Uterine Fibroids are growths in the muscle wall of the womb (uterus). They are, in 99.9% of cases, non-cancerous (benign). Fibroids often decrease in size after the menopause, when levels of oestrogen, the female hormone that circulates in the blood, decrease dramatically, reducing blood flow to the fibroids, which then shrink. Fibroids can range in size from tiny (less than 1cm) to large (over 20cm). There is usually more than one fibroid in the womb.

Alternative Names of Uterine Fibroids are: Leiomyoma; Fibromyoma; Myoma; Fibroids

Complications of Uterine Fibroids

Fibroids may cause pregnancy complications, although the risk is thought to be small:

• Most women are able to carry their babies to term, but some end up delivering prematurely because there is not enough room in the uterus.
• Some pregnant women with fibroids may need a cesarean section because fibroids can occasionally block the birth canal or cause the baby to be positioned wrong.
• Some pregnant women with fibroids have heavy bleeding immediately after giving birth.

Other complications of fibroids include:

• Severe pain or excessively heavy bleeding that may require emergency surgery
• A pedunculated fibroid can become twisted and cause a kink in the blood vessels feeding the tumor (this type of fibroid may need surgery)
• Anemia (which may be severe if the bleeding is very heavy)
• Urinary tract infections, if pressure from the fibroid prevents the bladder from fully emptying
• Cancerous changes called leiomyosarcoma (in rare cases)
• Infertility (rarely)

Causes of Uterine Fibroids

• Uterine fibroids are the most common pelvic tumor. As many as 1 in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause).
• Fibroids usually affect women over age 30. They are rare in women under 20, and often shrink and cause no symptoms in women who have gone through menopause. They are more common in African Americans than Caucasians.
• The cause of uterine fibroid tumors is unknown. However, fibroid growth seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.
• Fibroids can be so tiny that you need a microscope to see them. However, they can grow very large. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there are more than one.

Signs & Symptoms of Uterine Fibroids
Depending on their size and position in the womb, fibroids may cause:

• Heavy, prolonged periods (menorrhagia) and unusual monthly bleeding, sometimes with clots, which can lead to a low blood count (iron-deficiency anaemia). This is the most common symptom.
• Painful periods (dysmenorrhoea).
• Pressure on the bladder, causing frequent passing of water.
• Pressure on the bowel, leading to constipation and bloating.
• Pain in the back, buttocks or legs as the fibroid presses on the sciatic nerve.
• Pain during intercourse (dyspareunia).
• Abdominal swelling that can be misinterpreted as weight gain.
• Infertility or miscarriage, probably from distortion of the uterine cavity and occasionally from blockage of the junctions between the cavity and the fallopian tubes.

Diagnosis of Uterine Fibroids

Internal examination
Fibroids are often first diagnosed during an internal pelvic examination.
Abdominal or Transvaginal ultrasound
This is a painless procedure in which a small, handheld probe is moved across the abdomen. Sound waves are transmitted through the skin, allowing the technician to see the size, shape and texture of the uterus on a monitor. Uterine size, the position and number of fibroids and, with the use of Doppler techniques, the uterine and fibroid blood vessels can usually be evaluated. In Transvaginal ultrasound a sheathed ultrasound probe is put into the vagina so that the inside of the uterus can be seen more easily. This may be required if small fibroids are suspected or if images from an abdominal ultrasound are unclear. There is generally little, if any, discomfort associated with this.

MRI (Magnetic Resonance Imaging) scan
This is now the method of choice for imaging fibroids when alternatives to hysterectomy are being considered. It gives precise information of the number, size and location of fibroids. You will need to put on a hospital gown and lie flat on your back under the scanner. Usually an injection (contrast medium) is necessary to produce even more accurate images and to look at the relative blood supply of the uterus and the fibroids.

Hysteroscopy
A long, thin endoscope is passed through the vagina and cervix into the uterus, allowing the doctor to check for growths and take samples of tissue. It is sometimes required to confirm and treat small submucosal and intracavity fibroids. It can cause some discomfort and is generally performed by a gynaecologist, either with a local or general anaesthetic.

Laparoscopy
A small incision is made in the abdomen, usually next to the navel, allowing insertion of an endoscopic camera.

Treatments of Uterine Fibroids

Treatment depends on various factors, including:

• Age
• General health
• Severity of symptoms
• Type of fibroids
• Whether you are pregnant
• If you want children in the future

Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid's growth.

Treatment for the symptoms of fibroids may include:

• Birth control pills (oral contraceptives) to help control heavy periods
• Intrauterine devices (IUDs) that release the hormone progestin to help reduce heavy bleeding and pain
• Iron supplements to prevent or treat anemia due to heavy periods
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn for cramps or pain

Hormonal therapy (gonadotropin releasing hormone (GnRH) agonists or Depo Leuprolide injections) may be used to help shrink the fibroids. This therapy is used only for a short period of time, either before surgery to remove a fibroid or when a woman is expected to reach menopause soon. Side effects include hot flashes and vaginal dryness.

Surgery and procedures used to treat fibroids include:

• Hysteroscopic resection of fibroids: Women who have fibroids growing inside the uterine cavity may need this outpatient procedure. In this procedure, a small camera and instruments are inserted through the cervix into the uterus to remove the fibroid tumors.
• Uterine artery embolization: This procedure stops the blood supply to the fibroid, causing it to die and shrink. Uterine artery embolization is not used to treat large fibroids. Women who may want to become pregnant in the future should NOT have this procedure.
• Myomectomy: This surgery removes the fibroids. It is often the chosen treatment for women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that occurs in some women with uterine fibroids. More fibroids can develop after a myomectomy.
• Hysterectomy: This invasive surgery may be an option if medicines do not work and other surgeries and procedures are not an option.

Prevention of Uterine Fibroids

There is no known treatment that prevents uterine fibroids. But getting regular exercise may help. According to one study, the more exercise women have, the less likely they are to get uterine fibroids.

Preventing fibroids from coming back after treatment
It is common for fibroids to grow back after treatment. The only treatment that absolutely prevents regrowth of fibroids is removal of the entire uterus, called hysterectomy. After hysterectomy, you cannot get pregnant. While many women report an improved quality of life after hysterectomy, there are also possible long-term side effects to consider.

When to seek Medical Advice

Call your doctor if:

• You have gradual changes in your menstrual pattern, including a heavier flow, increased cramping, or bleeding between periods
• Fullness or heaviness develops in your lower abdomen