UTERINE FIBROIDS

What are fibroids?

Uterine fibroids are growths of tissue and muscle cells that develop on the inside of the uterus (womb). They are sometimes known as tumours, but are most likely benign (non-cancerous). The medical name for uterine fibroids is uterine leiomyomata. Fibroids can develop independently or in clusters and can be small or large.

What should women know regarding fibroids?

Uterine fibroids are general non-cancerous tumours that affect women of childbearing age. However, most people do not know much about fibroids and it is not fully understood what causes them. Fibroids can cause symptoms such as frequent urination (this is caused by the fibroids putting stress on the bladder), heavy periods and pain, which may make life more difficult. But a number of women with fibroids never experience symptoms.

Who gets fibroids?

Further research is being carried out to determine causes, but the following risk factors have been identified:

Age - fibroids are most common in women of a childbearing age.
Ethnicity - women of African descent are more liable to develop fibroids and they also tend to develop fibroids at an earlier age.
Being obese or overweight - women who are obese or overweight have a higher risk of developing fibroids.
Giving birth - women who have already given birth are more liable to developing fibroids.

Areas where fibroids grow

Doctors classify fibroids according to where they grow within the uterus. Uterine fibroids can grow in three areas which are outside the uterus, between the uterus muscles and underneath the womb lining. In most cases, fibroids develop within the uterus wall, but it is also possible for fibroids to grow on stalk-like projections called peduncles into the uterus cavity or out of the uterus.

Signs and symptoms of fibroids

Some women who have uterine fibroids do not develop symptoms; however, fibroids can cause:

Heavy menstrual bleeding.
Bleeding between periods.
Pain during sexual intercourse.
Pain in the lower back.
Feeling full in the lower abdomen.
Frequent urination.
Infertility and other reproductive difficulties, such as early labour.

What causes fibroids?

It is not fully understood what causes fibroids and researchers believe that a combination of factors lead to fibroids. These include:

Hormonal factors
Genetic factors
Environmental factors

It is also not known what factors determine the mass of the fibroid and what causes it to shrink or grow. Often, fibroids shrink or stop growing once a woman has gone through the menopause.

Can fibroids become cancerous?

Fibroids are nearly always benign (non-cancerous) and it is very rare for them to turn into cancer as this occurs in less than 1% of cases. If a woman has fibroids this will not increase the risk of them developing uterine cancer (cancer of the womb).

Diagnosing fibroids

In most cases, fibroids are found during routine examinations of the pelvis, with examinations carried out by doctors to check the uterus, vagina and ovaries. If you suffer with fibroids and they are causing symptoms, your doctor may advise you to have tests to determine the size and exact position of the fibroids. These tests may include:

MRI (magnetic resonance imaging) scan
Ultrasound scan
X-rays
CT (computerised tomography) or CAT scan

In addition to tests, diagnostic procedures may be carried out to confirm the presence of fibroids. These include:

Laparoscopy - this involves making a small incision into the abdomen and inserting a laparoscope (a small, thin tube containing a light source) to enable doctors to see inside the uterus. The procedure is carried out under general anaesthetic.
Hysteroscopy - this procedure involves inserting a long, flexible tube inside the vagina and up into the uterus. This enables doctors to check for the presence of fibroids and will also flag up any other problems with the uterus.

Treating fibroids

Your doctor will discuss possible treatment options with you based on your individual health, symptoms, age and the mass and position of the fibroids. They will also take into account whether you are pregnant or not or if you want to conceive in the future. If you have fibroids without any symptoms it may be possible to go without treatment. However, your doctor will monitor your condition closely to check if the fibroids have grown.

Types of treatment

Medication

If you have developed fibroids and only suffer from mild pain, your doctor may prescribe painkillers. If the pain gets worse they may prescribe a more effective painkiller and consider other treatment options.

Other types of medication used to address fibroids include gonadotropin-releasing hormone agonists (GnRHa). This drug is intended to reduce the mass of fibroids and can be used prior to surgery to make the procedure to remove the fibroids more straightforward. Possible side-effects of GnRHa include:

Joint pain
Decreased sex drive
Depression
Hot flushes
Difficulty sleeping

Anti-hormonal drugs such as Mifepristone can also impede the development of fibroids, but they only provide temporary relief and symptoms often return once therapy stops.

Surgery

If you have developed fibroids and suffer from mild or severe signs, surgery could be the best option. Surgical options include:

Myomectomy - this surgical procedure involves removing fibroids without taking away any of the healthy uterine tissue. There are various methods a surgeon can use to carry out the procedure and it can be either minor or major surgery. The form of surgery will depend on the mass and position of the fibroids.
Hysterectomy - this procedure involves removing the uterus and will only be carried out when a woman has severe symptoms and has already had children or doesn’t want children in later life. A hysterectomy is the only way to completely cure fibroids. There are different types of hysterectomy and your doctor will discuss the options with you.
Endometrial ablation - this procedure involves destroying the uterus lining and is used to control heavy bleeding. The procedure is very successful, but it prevents women from having children later in life.
Myolysis - this procedure involves inserting an electrical needle through a tiny incision made in the abdomen into the uterus and the needle is then used to remove the blood vessels that feed the fibroids.

Uterine fibroid embolisation (UFE)

Uterine fibroid embolisation (UFE) is a form of treatment that prevents the blood flowing to the uterus, which causes fibroids to shrink in size. UFE is an alternative to procedures such as a hysterectomy or myomectomy. The recuperation time is shorter and the chance of requiring a blood transfusion after treatment is also much lower. There can also be a diminutive chance of infection, but this can usually be managed very effectively with antibiotics, and recent studies show that the risk of re-growth is lower following UFE treatment.

UFE is not a suitable treatment for all cases of fibroids and patients must first have tests, including MRI scans or an ultrasound, to ensure the fibroids will react to UFE treatment. The most suitable patients for UFE treatment are:

Women who have fibroid tumours that causes heavy bleeding.
Women who experience pain as a result of a tumour that presses on the bladder.
Women who aren’t interested in having a hysterectomy.
Women who do not want to have any more children.

In rare cases, the particles used to cut the blood to the uterus can spread to the ovaries, causing them to stop working temporarily, or in very rare cases, this can be permanent. Your doctor will explain all the potential risks of treatment before you agree to go ahead and have UFE treatment.

ExAblate 2000 system

ExAblate 2000 is a treatment that deploys magnetic resonance image-guided ultrasound to destroy uterine fibroids and is designed for women who have already had children and do not aim to have any more in the future. ExAblate is a non-invasive procedure and offers an alternative to surgical procedures and medication. ExAblate combines two treatment methods; imaging to locate the fibroids and check the heat of the fibroid tissue, and an ultrasound beam that uses high-energy sound waves to destroy the fibroids.