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Fibroids (myomata)

Fibroids are benign swellings in the muscle of the womb that occur in women of all ages and races. They arise in the myometrium, the outer, muscular body of the womb, and vary in size from a grape pip to a melon. They are very common, affecting 30% of women over the age of 35. There are three subtypes of uterine fibroids, distinguished by their position in the womb. A fourth type, known as a pedunculated fibroid, can occur on the membrane that covers the womb. Fibroids do not occur before puberty and may become smaller after the menopause. In extremely rare cases, they can be cancerous.

Effects of fibroids

For most women that have them, fibroids cause no trouble at all. They are relatively slow growing and often go unnoticed, but can cause problems if they grow larger, when they may be associated with heavy periods, pelvic pain, or pressure symptoms such as abdominal discomfort or passing urine frequently. For very few women, they can be a cause of recurrent miscarriage.

Diagnosis

Pelvic Ultrasound Scan is useful in diagnosing fibroids. It detects a uterine mass which is then identified as either fibroids or a number of other possible pelvic swellings.

Treatment

Whether fibroids need treatment depends on their size and associated symptoms, as well as the individual's age and reproductive wishes. Small fibroids causing no symptoms rarely require treatment, and only need to be checked from time to time.

Women with fibroids and heavy periods

Some women may require a hysterectomy to get rid of fibroids. For those wanting to keep the womb, a mirena coil may control heavy periods. Alternatively, fibroids can be removed using a surgical procedure called a myomectomy, undertaken by hysteroscopy. As the womb itself is preserved, this is an option for women still wanting children. However, there are some possible side effects that might lead to infertility.

Hormone treatments (including drugs known as LHRH anologues) can be helpful. These cause the fibroids to shrink by causing an artificial (reversible) menopause. This is particularly useful prior to myomectomy to make the surgery easier and safer, especially in women wishing to have children in the future.

There are also some experimental new surgical techniques, including arterial embolisation, which works by cutting off the blood supply of fibroids. Women should consult their doctors about whether any of these treatment options are suitable for them.

Sources

Fibroid news
www.fly.to/fibroidnews

BBC: Women's Health
www.bbc.co.uk/health/womens_health/
issues_fibroids.shtml

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