Uterine fibroids are very common
It’s estimated that 20-50% of women of reproductive age have uterine fibroids, which may range in size from as small as a pea to as big as a grapefruit. We look at the causes, symptoms and treatment of these often benign growths.
What are uterine fibroids?
‘Fibroids are a condition that affects the uterus muscle layers. They are benign growths that may affect fertility,’ explains Dr Sibusiso Nhlapo, a gynaecologist and obstetrician at Mediclinic Secunda.
‘Medically, uterine fibroids are also called uterine leiomyoma, myoma or fibromyoma,’ adds Dr Ameera Adam, a gynaecologist and obstetrician at Constantiaberg Mediclinic. In more than 99% of fibroid cases, the tumours are benign, meaning non-cancerous.
What causes uterine fibroids?
The cause hasn’t been definitely established, although their formation is probably influenced by hormonal stimuli, especially by oestrogen.
What are the symptoms?
There are often no symptoms at all, although ‘abnormal and excessive endometrial [menstrual] bleeding’ could be a telltale sign, says Dr Adam. Larger fibroids can cause pressure and pain. Frequent urination, lower-back pain and pain during intercourse are other possible symptoms.
How are uterine fibroids diagnosed?
‘A routine gynaecological examination should include an abdominal and vaginal ultrasound to exclude fibroids, and if they are present, to determine their position,’ says Dr Adam.
‘Sonohysterogram and hysteroscopy are the optimal diagnostic tools,’ she adds. Sonohysterography is a safe, painless procedure to look at the inside of the uterus using sound waves, while hysteroscopy involves a thin, lighted tube inserted into the vagina to examine the cervix and inside of the uterus.
Dr Adam notes that transvaginal ultrasound, which is done by inserting an ultrasound wand into the vagina, and which was once thought to be an accurate diagnostic tool for intrauterine pathology, is no longer considered accurate enough.
Do uterine fibroids cause infertility?
This depends on the size and location of the fibroid, says Dr Adam. Statistics published in a 2012 study in Obstetrics & Gynecology Clinics of North America showed that fibroids are found in only 5-10% of women who are struggling to conceive, and may be the standalone cause of infertility in only 1-2% of women.
Is any specific group of women more prone to uterine fibroids?
No, but fibroids mainly affect women in their childbearing years. ‘Fibroids shouldn’t present as a clinical problem before puberty and shouldn’t grow after menopause,’ says Dr Adam.
Women who are obese seem to be at an increased risk, although the reasons for this are not clearly understood.
What are the treatment options?
‘If the fibroids are small and asymptomatic, conservative treatment can be followed,’ says Dr Adam. This includes the patient taking anti-inflammatory painkillers; gonadotropin-releasing hormone (GnRH) agonists, which lower levels of oestrogen and trigger a ‘medical menopause’; anti-hormonal agents that oppose oestrogen; and anti-progestins, which block the action of progesterone.
Surgery may be an option if:
- the fibroid is larger than or similar to the size of the uterus in a pregnancy at 14 weeks
- is causing pain or heavy persistent heavy bleeding, or
- is causing infertility.
Surgery comes with its own risks, however. An abdominal or laparoscopic myomectomy, which is a minimally invasive procedure in which the surgeon makes a small incision near the bellybutton, then accesses and removes any fibroids through it, can cause infection or damage to internal organs.
‘Also of concern for women who are struggling to conceive is the high rate of post-operative adhesion [formation of scar tissue],’ Dr Adam adds. ‘The added risks of uterine rupture and increased likelihood of Caesarean section means there are many reasons to be wary of myomectomy for unclear indications.’
Uterine artery embolisation (also called uterine fibroid embolisation, or UFE) cuts off the blood supply to the fibroids, thus shrinking them, and may reduce fibroid-related symptoms.