REPROSAIT 4 U

UTERINE MYOMA

Fibroids, or myomas, are growths or benign tumours that form inside the uterus (womb). Around four in 10 women over the age of 40 will have fibroids.

No one knows why fibroids develop, but it is suspected that the sex hormones – oestrogen and progesterone – play significant roles. This is because fibroids rarely grow in prepubescent girls and postmenopausal women.

Pre-existing fibroids stop growing, and may even shrink, once a woman passes the menopause.

Fibroids often cause no problems, but may occasionally be associated with infertility, miscarriage and premature labour. Other possible problems include heavy, lengthy and painful periods. Treatment depends on the size, number and location of the fibroids, but may include drugs, procedures performed under local anaesthetic and surgery. Fibroids rarely turn cancerous.

Symptoms

Most women with fibroids have no symptoms. When present, symptoms may include:

1. Heavy periods
2. Lengthy periods
3. Period pain
4. Spotting between periods
5. Painful intercourse
6. A sensation of heaviness or pressure in the back, bowel and bladder
7. Frequent urination
8. A lump or swelling in the lower abdomen.

Different types

Fibroids are categorised by their location, which includes:

• INTRAMURAL – growing in the uterine wall. Intramural fibroids are the most common variety.
• SUBMUCOSAL– growing in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain.
• SUBSEROSAL – growing on the exterior wall of the uterus. These sometimes appear like long stalks.

Common complications

Fibroids can cause a variety of complications, including:

• ANEMIA – excessive menstrual blood loss can cause anaemia, a disorder characterised by the body’s inability to carry sufficient oxygen in the blood. Symptoms of anaemia include breathlessness, fatigue and paleness.
• URINATION PROBLEMS– large fibroids can bulge the uterus against the bladder, causing a sensation of fullness or discomfort and the need to urinate often.
• INFERTILITY – the presence of fibroids can interfere with implantation of the fertilised egg in a number of ways. For example, the egg may try to burrow into a fibroid, or fibroids close to the uterine cavity may ‘prop open’ the uterus, making successful implantation difficult.
• MISCARRIAGE and PREMATURE DELIVERY – fibroids can reduce blood flow to the placenta or may compete for space with the developing baby.

Diagnosis

Uterine fibroid (right lateral wall)
Nine (9) weeks and 4 days gestation

Fibroids can be detected using an ULTRASOUND , where sound waves create a two-dimensional picture.

The inside of the uterus can be examined with a HYSTEROSCOPE , which is a thin tube passed through the cervix (neck of the womb). A small camera may be placed at the tip of the hysteroscope, so that the interior of the uterus can be viewed on a monitor.

Treatment

Treatment depends on the location, size and number of the fibroids, but may include:

• MONITORING – if the fibroids are causing no symptoms and are not large, a ‘wait and see’ approach is usually adopted.
• DRUGS– such as hormones, used in combination to shrink the fibroids prior to surgery.
• ARTERIAL EMBOLISATION – under local anaesthetic, a fine tube is passed via an artery in the arm or leg into the main artery supplying the fibroid with blood. The whole process is monitored by x-ray. Fine particles (like sand) are then injected into the artery to block the blood supply to the fibroid. The fibroid slowly dies and symptoms should settle over a few months.
• HYSTEROSCOPY – the fibroids are removed via the cervix, using a hysteroscope.
• LAPAROSCOPY – or ‘keyhole surgery’, where a thin tube is inserted through the abdomen to remove the fibroids.
• OPEN SURGERY– larger fibroids need to be removed via an abdominal incision. This procedure weakens the uterine wall and makes Caesarean sections for subsequent pregnancies more likely.
• HYSTERECTOMY – the surgical removal of some, or all, of the uterus. Pregnancy is no longer possible after a hysterectomy.