UTERINE FIBROIDS
In 1994 there is a woman I knew , she is a mother
of 2 children, she has being having the problem of
heavy menstrual periods for years, like many other
women in Nigeria. She has been diagnosed and
confirmed to have a large womb with multiple
fibroids in different locations and of varying sizes.
This particular month, the menstrual period came
and refuse to stop, she bled heavily for days and
fainted [she almost died, many other women have
died from excessive bleeding], her husband and
neighbours had to quickly rush her to the nearest
hospital, the doctor did all he could to stop the
bleeding and revive the woman, all failed , the last
resort was to remove the entire womb
[hysterectomy]
so as to save the woman’s life.
The entire womb was removed and the woman
survived till this day, but she could no more have
any other child.
Fibroids are common, benign growths of womb
(uterine) muscle. They are present in around 1/4
of white women and 1/2 black women. They are
most common toward the end of the reproductive
years. They exist sometimes singly, but most often
are multiple and range in size from microscopic to
filling the whole of the lower abdomen! They are
more common in obese women and those who
have no children, there probably is some genetic
determinant and they are less common in
smokers.
Most fibroids do not cause symptoms, but overall
symptomatic fibroids account for about one third
of all hysterectomy operations.
Fibroids are named according to where they are
found in your womb.
Intramural fibroids grow within the muscular
wall of the womb.
Subserous fibroids grow from the outside wall of
the womb into the pelvic cavity. They can become
very large.
Submucous fibroids grow from the inner wall of
the womb into the space inside the womb.
Pedunculated fibroids grow from the outside of
your womb. These fibroids are almost free of the
wall of your womb and are only attached by a
narrow stalk.
Fibroids range from the size of a pinhead to up to
20cm across.
Fibroid growth is very slow and can be stimulated
by hormones, especially oestrogen. A hormone is a
chemical found naturally in your body. Fibroids
tend to become smaller and reduce in number
when oestrogen levels fall, such as after the
menopause.
CAUSES
The reason why women get fibroids isn’t known.
Although oestrogen seems to make the fibroids
grow, it is not thought to be responsible for their
initial development.
You are more likely to get fibroids if you:
[1]are in your 30s or 40s
[2]are overweight
[3]are African-Caribbean – African-Caribbean
women are three times more likely than white
women to get fibroids
[4]have no children or had your last child at a
young age
[5]have a family history of fibroids
SYMPTOMS
Symptoms relate to the location of the fibroids and
its size. Important symptoms include abnormal
gynaecologic haemorrhage[bleeding], heavy or/and
painful periods, abdominal discomfort or bloating,
back ache, urinary frequency or retention, and in
some cases infertility. There may also be pain
during intercourse depending on the location of
the fibroids.
During pregnancy they maybe the cause of
miscarriage, bleeding, premature labour, or
interfere with the position of the fetus.
Fibroids don’t usually cause symptoms. However,
you may get one or more of the symptoms listed
below, often depending on where the fibroid is
within your womb.
Heavy periods, sometimes leading to anaemia, can
occur in up to a third of all women with fibroids.
Large fibroids can lead you to feeling some pain in
your tummy (abdomen).
If the fibroid(s) is pressing on your bladder, you
may need to pass urine more often than normal.
If the fibroid(s) is pressing on your rectum, it can
cause constipation.
You can get severe pain if a fibroid growing on a
stalk twists or if a fibroid outgrows its blood
supply causing it to break down, but this is rare.
DIAGNOSIS
Fibroids are often diagnosed and discovered on
pelvic examination, where the uterus feels larger
than expected with hard round lumps felt arising
from the surface. Ultrasound scan can tell where
the fibroids are located and give an idea of their
size. Sometimes they are detected on laparoscopy
(looking into the abdomen with a small telescope)
or hysteroscopy (looking into the uterus with a fine
telescope). Hysteroscopy is particularly useful for
seeing the submucous fibroids and assessing how
much of the uterine cavity is involved.
COMPLICATIONS
FIBROIDS AND PREGNANCY
Most women with fibroids have a normal
pregnancy and delivery. In around two-thirds of
women, the fibroids stay at a constant size or
shrink.
Submucosal fibroids can affect the shape and
internal environment of the womb, which can
make it more difficult to become pregnant.
Problems such as miscarriage, premature labour
and bleeding can happen, but they are rare.
If you are pregnant and have fibroids, you should
consider seeking specialist pregnancy care from an
obstetrician (a doctor specialising in pregnancy
and childbirth).
FIBROIDS AND CANCER
Fibroids very rarely become cancerous.
TREATMENTS FOR FIBROID
If you don’t have any symptoms, or if they are only
mild, you don’t need treatment.
If you are getting symptoms, there is a range of
treatments available. Your doctor will explain
which is most suitable for you.
[1] Medicines
There are no known confirmed medicine that cures
fibroids. However, hormone-based treatments can
help relieve the symptoms.
Treatment with gonadotrophin releasing hormone
analogues (GnRH analogues) can lower your
oestrogen level. This usually shrinks the fibroids.
GnRH analogues such as goserelin (eg Zoladex) or
leuprolin acetate (eg Prostap SR) are often
prescribed for three to four months before surgery
to make it easier to remove fibroids.
GnRH analogues can cause side-effects such as
hot flushes and, long-term, osteoporosis (thinning
of the bones). Therefore, you can only take GnRH
analogues for a maximum of six months. Taking
progestogen hormone replacement therapy or
tibolone (Livial) at the same time reduces the
chances that you will get side-effects.
[2]Non-surgical treatments
[a]
Uterine Artery Embolisation (UAE)
This treatment blocks the blood supply to a
fibroid, causing it to shrink. It’s performed under a
local anaesthetic, meaning that the feeling in the
area will be completely blocked but you will stay
awake during the operation.
UAE gives relief from symptoms such as bleeding
and pain for at least two-thirds of women treated.
Side-effects and complications with UAE are lower
than with open surgery.
The National Institute for Health and Clinical
Excellence (NICE) states that UAE is a relatively
new treatment with uncertain long-term results. If
you are considering UAE, please talk to your
gynaecologist (a doctor specialising in identifying
and treating conditions of the female organs).
[b]
Endometrial ablation
An endometrial ablation is a procedure to remove
the lining of your womb or an individual fibroid
using laser energy or ultrasound. You can still get
pregnant after an endometrial ablation.
[c]
Magnetic Resonance Guided Focused
Ultrasound [HIFU]
HIFU (high intensity focused ultrasound) is a
highly precise procedure using high intensity,
focused ultrasound to heat and destroy diseased
fibroid tissues.
Surgery
There are a number of surgical options including
those outlined below.
A myomectomy is an operation to remove fibroids
leaving the womb in place. It may be done through
cuts in the tummy or through your vagina using
keyhole surgery. A myomectomy is usually only
offered to women who prefer the option to become
pregnant in the future.
A hysterectomy is a major operation to remove
the entire womb, usually via a “bikini-line” cut in
the tummy or, if the fibroids are not too large, via
the vagina. It’s not possible to get pregnant after a
hysterectomy.
Sometimes it’s possible for these operations to be
performed by keyhole surgery.
JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria, offer comprehensive infertility screening tests for both couples like Transvaginal Scan for uterine and ovarian functions,Ovulation/follicular tracking, HSG to evaluate the fallopian tubes, blood tests for hormone check, semen analysis etc. We also offer a simple assisted reproductive procedure like INTRAUTERINE INSEMINATION [IUI].
For accurate assessment of your fertility situation, contact us at JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria.
For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests Contact
JOAS MEDICAL DIAGNOSTIX
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We are located at
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Postcode: 100265
Nigeria.
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