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What you should know about fibroids

What are Fibroids?

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.

  • Submucosal Fibroids

    Grow from the uterine wall into the uterine cavity sometimes distorting it which can cause pain, abnormal bleeding and infertility.

  • Subserosal Fibroids

    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.

  • Intramural Fibroids

    Remain confined within the uterine wall and can cause symptoms similar to those of submucosal and subserosal fibroids.


How are fibroids diagnosed?

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.

  • Ultrasound use high frequency sound waves to create picture of the pelvic organs. No anaesthesia is necessary for this office procedure. Sometimes the uterus is filled with a water solution, through the cervix, to improve visibility.
  • Hysterosalpingograph (HSG) is an X-ray of the inside of the uterus in which a special dye is used to outline abnormalities. If there is a fibroid inside the uterus, it can usually be seen during this procedure. HSG is typically performed in the radiology suite with no anaesthesia.
  • Diagnostic hys–ter–os’–copy allows the physician to look into the uterine cavity through a telescope-like instrument called a hysteroscope which is inserted into the uterus through the cervix. Hysteroscopy can be performed as an office procedure under local anaesthesia or in an outpatient surgery center with general anaesthesia. Sometimes fibroids can be removed with hysteroscope (described under myomectomy).

Treatment Options

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.

What are surgical options?

  • Hysterectomy is the surgical removal of the uterus which may be required in cases of very large, rapidly growing or multiple fibroids. A hysterectomy can be performed by making an incision in the abdomen, or by removing the uterus through the vagina. The procedure is most often performed in the hospital with a general anaesthesia. Recovery time is typically two to six weeks.
  • Myomectomy is a surgical procedure which removes only the fibroid, leaving the uterus intact. Traditionally, myomectomy has been performed,1) through an open incision in the abdomen, or 2) by electrosurgical “resection” which uses electric current instead of a knife(scalped) to cut away fibroid tissue.
  • “Resection” myomectomy is performed with a telescope-like instrument called a hysteroscope that is inserted through the vagina and cervix into the uterus. No incision is made. Electric current passes through a loop structure called electrode which is built into the hysteroscope. As the electrode shaves the fibroid, small pieces of tissue accumulate in the uterus which the surgeon must remove during the procedure.

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.

  • Does a fibroid mean cancer?

    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.

  • What causes fibroids?

    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.

  • Do all fibroids cause symptoms?

    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.

  • What are the symptoms of fibroids?

    Some fibroids, due to size, number or location may cause symptoms such as:

    • Changes in your period(heavy bleeding, longer periods or more frequent periods)
    • Pain or pressure in your abdomen or lower back
    • Pain during sex
    • Difficulty urinating, frequent urination or constipation
    • Miscarriages or inability to conceive
    • Anaemia due to chronic excessive bleeding

    Can fibroids cause infertility?

    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.