Fibroids: What to know about these common growths

If you’ve got bloating, longer- or heavier-than-usual periods or you’re having trouble getting pregnant, you could be experiencing the symptoms of fibroids. Here, gynaecologists tell us more about these super-common growths, and when treatment for fibroids might be necessary.

What are uterine fibroids – and are they dangerous?

Uterine fibroids are tumours that grow from muscle tissue in the uterus (womb). They can grow on the outer surface of the uterus, within the uterine muscle wall or within the uterine cavity.

Luckily, these growths are almost always non-cancerous. Many cases don’t even require treatment, explains DR ANUPRIYA AGARWAL – senior consultant obstetrician and gynaecologist, fertility specialist and advanced laparoscopy surgeon at Parkway hospitals.

But, while the growths themselves are benign, they can affect a woman’s periods and pregnancy in some cases. Depending on their size and location, these fibroids can impact the shape and lining of the uterus. This can increase the risk of period problems and pregnancy complications such as miscarriage.

Who gets fibroids and why?

Though fibroids can occur at any age, they are most commonly found in women in the reproductive age group between the ages of 30 and 50. The incidence increases with increasing age, says Dr Anu.

And, while the exact cause of uterine fibroids is unknown, hormones like oestrogen and progesterone are thought to encourage their growth. This explains why fibroids typically start to shrink once a women reaches menopause.

A woman has higher chances of developing fibroids if she:

• Is older (older women are at higher risk of developing fibroids compared to younger women);
• has a family history of uterine fibroids;
• is obese with a high body mass index;
• experienced the onset of menstruation at a young age; or
• has no history of pregnancy

What are the symptoms of fibroids?

Some women with fibroids don’t experience any symptoms at all. Their fibroids are only discovered during incidental pelvic exams or ultrasounds.

Many women, however, do experience symptoms. A woman’s symptoms can depend on the number of fibroids she has, and their location and size, says DR NG KAI LYN, consultant obstetrician and gynaecologist, urogynaecologist and advanced laparoscopic surgeon at Parkway Hospitals. Some of the most common symptoms of fibroids include:

• menstrual changes such as heavy periods, long periods, painful periods or bleeding in between periods;
• abdominal bloating;
• lower back pain – often accompanied by bloating;
• anemia (low blood count);
• difficulty passing urine, incomplete emptying of the bladder or constipation; and
• trouble getting pregnant or pregnancy complications

When is treatment necessary?

For a proper diagnosis, you’ll need to visit your gynaecologist for a check and a pelvic ultrasound scan.

Fibroids that are small and do not cause any symptoms can usually be monitored, say Dr Anu and Dr Ng. However, if you have fibroids symptoms that interfere with your quality of life, getting treatment would certainly help.

If you’re struggling with heavy menstrual bleeding due to fibroids, your gynaecologist may recommend non-hormonal or hormonal medication to regulate your menstrual cycle and reduce this bleeding and pain. These medications provide symptomatic relief but do not shrink or remove fibroids.

Surgical treatment for fibroids

There are various surgical procedures to treat fibroids. The type of surgery to go with really depends on the location of the fibroids, and whether or not a woman plans on getting pregnant in the future. Some of the most common surgical treatment approaches include:

If a woman plans on getting pregnant in the future…

She may want to consider a myomectomy, says Dr Anu, a fertility specialist. It’s a surgical procedure that removes the fibroids but preserves the uterus. Depending on the size of fibroids, this type of procedure can be done laparoscopically (key-hole) or as traditional open surgery. However, with this method comes the risk of fibroids developing again down the line. So, it may not be a permanent solution for every woman.

If a woman does not plan on getting pregnant in the future…

A hysterectomy may be the appropriate fibroids treatment route, says Dr Ng. This method permanently removes the fibroids, as well as the uterus. Depending on the size of the uterus, this method can be done laparoscopically or as open surgery. If the ovaries are normal, they do not need to be removed.

Following a hysterectomy, a woman will not have any more periods and will not be able to get pregnant. However, as long as her ovaries are retained, she will not be rendered menopausal following the hysterectomy.

Additional treatment options

There are some relatively new procedures that are less invasive compared to traditional surgery, say Dr Anu.

Uterine Artery Embolization (UAE) is a minimally invasive procedure that involves blocking the blood supply to the fibroids, causing them to shrink. 

High Intensity Focused Ultrasound (HIFU) is another minimally invasive method. It involves using ultrasound to heat and destroy the fibroids. 

While pregnancy may be possible after both of these procedures, there is currently insufficient long-term data on the implications and risks on future pregnancies. There is also a considerable risk of fibroid regrowth down the line. Therefore, these methods are not usually not recommended as first-line treatment options for women who wish to conceive in the future, say Dr Anu.

Advanced Centre for Reproductive Medicine
#05-35 Gleneagles Hospital, Annexe Block, 6A Napier Road
6474 3900 | acrm.com.sg

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