screen. It is conducted in 15 to 30 minutes and is safe for pregnant women.

Magnetic resonance imaging (MRI) is another test that creates a picture of the internal organs. It is conducted in 30 to 45 minutes and is safe for pregnant women. It gives more detailed imagery of the fibroids and other organs that may be difficult to visualise in an ultrasound scan such as the ovaries. Like the ultrasound scan, it does not use X-rays. However, it is much more expensive than an ultrasound scan and is therefore not a routine test.

In rare cases a doctor may request a computerised tomography (or CT) scan of the pelvis if MRI is not available. CT scan uses X-rays and is not safe for a pregnant woman.

Do fibroids have symptoms?
The following symptoms may indicate you have fibroids. There may be other reasons for these symptoms so do not conclude you have fibroids until you are examined by a doctor.

o Lower abdominal pain in the pelvis area may occur due to pressure of large fibroids on other internal organs. In some cases a fibroid may degenerate or die due to lack of sufficient blood flow, and cause pain. The stalk of a pedunculated fibroid may also twist and prohibit blood supply to the fibroid, which also causes pain.
o Heavy or prolonged menstrual periods lasting more than seven days may indicate the presence of fibroids. Such bleeding can lead to anaemia (deficiency in red blood cells).
o One may get constipated due to fibroids exerting pressure on the bowels. Likewise if the fibroids lie on the bladder, they exert pressure, which makes the woman feel the urge to urinate frequently.
o In serious cases fibroids may cause kidney problems if they lie on the kidneys and cause pressure on the ureters (the tubes which convey urine from the kidney to the bladder). This is not painful and may go unnoticed for long, during which time kidney infection and damage may occur as a result.
o Miscarriage may indicate the presence of fibroids competing for space with the foetus in the uterus.
o Pain in the back of the legs and during sexual intercourse are also possible indications of fibroids.
o A large tummy, usually creating the impression of a pregnancy or excessive weight gain, may indicate the presence of fibroids. During pregnancy, a tummy that looks larger than expected relative to the age of the pregnancy may indicate uterine fibroids.
o Sometimes inability to conceive may be the result of fibroids blocking one or both fallopian tubes and prohibiting sperm movement, or blocking the implantation of a fertilised egg in the uterus.

What is the treatment?
There are two ways of treating fibroids: surgical and medical.

If the fibroids are not causing any problems one should not bother with them. However, proper follow up is essential. One may be given medicine that makes the fibroids shrink. But this is a temporary measure as it does not eradicate them but makes them shrink for a short period.

Surgical treatment may involve removing the fibroids, a procedure called myomectomy. For women who have completed giving birth or are past child-bearing age, the whole uterus is removed in a process called a hysterectomy.

Can uterine fibroids recur?
Uterine fibroids can still recur after myomectomy. Medication is given to reduce bleeding or make surgical removal easier.

Can uterine fibroids lead to death?
Uterine fibroids are not cancerous and therefore cannot lead to death. In addition, 95 percent of fibroid types are not harmless and cause no problems. The remaining five per cent may cause discomfort and inconvenience through symptoms like pain, heavy menstruation and miscarriage. These complications can lead to death.

Can one get pregnant while having uterine fibroids?
Yes. If small, uterine fibroids may not prevent a pregnancy from occurring. In addition, once fibroids are removed, a woman can be able to carry a foetus as long as there are no other medical
factors and one is ovulating normally. Provided the uterus was not removed, a woman can still conceive upon recovery and carry a pregnancy to term.

PG MAY 07/ 26-27