What are fibroids?
The wall of the uterus (womb) is made up mainly of muscle. In some women there is an overgrowth of these muscle cells, forming 'lumps' called fibroids. These are benign and can vary in size from microscopic to huge - some can grow to fill the entire abdomen! Often, fibroids are multiple and it is quite common to have more than one.
Fibroids are very common, with around 1 in 4 women in the reproductive age group having at least one. Women of an African-Caribbean ethnicity are more likely to develop them and often develop them at a younger age than other ethnic groups. Fibroid growth depends on hormones produced by the ovary, so when ovarian hormone production declines at the menopause, fibroids usually shrink and cause less of a problem.
In many women, fibroids cause no problems and the woman may not even know she has a fibroid. In other women, however, fibroids can be associated with heavy periods, pelvic pain and infertility. Symptoms depend on the size of the fibroids, with larger ones more likely to cause pressure symptoms due their sheer size, and on the exact location of the fibroid. A fibroid that protrudes into the inner lining of the womb (also called 'submucous' fibroid) is more likely to be associated with infertility and pregnancy loss than one that does not affect the lining of the womb. For this reason, a full assessment of the womb by means of tests such as hysteroscopy and MRI scanning is important and is part of my care pathway.
- Drugs and hormone treatments
Pain and heavy bleeding can often be managed by the use of Tranexamic Acid and Mefenamic Acid taken during the period. These medications will not cause the fibroid to shrink or stop growing, but they can improve your quality of life significantly.
A number of hormone-related treatments have been developed to help with fibroids, but none of them is as yet approved for long-term use. These include GnRH analogues (such as Zoladex) and Ulipristal. Ulipristal ('Esmya') is particularly effective in stopping bleeding within days, but can only be used for 3 months and only prior to surgery.
A lot of research is being carried out to test newer drugs in patients with fibroids, with some very exciting prospects. CLICK HERE for a recent presentation I did on this topic to the Ulster Obstetrical and Gynaecological Society. Scientists are looking at a variety of products, including components of your diet such as Vitamin D and curcumin (the chemical that gives turmeric its distinctive yellow colour).
- Uterine Artery Embolisation
This is a treatment carried out in the X-Ray department. A tube is passed through one of the blood vessels in the groin and guided into the uterine artery (which is the major source of blood supply to the womb). Special particles are injected to block the uterine artery.Starved of blood, the fibroids die and symptoms are reduced. The rest of the womb can develop a new blood flow from the ovaries and survives as before.
One advantage of this treatment is that it requires only a small cut in the groin to introduce the tube. However, it can cause quite severe pain for the first day or so after the procedure and for this reason, hospital admission and strong pain relief is advised for a day. Some women will have lower abdominal pain, vaginal discharge and a low-grade fever after the procedure. This is called 'post-embolisation syndrome' and can persist for several weeks.
It is not clear at present whether this procedure is right for women trying to conceive or those who wish to retain their fertility. The worries are as follows: a small proportion of women (around 7%) may fine that their periods completely stop after embolisation. This is more likely in women over 40. Hence, there may be difficulty in falling pregnant. Additionally, the risk of some pregnancy complications, such as miscarriage, may also be increased. However, it must be recognised that all fibroid treatments carry some risks and this is where it is important to individualise the care offerred. In some women with subfertility, uterine artery embolisation MAY be the best option available, if the fibroids have to be treated and the surgical risks are significant.
An operation can be performed to either remove just the fibroid ('Myomectomy') or the entire womb ('Hysterectomy'). Myomectomy is an option for women who are trying to conceive or wish to keep this option open, while hysterectomy may make sense if your family is complete. Depending on the size of the fibroids, it is sometimes possible to do these operations through the laparoscope ('key hole surgery'), but in other cases a cut on the tummy is required. You can expect to be in hospital between 1 and 3 nights and it can take upto 4 weeks to be back doing your normal activities.