A fibroid is the most common abnormal growth found inside a women’s pelvis; in fact, they occur in 20 – 30% of women over age 30. The fibroid itself is an over-growth of the smooth muscle tissue which grows in the uterine wall. Fibroids are also known as myomas from myo (muscle) and oma (new growth). A fibroid can be a small as a pea, or grow larger than a grape-fruit. Fibroids can occur as one single growth or multiple growths inside the uterus, within the walls, or the surface.
Grow from the uterine wall into the uterine cavity sometimes distorting it which can cause pain, abnormal bleeding and infertility.
Grow from the uterine wall to the outside of the uterus and can push on the bladder, bowel or intestine causing bloating, abnormal pressure, cramping and pain.
Remain confined within the uterine wall and can cause symptoms similar to those of submucosal and subserosal fibroids.
Many fibroids can be felt during a routine pelvic examination. In order to rule out other conditions such as ovarian tumors, bowel masses or early pregnancy which can sometimes be mistaken for fibroids, there are several diagnostic tests which may be performed to determine the best treatment.
If your fibroids are small, or you don’t feel any symptoms, you may not need treatment. If you develop fibroids when you are close to menopause, your physician may wait to see if the fibroid will shrink as estrogen levels decline.
For fibroids that are large enough to cause bleeding or painful symptoms, several surgical options may be considered. Your physician will evaluate that best course of treatment based on the number of fibroids, their size and location within the uterus.
But what about medical treatment?
Is surgery my only option?
There are no drugs currently available to totally eliminate fibroids. However a class of hormones called GnRH agonists may be used to temporarily shrink fibroid size in preparation for surgery, or, to delay surgery in a patient who has menopause. Once you stop taking the medication the fibroid will usually return to pretreatment size. GnRh agonists work by decreasing estrogen levels which stop your period, and may produce symptoms experienced in menopause such as hot flashes, vaginal dryness. These symptoms are reversible once you stop taking the drugs.
Myomectomy is usually performed using a general anaesthetic because the cervix must be stretched or dilated to accommodate the size of the hysteroscope. The two major advantages of “resection” compared to open myomectomy are minimizing blood loss and preventing surgically induced adhesions (scar tissue) that may impair future fertility. In most cases you can return to normal activity within a few days of the procedure.
In over 99% of cases, fibroid tissue is benign, (non-cancerous.) In very rare cases, (less the 1%), a fibroid may become malignant or cancerous.
The exact cause of fibroids is unknown, but there is evidence suggesting that many fibroids require estrogen to grow. Typically when a women reaches menopause, (average age of 51), estrogen levels decline and existing fibroids will tend to shrink.
Many women have a fibroid and may not even know it. Medical studies have shown that 50% to 80% of fibroids cause no symptoms, and they don’t cause abnormal bleeding or discomfort they may be no reason to treat them.
Some fibroids, due to size, number or location may cause symptoms such as:
The medical literature reports that between 2-10% of fertility problems can be caused by fibroids which can block the fallopian tubes or prevent implantation.