Uterine Fibroids

Based on their location in the uterus, fibroids can be categorised as:

• Subserosal fibroids grow on the outer surface of the uterus.
• Intramural fibroids grow within the muscular uterine wall.
• Submucosal fibroids grow into the inner cavity of the uterus.
• Pedunculated fibroids grow on a long stalk, either inside or outside the uterine wall.

Symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Pressure in the pelvic region or pain
• Frequent urination if fibroids press on the bladder
• Painful sexual intercourse (dyspareunia)
• Lower back pain
• Constipation

Several factors contribute to the development of uterine fibroids:

• Fibroids are sensitive to hormones, particularly oestrogen and progesterone, which stimulate the growth of the uterine lining. They often shrink after menopause when hormone levels drop.
• Women with a family history of fibroids are more likely to develop them and certain genetic mutations have also linked to fibroid formation.
• Fibroids develop from uterine smooth muscle cells that multiply faster than normal. This growth may be influenced by various growth factors and hormones.
• Lifestyle and environmental factors such as diet, obesity, and exposure to certain chemicals may also play a role in fibroid development.

Usually, doctors diagnose fibroids with a physical examination to check for abnormalities in the uterus and pelvic area. In addition, several tests may also be used:

• Ultrasound uses sound waves to create images of the uterus and helps determine the presence of fibroids and their size and location.
• Magnetic resonance imaging (MRI) provides detailed images of the uterus and can help distinguish between fibroids and other conditions.
• Hysterosalpingography (HSG) is an X-ray-based procedure in which a contrast dye is injected into the uterus to examine its shape and check for fibroids or blockages.
• Hysteroscopic surgery involves inserting a thin, lighted tube through the vagina into the uterus, so the doctor can directly view the inside of the uterus.

The treatment approach of fibroids depends on their size, location, and symptoms and whether you plan to become pregnant in the future. Here are some common treatment options:

• For small fibroids that do not cause notable symptoms, the doctor may recommend watchful waiting.
• Medications such as hormonal therapies (e.g., birth control pills) can help reduce heavy bleeding. Gonadotropin-releasing hormone (GnRH) agonists can temporarily shrink fibroids.
• Minimally invasive procedures such as uterine artery embolisation (UAE) may be performed to block the blood supply to the fibroids causing them to shrink.
• Laparoscopic myomectomy is a minimally invasive surgery used to remove fibroids.
• Traditional fibroid surgery i.e. abdominal myomectomy involves the removal of fibroids through an incision in the abdomen. This is usually recommended for larger fibroids or those present in challenging locations.
• Hysterectomy or removal of the uterus may be necessary, if the fibroids cause significant problems and if a woman does not wish to get pregnant in the future. Laparoscopic hysterectomy is a minimally invasive surgery.

See a doctor if:

• You experience heavy or prolonged menstrual bleeding that disrupts your daily life.
• You experience severe pelvic pain or discomfort.
• You experience changes in your menstrual cycle or bleeding patterns.
• You exhibit symptoms of anaemia, such as fatigue or weakness, due to heavy bleeding.
• You observe any concerning changes in bladder or bowel habits.

Currently, there are no guaranteed ways to prevent fibroids. However, maintaining a healthy lifestyle, such as managing weight, following a balanced diet rich in fruits and vegetables, limiting alcohol intake, and exercising regularly may help lower the risk of developing fibroids or reduce their growth.

Women with symptoms suggestive of fibroids should consult a gynaecologist, who specialises in female reproductive health. In some cases, referral to a reproductive endocrinologist (for fertility concerns) or an interventional radiologist (for procedures like UAE) may also be appropriate.