Uterine fibroids and you

Uterine fibroids are not cancerous growths of the uterus and they often appear during childbearing years. They are not associated with an increased risk of uterine cancer and almost never develop into cancer.

They range in size from super small and undetectable to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones.

Many women have uterine fibroids sometime during their lives. But most don’t know they have uterine fibroids because they often cause no symptoms.

If you have any of the following symptoms, see a doctor:

• Pelvic pain that doesn’t go away.
• Overly heavy, prolonged or painful periods.
• Spotting or bleeding between periods.
• Difficulty emptying your bladder.

Symptoms

Many women who have fibroids don’t have any symptoms. In women who have symptoms, the most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding.
• Menstrual periods lasting more than a week.
• Pelvic pressure or pain.
• Frequent urination.
• Difficulty emptying the bladder.
• Constipation.
• Backache or leg pains.

Rarely, a fibroid can cause acute pain when it outgrows its blood supply and begins to die.

Causes

Although not certain, these are the suspected ones:

• Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
• Hormones. Oestrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more oestrogen and progesterone receptors than normal uterine muscle cells. Fibroids tend to shrink after menopause due to a decrease in hormone production.
• Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Complications

Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications, such as anaemia from heavy blood loss. They don’t usually interfere with getting pregnant but, if large, could cause infertility or pregnancy loss. They may also raise the risk of certain pregnancy complications, such as placental abruption, foetal growth restriction and pre-term delivery.

Diagnosis

Uterine fibroids are frequently found incidentally during a routine pelvic examination. If suspected from clinical presentation,
the doctor may order these tests:

• Ultrasound;
• Lab tests – a full blood count (FBC) will determine if you have anaemia because of chronic blood loss.
• Magnetic resonance imaging (MRI) – this imaging test can show the size and location of fibroids.
• Hysterosalpingography uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images.
• Hysteroscopy: the doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus.

Treatment

Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option. Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. Medications include:

• Gonadotropin-releasing hormone (Gn-RH) agonists. These treat fibroids by blocking the production of oestrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anaemia often improves.
•  Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn’t shrink fibroids or make them disappear. It also prevents pregnancy.
• Tranexamic acid. This nonhormonal medication is taken to ease heavy menstrual periods. It’s taken only on heavy bleeding days.
• Oral contraceptives. Oral contraceptives or progestins can help control menstrual bleeding, but they don’t reduce fibroid size.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). May be effective in relieving pain related to fibroids, but they don’t reduce bleeding caused by fibroids.

Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

• Uterine artery embolisation. Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die.
• Myolysis. In this laparoscopic procedure, radiofrequency energy, an electric current or laser, destroys the fibroids and shrinks the blood vessels that feed them.
• Laparoscopic or robotic myomectomy. In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place. If the fibroids are few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus.
• Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.
• Endometrial ablation. This treatment, performed with a specialised instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow.
• Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids. Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead. However, scarring after surgery can affect future fertility.
• Hysterectomy. This surgery, the removal of the uterus, remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. Hysterectomy ends your ability to bear children. If you also elect to have your ovaries removed, the surgery brings on menopause and the question of whether you’ll take hormone replacement therapy. Most women may be able to choose to keep their ovaries.

• Send your questions to Dr Dulcy
• SMS the world HEALTH followed by your question to 32212, or send an e-mail to health@citizen.co.za

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