They’re described as “benign” tumours, yes, and they’re common – but that doesn’t mean they can’t be problematic. Dr Kelly Loi of the Health and Fertility Centre answers some of our questions about fibroids, growths in the wall of the uterus that affect up to 80 percent of women by the age of 50.
What are fibroids and what causes them?
Fibroids are typically non-cancerous tumours that form in the wall of the womb. The exact cause of fibroids is unknown. However, fibroids are linked to high levels of oestrogen, the female reproductive hormone produced by the ovaries. They usually develop during a woman’s reproductive years and tend to get larger with time until she reaches menopause, generally around the age of 50 or 51, after which they tend to shrink.
How would one know one had them?
Many women with fibroids have either no symptoms or only mild ones that hardly bother them. Depending on their size and location, however, fibroids can manifest more serious symptoms: heavy and painful menstruation, for one.
A fibroid that’s pressing on the bowels could cause bloatedness and constipation. Ones that grow on the front wall of the uterus, near the bladder, may bring on the urge to rush to the toilet more frequently, or even cause incontinence. In the case of fibroids that press on the bladder neck and cause urinary retention – that is, an inability to empty the bladder – surgery is needed to remove the fibroid (or even the uterus).
Could fibroids affect a woman’s fertility?
Absolutely. Large fibroids can sometimes prevent a fertilised egg from attaching itself to the lining of the womb, and this may cause miscarriage.
In other cases, the fibroid may be “submucosal”, meaning that it grows into the cavity of the womb. If it is blocking a fallopian tube or the entrance to the uterus, it will make it harder for eggs and sperm to meet.
For a number of my patients who experienced difficulty getting pregnant, an ultrasound scan showed the presence of such fibroids. The good news is that pregnancy may be achieved soon after the surgical removal of these fibroids.
Can fibroids cause complications during pregnancy?
Yes, they can. They may increase in size, which could impair the growth of the baby and also cause problems during labour and delivery. In some cases, a Caesarean section may be required. Fibroids can also cause pain to the pregnant woman. The pain can be so severe as to require hospitalisation for bed rest and pain relief.
What are the options for treatment?
The conservative treatment approach involves observation of the fibroids with repeat ultrasound scans every few months to ensure that they remain stable in size. (Ones that are large or grow rapidly are at risk of undergoing cancerous change.)
Medical treatment usually involves medication such as nonsteroidal anti- inflammatory drugs (NSAIDs) to lighten menstrual flow and ease pain. Iron supplements can be taken to treat any anaemia that may have been caused by heavy menstruation.
Though there is no oral medication that can remove fibroids, hormonal injections (which act to induce an articifical state of menopause) can help to reduce the size of the fibroids. However, they’re not usually given on a long- term basis because of potential side effects such as bone loss, which accelerates with the onset of menopause.
Sometimes, surgery may be the best option, especially where medical treatment is not working.
Tell us about the surgical options.
We can perform surgery to remove the fibroids and conserve the uterus – that’s the best option for a woman who wants to retain her fertility. However, as there is a risk of fibroids recurring over time, and more so in cases where fertility is not an issue, we can consider hysterectomy – that is, removing the entire uterus along with the fibroids.
When performing a hysterectomy, would you recommend removing the ovaries at the same time?
That depends on the woman’s age and other risk factors. Although some studies show that the ovaries may continue to be useful even after menopause, it’s still debatable, and for gynaecological purposes we regard menopause as the point where the ovaries stop working. So, for a menopausal woman undergoing hysterectiomy, we would offer the option of simultaneously removing the ovaries, too.
In the case of a younger (pre-menopausal) woman, we would advise her to keep her ovaries so as to benefit from ovarian function until menopause. But if she has a strong family history of cancer, or an ultrasound scan shows any signs of cysts, we would advise her to have her ovaries removed at the same time as her uterus. This would help her to avoid further surgery down the line.
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This story first appeared in Expat Living’s August 2015 issue.