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Uterine fibroids are benign (not cancerous) growths that develop in the muscle of the uterus. They can occur in about 20% of all women. Some will remain small and not cause any symptoms but others may grow much larger and because of their location, number and size, may cause some difficulties.
They may be positioned along the lining of the uterus (endometrium), in the muscle of the uterus (myometrium) or on the outside of the uterus (subserosal). Their size may vary from very small marble-like structures to very large ones. When they grow they can distort the lining of the uterus and the endometrial cavity.
The most common age group is between 30 and 40 years of age but they can occur at any stage of life. No known cause is apparent at this stage although Oestrogen seems to increase their size.
Symptoms
Many women will not even know that they have a fibroid at all. However, these symptoms are not necessarily related to the size of the fibroid. Symptoms may include:
- Changes in menstruation
- Heavier bleeding
- Prolonged bleeding
- Bleeding in the middle of the cycle
- Anaemia due to blood loss
- Pain
- Painful periods (dysmenorrhoea)
- Backache and lower abdominal pain due to pressure in the pelvis
- Pain during sex
- Pressure on bowel and bladder
- Constipation and rectal pain with difficult bowel movements
- Frequent or difficulty with urination due the pressure on the bladder
- Infertility
- Miscarriages
Diagnosis
Fibroids can be diagnosed at a routine pelvic examination. Additional tests include
- Ultrasound
- Hysteroscopy, where a tiny camera is inserted into the uterine cavity to look at the endometrium.
- Laparoscopy. This is the device that is inserted into the umbilicus (belly button); a good view is then obtained of the pelvis. Fibroids can be seen on the outside of the uterus and some on the inside wall.
- Hysterosalpingogram (HSG). This is an x-ray that will pick up abnormal contours in the lining of the uterus and fallopian tubes.
Treatment
Treatment is ONLY indicated when fibroids cause symptoms such as described above.
Medical treatment
- Includes drugs such as Gonadotrophin Releasing Hormone (GnRH) agonists.
These are used to shrink the fibroids temporarily to control bleeding.
May help control bleeding but will not control the growth of the fibroids.
- Mirena (progesterone containing IUCD).
In some cases, may reduce symptoms.
Surgical treatment
This is an operation to remove only the fibroids from the uterus. The uterus is retained and in many situations, pregnancy and normal bleeding could follow. The myomectomy can be done either hysteroscopically (through the uterus and vagina), or laparoscopically (through the umbilicus). For very large fibroids, a cut into the abdomen (laparotomy) may become necessary.
For very large fibroids and where a woman does not want to retain her uterus, then this may be an option for treatment. |