Every woman who has hopes of one day becoming a mother is usually perturbed by any condition that may pose some danger to her reproductive health.
One of such well known but poorly understood conditions is uterine fibroids. In this piece, I will attempt to paint a clear picture on what exactly fibroids are; limiting my medical jargons to the barest minimum, and also attempt to demystify some of the misconceptions associated with this condition.
Uterine fibroids, medically known as Leiomyoma are benign, well-circumscribed, smooth muscle tumours of the uterus. Benign meaning that they do not spread out of the uterus, well circumscribed meaning they have well defined borders/edges.
Fibroids are a bit commonplace and it can be found in up to 20% of women above 30 years of age. Some autopsy studies also show that its prevalence rate may be up to 50%. No specific cause/causative factor has been identified in the development of fibroids.
Risk factors, which are conditions (natural or artificial) that increase the likelihood of developing fibroids have however been identified.
Risk factors for clinically significant fibroids are nulliparity i.e. condition of having borne no children, obesity, a positive family history and African racial origin. It is important to know that having any of these risk factors does not necessarily mean a woman will have fibroids.
Fibroids are medically classified based on the location in and around the uterus from which they arise. Fibroids may be found singly within the uterus, but are more commonly multiple and may vary in size from seedling fibroids to enormous tumours filling the whole pelvic cavity and extending into the abdominal cavity.
After menopause, fibroids are noted to shrink and regress, presumably due to the withdrawal of oestrogen support. Fibroids can go through a variety of degenerative processes which often manifest as different clinical presentations. I guess we will leave all these intricacies to the medical professionals, so I don’t bore you.
The clinical manifestations of uterine fibroids are largely based on the location of the tumour within and around the uterus. Women with uterine fibroids will present with heavy and/or irregular menstrual bleeding (menorrhagia), pressure symptoms or problems conceiving (subfertility), especially if there is a fibroid in the uterine cavity.
The pressure symptoms include pelvic discomfort, urinary incontinence, frequency and retention, constipation and backache. When large fibroids are present, back pressure may cause or exacerbate enlargement of veins in the legs. Although these symptoms are common, it is important to note that some women with fibroids are asymptomatic i.e they show no symptoms of the disease.
Fibroids have been known to co-exist with pregnancies to their full term and once a pregnancy is established, however, the risk of miscarriage is not increased. Abdominal examination might indicate the presence of a firm mass arising from the pelvis, and on bimanual examination the mass is felt to be part of the uterus, usually with some mobility.
The presence of fibroids can be confirmed by ultrasound scan, differentiating it from ovarian tumour which is the main differential diagnosis.
The management of fibroids is broadly categorised into medical and surgical. Except in emergencies, the choice depends upon the woman’s age and fertility intentions, the size and number of fibroids and their location. Medical management is appropriate for patients with menorrhagia and small fibroids or for those with subfertility where fibroid size requires some shrinkage mostly before surgery.
Gonadotropin releasing hormone (GnRH) analogues are drugs that will cause shrinkage of fibroids, which may be appropriate short term either in the management of subfertility or prior to surgical removal of large fibroids – limiting blood loss at the time of operation and decreasing morbidity.
Long-term use is limited by the loss of bone mineral and fibroids will return to the previous size after cessation of the drugs. The surgical options in the treatment of fibroids include myomectomy (surgical removal of a fibroid), hysterectomy (complete removal of the uterus) and more advanced procedures like Uterine Artery Embolisation (UAE) in which arteries supplying the tumours are blocked, cutting off blood supply to the fibroid.
Surgery comes with its own complications sometimes, mainly blood loss, but it is the definitive treatment of fibroids. The surgical option chosen by a woman is largely dependent on her fertility needs.
Fibroids are very treatable. However, it is very important to know that diagnosis and management of uterine fibroids is best done by a medical practitioner, preferably a gynaecologist. It has been observed that most women with suspected cases of fibroid do not seek care in the right places, and some of these women don’t even have fibroid in the first place.
Concoctions or mixtures that are taken with the view of ‘dissolving’ the tumour are known to cause more harm than good. Uterine fibroids are very curable, if help is sought in the right place and early.
