Fibroids in younger women

Fibroids in younger women


Sunday, August 02, 2015

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PAINFUL and heavy periods, bloating and constipation are common indicators of women with fibroids. However, many young women ignore these symptoms because of a common misconception that fibroids only affect older women.

According to obstetrician-gynaecologist at Gynae Associates, Dr Daryl Daley, uterine fibroids can affect any woman in the reproductive age group, which means that women who are within the sexually reproductive age are at risk of developing fibroids.

He said uterine fibroids are an abnormal proliferation of the uterus. They are referred to as hormone dependent tumours.

"This is because their growth is dependent on the production of oestrogen and progesterone - hormones which maintain and regulate the female reproductive system," Dr Daley said.

But the ObGyn said that while many women may become concerned by the description of fibroids as tumours, they are not usually cancerous.

"These tumours can go unnoticed for many years because they do not have any symptoms in some women," he said.

Dr Daley further explained that symptoms of the fibroids depend on the actual location of the fibroids.

"I equate the uterus to an avocado - the skin can be compared to the serosa of the uterus; the pulp of the avocado can be compared to the myometrium (or muscle of the uterus) and the cavity of the avocado can be compared to the endometrial cavity of the uterus. Fibroids can occur at any level of the uterus and cause different symptoms. Heavy bleeding is usually associated with fibroids in the endometrial cavity."

Symptoms of fibroids include:

1. Heavy bleeding during periods

2. Cramps before and after periods

3. Constipation (usually when fibroids rest on the rectum)

4. Urinary frequency (increase in the desire to pass urine when fibroids compress the bladder)

5. Increased abdominal growth.

He added that it is also associated with infertility.

Moreover, Dr Daley said a medical investigation has to be carried out to determine if a person has fibroids.

"The symptoms that a patient presents with, while they may point into the direction of fibroids, cannot be the basis upon which a diagnosis is made" Dr Daley explained.

"The doctor has to do a physical examination and an ultrasound before there can be a diagnosis."

In relation to treatment options, Dr Daley said patients with uterine fibroids can be exposed to a number of therapies that may inhibit the growth of these tumours in the uterus.

"Definitive treatment is dependent on the patient's age, future fertility desires, the number and the size of the fibroids and the symptoms present," explained Dr Daley.

Treatment can either be surgical or non-surgical.

Traditionally, in the young woman, fertility is an issue and these women are desirous of conceiving in the future. As a result, for large symptomatic fibroids, a myomectomy may be offered. A myomectomy involves removal of the fibroids through an abdominal incision. These fibroids can also be removed laparascopically or robotically through small incisions in the skin with the aid of multiple ports. However, it must be noted that there is a possibility of fibroids to regrow even after myomectomy.

Uterine artery embolization involves the blockage of the uterine arteries which are the main blood supply to the uterus. When this is done, the fibroids gradually decrease in size. It is done by a radiologist and involves the use of a special chemical which is used to block the arteries. This is a good alternative to surgery; however, it is not recommended in women who wish to conceive as there is a potential association with future miscarriages because of the disruption in the blood supply to the uterus.

Hysterectomy involves removal of the entire uterus via an abdominal incision or vaginally; however, this is reserved for older women who have completed their reproductive careers.

Non-surgical treatment involves:

Observation. If the fibroids are small, and the woman has no symptoms, there is a role for observing the patient and not intervening unless symptoms evolve

Medications. Examples include the oral contraceptive pill, contraceptive injection_, tranexamic acid, and mefanamic acid all have different mechanisms of action; however, the overall action is to decrease the blood flow and associated pain that are caused by uterine fibroids. These medications however are not associated with fibroid shrinkage.

Gonadotropin releasing hormone anaologues (gnrh). These are associated with fibroid shrinkage. They act by shutting down the ovarian function and oestrogen levels. These are injections which are given monthly. However, they are associated with menopausal symptoms such as hot flashes, vaginal dryness, mood irritability and loss of libido. They are not recommended to be used for more than six months without the use of supplemental oestrogen. This medication is used as a temporary method until surgery is achieved.

The newest drug made available, Ullipristal Acetate, which is now available in Jamaica, is a selective progesterone receptor modulator. It is a tablet which is taken daily for three months. It blocks the actions of progesterone on the fibroids and results in a substantial decrease in fibroid volume and symptoms without the associated menopausal symptoms. This new drug seems very promising, and can also be used as an aid to shrink large fibroids and optimise the patient for surgery.

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