The Common Female Health Challenge: Uterine Fibroids

By Dr. Marion Ntsako Nkanyane
Obstetrician/Gynaecologist and currently practices at Melomed Richards Bay

Fibroids are growths that arise from the muscle of the uterus. They are common, affecting about 80% of women although not everyone will have problematic symptoms. The cause of fibroids is unknown however age, ethnicity and genetics have been found to play a role. The influence of the hormones estrogen and progesterone also contribute to their growth and development.

What symptoms are caused by fibroids?

The symptoms depend on the size, number and site of the fibroids on the womb. Some of the symptoms are:
• Increased menstrual bleeding: the amount and the number of days of bleeding may be increased and prolonged. This can lead to loss of too much blood and anemia.
• Pelvic pressure and pain.
• Constipation and increased urination if the fibroids are located close to the bladder or rectum.
• Fertility problems: fibroids may make it difficult to fall pregnant and may also increase the risk of miscarriages.

How are fibroids diagnosed?
Your symptoms may suggest that you have fibroids, and this will be confirmed by an ultrasound. The ultrasound can also indicate the location and size of the fibroids which will assist in choosing the right treatment plan.

Treatment for fibroids?
Treatment is usually indicated for women with bothersome symptoms. If the fibroids are not causing any problems and they were diagnosed incidentally, a more conservative approach with monitoring of their growth can be applied. The treatment options for fibroids depend on their size, number and site on the uterus. Also influencing the treatment will be whether future fertility is desired or not. The options can be either medications, surgery or interventional as discussed below.

Medications

NON-HORMONAL MEDICATIONS
• Tranexamic acid to decrease the amount of bleeding.
• NSAID to help with the cramps and to also reduce the amount of bleeding.
• Iron and vitamin supplements to boost your blood levels.

HORMONAL OPTIONS
• Birth control medications in the forms of pills, patch, Implant, injections, vaginal rings and intra-uterine devices can be used to treat the symptoms caused by fibroids.
• Hormonal medications that stop the production of estrogen and progesterone can be used for a short period to reduce the size of fibroids prior to surgery. These hormones are not recommended for prolonged periods as they induce menopause, and this can cause certain adverse effects.

Surgical and Interventional Options
• Myomectomy - involves the removal of the fibroids only. This is ideal for women who still want to have children in future. There is a 10-20% risk that the fibroids will recur after myomectomy and the surgery carries a risk of bleeding which can necessitate a hysterectomy.
• Hysterectomy - removal of the entire uterus. Women will not be able to fall pregnant afterwards this surgery. The ovaries are often not removed if they are healthy, and the woman has not reached menopause yet.
• Uterine artery embolization - this blocks the blood supply to the uterus and thus causing the fibroids to shrink over several weeks to months. It may be difficult to fall pregnant after this procure with the risk of miscarriages hence this procedure is not recommended if future fertility is still desired.
• Magnetic resonance guided focused ultrasound - this option is not widely available and involves the use of ultrasound waves guided by an MRI to destroy the fibroids leading them to shrink within weeks to months after the procedure.
• Endometrial ablation - this procedure destroys the inside lining of the womb. It usually improves the amount of bleeding but has no effect on the size of the fibroids. This procedure is not recommended for women with future fertility desires.

It is of paramount importance for women who have any of the symptoms above to have a gynaecological assesment to rule out the presence of fibroids as earlier diagnosis can result in more favourable treatment outcomes.