Fibroid awareness

FIBROIDS are a very common women’s health issue and it deserves all our attention because between 60 and 80 per cent of women have them. Fibroids (uterine leiomyomas) are benign tumours that develop in the uterus and can grow inside the inner cavity, within the muscle wall or on the surface of the organ. Women can have multiple fibroids which can vary in size from a small seed to as large as a melon!

Not all women are affected by their fibroids — actually most women won’t even know they have them and even though fibroids aren’t cancerous or life-threatening, they can cause health problems. About a quarter of women will experience heavy menstrual bleeding resulting in anaemia, bleeding between periods, painful periods, pelvic pain and pressure, an increase in the size of the abdomen, urinary frequency and even constipation. Depending on the location and size of the fibroids, they can cause infertility, miscarriages and preterm labour in some women.

Fibroids are usually caused by a genetic predisposition (family history of fibroids) and the risk of fibroids increases with ageing, diets with excess refined carbohydrates, alcohol consumption, obesity, and hormonal changes. Studies show that fibroid growth is affected by the female hormones oestrogen and progesterone and that black women are more susceptible to having numerous larger fibroids compared to non-black women.

A pelvic examination and ultrasound are used to diagnose fibroids. Once diagnosed your doctor will embark on a treatment plan. Intervention may not be necessary if your symptoms are mild or not bothersome to your daily life— in many cases fibroids will shrink and disappear after menopause.

A common misconception is that all fibroids need surgery, which is not true. Management will depend on the woman’s fertility desires, symptoms and the size of the growths. Initially, most doctors will recommend non-surgical options and for women with symptoms that are bothersome, a combination of therapies may be necessary. In mild cases, lifestyle modifications such as dietary changes, exercise and natural herbal remedies may relieve symptoms, while for women who suffer from more problematic symptoms, powerful painkillers and hormonal medications will be needed to control heavy bleeding and pain.

When lifestyle changes and medications do not provide enough symptom relief, non-invasive options such as lasers and ultrasound energy can be focused toward the fibroids to shrink them. Uterine artery embolisation is another method performed by a radiologist which involves blocking the blood vessels that supply the fibroids, thus causing them to shrink.

If non-surgical methods have not improved symptoms or shrunk the fibroids, then surgery is advised. Your doctor may recommend surgery if the fibroids are very large, causing problems of the kidney, bladder or bowel, or if you are suffering from persistent pelvic pain or very heavy bleeding. Surgical intervention is also recommended if fibroids are causing infertility or pregnancy loss.

Surgery can be done using either open techniques, laparoscopy, or robotic assistance. Women who wish to preserve their fertility should opt for a myomectomy which removes only the fibroids, while older women who have completed their families may choose a hysterectomy to remove the uterus.

Fibroids are treatable — women do not need to suffer. There are many available treatment options, and not all fibroids require surgery. If you or anyone you know has fibroids, by all means consult a gynaecologist for support and treatment.

Dr Astrid Batchelor, MBBS, DM (OBGYN), FACOG is an obstetrician/gynaecologist who practices at Gynae Associates Kingston and Portmore.