Fibroids - FAQs
A Multidimensional Approach to Infertility Management
Q. What are Uterine Fibroids?
A. Fibroids, also known as uterine leiomyoma, are non-cancerous (benign) growths in the uterus, which grow from the muscle and surrounding layer of the uterus. In most women, the fibroids remain small or do not cause any symptoms or problems. However, in some women, the fibroids can cause problems because of their size, number and location.
Q. Where do Uterine Fibroids Grow?
A. Uterine fibroids can grow in various parts of the uterus. Depending on where they grow, fibroids are of three types:
- Intramural: This is the most common type, which grows in the muscular wall of the uterus and can cause an increase in menstrual bleeding, abdominal pain, back pain or pressure.
- Subserosal: These are the second most common type of fibroids, which are located on the outer wall of the uterus and usually do not affect the monthly menstruation. However, they can cause pain in the abdomen, back pain or pressure.
- Submucosal: These are located on the inner surface of the uterus and can cause heavy bleeding, even if the fibroids are very small.
Q. What Causes Uterine Fibroids?
A. The exact reason why uterine fibroids develop is unknown. However, two factors may play a role:
- Hormones: Oestrogen and progesterone, the two female hormones, promote the growth of fibroids. As a result, they may grow rapidly during pregnancy, when the hormone levels are high, and stop growing or shrink once a woman reaches menopause (permanent stopping of the monthly periods), when the hormone levels are low.
- Genetic: Fibroids can also run in families. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
Q. Who can Get Fibroids?
Mostly, fibroids grow in women of childbearing age. It is more common in woman who has never given birth to a live baby and there exists an inverse relationship between the number of pregnancies and fibroids (more the number of pregnancies less is the risk of fibroids). Some factors can increase a woman's risk of developing fibroids. These are as follows:
- Age: Fibroids become more common as a woman ages, especially during her thirties and forties. After menopause, the fibroids usually shrink.
- Family history: Having a family member with fibroids increases the risk.
- Obesity: Women who are overweight are at a higher risk for fibroids. For very obese women, the risk is two to three times greater than average.
- Eating habits: Eating a lot of red meat (e.g., beef) is linked with a higher risk of fibroids, but eating plenty of green vegetables seems to protect women from developing fibroids.
Q. What are the Typical Symptoms of Uterine Fibroids?
A. Most fibroids do not cause any symptoms, but some women with fibroids can have the following symptoms:
- Excessive bleeding.
- Longer or more frequent menstrual periods.
- Pain during the menstrual cycle.
- Vaginal bleeding at times other than menstruation.
- Feeling of fullness in the abdomen (bloating).
- Frequent urination.
- Pain during sexual intercourse.
- Lower back pain.
- Inability to get pregnant (infertility).
Q. Does Having Uterine Fibroids Lead to Infertility?
A. Most women who have fibroids are able to get pregnant. In some cases, fibroids can prevent a woman from getting pregnant through natural methods. However, advances in the treatments for fibroids and infertility have greatly improved the chances for a woman to get pregnant.
Q. How are Uterine Fibroids Diagnosed?
A. Sometimes, women are unaware that they have fibroids and are first diagnosed during clinical examination by a Gynaecologist. Some of the tests used to confirm the presence of fibroids are as follows:
- Ultrasound: An instrument/ probe is moved over the abdomen or inserted inside the vagina to get a picture of the uterus.
- Hysterosalpingogram (HSG): A special dye is injected into the uterus through the vagina and cervix, and X-ray pictures are taken.
- Magnetic resonance imaging (MRI): Magnetic rays are used to build a detailed picture of the body.
- CT scan: Many X-ray pictures of the body are taken from different angles for a more complete image.
At times, different procedures might be needed to confirm and treat fibroids. These are as follows:
- Laparoscopy: Laparoscope, a special instrument that has a light source and a camera, is inserted into a small cut made near the navel. This allows the doctor to view the uterus and other surrounding organs. Pictures can also be taken.
- Hysteroscopy: A hysteroscope, which has a light source and a camera (like a laparoscope), is passed through the vagina and cervix into the uterus. The doctor can look inside the uterus for fibroids and other problems.
Q. Can Fibroids During Pregnancy Cause Harm?
A. Some women who have fibroids may have problems during pregnancy and delivery. The commonly seen problems in pregnant women with fibroids are as follows:
- May need caesarean section during delivery.
- Abnormal position of the baby.
- The placenta (the organ that connects the baby to the uterus) may detach before delivery.
- Early birth of the baby.
Q. How are Uterine Fibroids Treated?
The treatment for uterine fibroids depends on the size and location of the fibroids and the severity of the symptoms. If there are no symptoms, no treatment may be required but yearly visits may be needed to check up on them. If symptoms develop, the following treatment options are available:
- Medical therapy: Medical therapy may include the use of drugs to shrink the fibroids or to provide control of the symptoms. These drugs include birth control pills, GnRH analogues, etc. Medical therapies are only temporary and are used awaiting surgery or menopause.
- Surgical therapy: There are many surgical options for uterine fibroids:
Myomectomy: It is the partial or total removal of the fibroids from the wall of the uterus. It can be done with the help of minimal invasive techniques like laparoscopy or hysteroscopy depending on the size, number and location of the fibroids. Since the uterus is not removed, the woman will still be able to get pregnant after the surgery. Sometimes fibroids can grow again after surgery.
Uterine artery embolization: In this procedure, the blood vessels that supply blood to the fibroids are blocked. This causes the fibroids to shrink in size and, thereby, reduces the related symptoms.
Hysterectomy: It is a procedure in which the entire uterus is removed. It is done in older women or in those who do not wish to have any children further.
Q. How Does One Decide Which Treatment is the Best?
A. Treatment of uterine fibroid depends on many factors like age of the patient, number and size of the fibroid, symptoms associated with the fibroid, etc. It is therefore important to understand all the treatments that are available. The patient should have a detailed discussion with the doctor about the available options, including the benefits and risks, and then decide as to which treatment is most suitable.
For more information, please contact your doctor.