Uterine fibroids, also called leiomyomata uteri, are smooth muscle cells of the myemetrium and other connective tissues that grow in and around the wall of the uterus (womb). They grow in various sizes from as small as a maize seed to as large as watermelon.
Fibroids are the most common benign (non cancerous) tumours in women of childbearing age, between 16-50years and affect around 30% of all women by the age of 35 and 20%-80% by age 50.
It is unclear about what causes fibroids and how they are formed, but they appear to be related with high levels of estrogen and are therefore absent before puberty and after menaupause when the woman’s estrogen are at lower levels.
WHO IS AT RISK?
- Women of childbearing age
- Women who are overweight or obese
- Women of African descent
- Women taking estrogen oral contraceptive pills
- Women with family history of fibroid
- Women who are nulliparous (have never given birth)
CLASSIFICATION OF UTERINE FIBROID
Fibroids are classified based on their site or location on the uterus. The types of fibroids are:
- Intramural fibroids: Located within the myometrium (muscle wall of the uterus. This type is usually asymptomatic and can go unnoticed.
- Subserosal fibroids: Located on the outer surface of the wall of the uterus.
- Submucosal fibroids: Located on the inner lining of the uterus (endometrium). Submucosal fibroids are associated with heavy menstrual bleeding and infertility.
- cervical fibroids or polyps: Located on the surface of the neck of the uterus (cervix).
- Pedunculated fibroids: Sometimes subserosal or submucosal fibroids can develop a “pedicle” or stalks which contains blood vessels. If that happens, the fibroid is called pedunculated fibroid.
Most fibroids are usually asymptomatic. Associated symptoms include :
- Heavy and painful menstrual bleeding
- Abdominal discomfort or bloating
- Painful defecation
- Back ache
- Urinary frequency or retention
- Dyspareunia (painful sex)
- History of miscarriage, infertility or preterm labour.
HOW FIBROID IS DIAGNOSED
- History of associated symptoms.
- Abdominopelvic palpation with enlarged, irregularly shaped, firm, non-tender uterus.
- Pelvic ultrasound scan suggestive of uterine fibroid.
- Laparoscopy and hysteroscopy to view the uterus.
- Magnetic Resonance Imaging (MRI) can also be used to locate size and number of fibroids.
Asymptomatic fibroids usually shrink on their own and so do not require any treatment, only close monitoring of the woman. Treatment is recommended only for women who are having symptoms and can be medication or surgery.
- First line treatment with Gonadotropin Releasing Hormone agonist (GnRHa) to reduce estrogen levels. It has high risk of osteoporosis (reduction of bone density).
- Non-estrogen oral contraceptive which help regulate the ovulation cycle can be used to reduce amount of menstrual bleeding.
- Non Steroidal Anti Inflammatory Drugs (NSAIDs) like ibuprofen can be used for reducing fibroid pain.
- Myomectomy Surgery (removal of fibroid from wall of uterus) for women who still wish to have children.
- Hysterectomy Surgery (partial or total removal of the uterus) for extremely large fibroids and women who no longer have childbearing use of their uterus.
- Endometrial Ablation (surgical removal of the inner lining of the uterus) as an alternative for hysterectomy in submucosal fibroids.
- Uterine Artery Embolization (UAE) or Uterine Fibroid Embolization (UFE) to cut off the blood supply to the part of the uterus affected to shrink the fibroid through the guidance of fluoroscopic X-ray imaging.
- MRI-guided percutaneous ablation where the fibroid is located through MRI and fine needles with laser fibre device are inserted through the skin to shrink fibroid.
- MRI-guided focused ultrasound surgery where high energy ultrasound waves are delivered to shrink fibroids located through MRI.
COMPLICATIONS OF FIBROID
- Labour problems in pregnancy (Preterm).
- Menorrhagia (excessive menstrual bleeding).
- Degeneration of the fibroid.
- Torsion of the pedicle in pedunculated fibroids.
- cuc.gov : “Common Reproductive Health Concerns for Wonen” (Accessed 15/01/2018).
- Medicalnewstoday.com : “Fibroids” (Accessed 15/01/2018).
- D. M. Hart et al, (2000): “Diseases of the Uterus ” Gynaecology Illustrated, 5th edition (pg 213 -216).
- S. Campbell, A. Monga (2006): “Benign Diseases of the Uterus ” Gynaecology by Ten Teachers, 18th edition (pg 103-106).