Uterine fibroids are the most common benign pelvic tumors in women of reproductive age. They affect 20–40% of those women but are found in 75% of hysterectomy specimens . This is due to the fact that most fibroids are asymptomatic. From ultrasound-based screening studies in the USA and Europe it is estimated that women have a risk of 50–70% of suffering from fibroids during their lifetime. Onset under the age of 30 years is rare although not impossible. After menopause (12 months after the last period) fibroids tend to decrease in size or remain stable.
From studies in the USA it is known that women of African descent more often have fibroids with an earlier onset, bigger tumors and earlier symptoms than caucasian or Asian women3 . Studies imply that this fact is due to different numbers of estrogen, progesterone and aromatase receptors in fibroids and normal uterine muscle according to ethnicity. Fibroids can cause high morbidity and suffering when they grow and cause symptoms.
What Are The Symptoms?
- Increase in size and number
A uterine tumor rapidly growing after menopause is unlikely to be a fibroid. Around the last period, however, fibroids can grow due to an increased number of cycles without ovulation and high estrogen levels in the body. - Menorrhagia (prolonged and heavy bleeding within normal cycle)
- Subfertility
- Secondary dysmenorrhea (new onset of period pain)
- Pressure symptoms from the bowel and bladder, e.g. constipation, frequency, chronic urinary tract infections (UTIs)
- Chronic pelvic pain, dyspareunia.
- Pregnancy-associated symptoms:
Spontaneous abortion, recurrent abortion, abdominal pain and pressure signs in pregnancy, premature rupture of membranes, dystocia, post-partum hemorrhage - Less common symptoms include:
- For submucosal, pedunculated fibroids: protrusion through cervical os with pain and bleeding.
- For subserosal, pedunculated fibroids: torsion with infarction and acute abdominal pain and separation from the uterus.
- Malignant change into leiomyosarcoma ( approx. 0.13–0.23%)
How Do We Diagnose Fibroids?
- Abdominal palpation
- Speculum examination ( to visualize the cervix and possible with Pap smear to rule out Cervical cancer)
- Bimanual palpation
- Ultrasound Pelvis
- Laboratory investigation
- Full blood count (anemia)
- ESR (infection/inflammation)
- Other related blood test: Iron studies (For constitutional symptoms due to menorrhagia) – Iron deficiency anemia
- Further investigations:
- Saline infusion hysterosonography
- Hysterosalpingography
- Hysteroscopy
- Intravenous pyelography
How To Treat It?
There are multiple ways we can overcome fibroids – sometimes we would wait and see the progress of the fibroids. This can be from six week intervals to a year apart. If there is any suspicion that this could be cancer, we would adopt a more aggressive approach to this.
Medications for fibroid conditions can include hormonal treatment to balance the natural environment. We can do this via injections, tablets, or intrauterine devices. Ultimately, the doctor can advise you further on this. In certain conditions, surgery may be required.
