Fibroids and Their Management

Fibroids are benign tumours that develop in the muscular wall of the uterus and are a common problem for many women. Although most fibroids do not cause serious problems, some may affect quality of life and fertility. In this article, we will explore what fibroids are, their symptoms, how they are diagnosed, and the available treatments for managing them.

What are Fibroids?

Fibroids are benign tumours composed of muscle and connective tissue that develop in the uterus. They typically appear in women of reproductive age and can vary in size from very small to very large. There are different types of fibroids, depending on their location in the uterus. The main types are:

Intramural fibroids: Develop in the uterine wall and are the most common type.
Submucosal fibroids: Develop just beneath the lining of the uterus (the endometrium) and can bulge into the uterine cavity. They can often contribute to difficulty conceiving or pregnancy loss.
Subserosal fibroids: Develop under the outer surface of the uterus and may extend toward the abdomen.
Pedunculated fibroids: Connected to the uterus through a narrow stalk.

What are the Symptoms of Fibroids?

Fibroid symptoms can vary depending on their size, number, and location. Some women may have no symptoms at all, while others may face serious problems. The most common symptoms include:

Heavy menstrual bleeding: periods may be heavier and last longer than usual.
Pain and cramps: They may feel pain and cramps in the abdomen or pelvis, especially during menstruation (period).
Pressure and bloating: Large fibroids can cause a feeling of pressure and bloating in the abdomen.
Frequent urination: The pressure that fibroids exert on the bladder can cause frequent need to urinate.
Constipation: Pressure on the intestine can cause constipation.
Pain during sexual intercourse: May cause pain during sexual intercourse (dyspareunia).

What are the Causes of Fibroids?

The exact cause of fibroids is not known, but there are various factors that may contribute to their development:

Genetic factors: Women with a family history of fibroids have a greater risk of developing them.
Hormonal factors: Estrogen and progesterone appear to promote fibroid development. Levels of these hormones are higher during the reproductive years.
Age: Fibroids are more common in women aged 30-40 years and usually shrink after menopause.
Obesity: Women who are overweight or obese have an increased risk of developing fibroids.
Diet: A diet high in red meat and low in vegetables, fruit and dairy products may increase the risk.

How are Fibroids Diagnosed?

The diagnosis of fibroids is made through clinical examination and diagnostic tests. The main diagnostic methods include:

1. Clinical Examination

The gynaecologist can detect the presence of fibroids during clinical examination through palpation of the uterus.

2. Ultrasound

Pelvic ultrasound is the most common imaging test used to detect fibroids. Ultrasound can show the number, size, and location of fibroids.

3. Magnetic Resonance Imaging (MRI)

MRI can provide a more detailed image of fibroids and help diagnose cases that are not clear with ultrasound.

4. Hysteroscopy

Hysteroscopy is a procedure in which a thin telescope (hysteroscope) with a camera is inserted into the uterus through the cervix. It allows direct examination of the interior of the uterus and can help detect submucosal fibroids.

5. Hysterosalpingography (HSG)

HSG is an X-ray examination in which contrast dye is injected into the uterus and fallopian tubes. This examination helps identify abnormalities in the uterine cavity and fallopian tubes.

Management of Fibroids

Treatment for fibroids depends on the severity of symptoms, the size and location of the fibroids, and whether the patient wants to become pregnant. The main treatment options include:

1. Monitoring

For women with small fibroids that do not cause serious symptoms, monitoring and regular examination may be sufficient. Fibroids that do not grow or cause problems may not require immediate treatment.

2. Pharmacological therapy

Various medications can be used to relieve symptoms and shrink fibroids:

Non-steroidal anti-inflammatory drugs (NSAIDs): Can be used to relieve pain and inflammation.
Hormonal therapies: Contraceptive pills, gonadotropin-releasing hormone (GnRH) agonists, and A progestogen-releasing intrauterine system (IUS) can help regulate periods and reduce bleeding..
Progesterone antagonists: Drugs such as mifepristone can help shrink fibroids and reduce symptoms.

3. Non-surgical therapies

Uterine artery embolization (UAE): This procedure involves injecting microspheres into the arteries supplying the fibroids, causing blockage of blood supply and shrinkage of fibroids.
Focused ultrasound surgery (FUS): uses focused ultrasound energy to heat and destroy fibroids without an incision.

4. Surgical therapy

Surgical intervention may be necessary to remove fibroids in cases where symptoms are severe or do not respond to other therapies. The main surgical methods include:

Myomectomy: Removal of fibroids from the uterus. Myomectomy can be done through laparoscopy, hysteroscopy, or open surgery. It is the preferred option for women who wish to preserve their fertility.
Hysterectomy: Removal of the uterus. It is the most radical solution and is used in cases where other therapies are not effective or if the fibroids are very large. After a hysterectomy a woman can no longer become pregnant.

Fibroids and Infertility

Fibroids can affect fertility in various ways:

Endometrial receptivity: Submucosal fibroids can distort the uterine cavity, not allow proper endometrial preparation, and prevent embryo implantation.
Miscarriages: Fibroids may increase the risk of miscarriages due to their interference with normal placental and embryo development.
Frequency of sexual intercourse: Fibroids may lead to decreased frequency of sexual intercourse due to pain or prolonged and heavy periods (menorrhagia).
Blocking sperm and egg from meeting: fibroids near the fallopian tubes may distort or block them and prevent the sperm and egg from meeting.

Assisted Reproduction and Fibroids

Assisted reproduction may be necessary for women with fibroids who have difficulty conceiving. The main methods include:

1. Intrauterine insemination (IUI)

IUI can be used in cases of small fibroids that do not significantly affect fertility and provided the other conditions for this treatment are met. During IUI, sperm is placed directly into the uterus during ovulation, increasing the chances of conception.

2. In Vitro Fertilisation (IVF)

In vitro fertilisation (IVF) is often the preferred method for women with fibroids that affect fertility. During IVF, eggs are collected from the ovaries and fertilised with sperm in the laboratory. The embryos are then transferred to the uterus.

Psychological Support for Women with Fibroids

Fibroids can have significant effects on emotional wellbeing, such as anxiety, depression, and low self-esteem. Psychological support, such as counselling and support groups, can help women cope with the emotional challenges related to fibroids.

Conclusions

Fibroids are a common and often manageable condition that can affect fertility and women’s quality of life. With proper diagnosis and treatment, many women can manage symptoms and achieve pregnancy. Understanding treatment options and seeking specialised medical care are vital for managing fibroids and achieving the dream of building a family.

If you would like advice based on your circumstances, contact Dr Christos Venetis to arrange a consultation.