Fibroids: Benign uterine tumours

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Uterine fibroids are not associated with an increased risk of uterine cancer and almost never develop into cancer.

Uterine fibroids develop from the smooth muscular tissue of the uterus.A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms.

In women who have symptoms, the most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding

• Prolonged menstrual periods — seven days or more of menstrual bleeding

• Pelvic pressure or pain

• Frequent urination

• Difficulty emptying your bladder

• Constipation

• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply.

Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and, rarely, fever. A _ broid that hangs by a stalk inside or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk and cutting off its blood supply.

Most uterine fibroids are harmless and do not cause symptoms, and shrink with menopause. If there are few or no symptoms, treatment is generally not required. This management is known as watchful waiting.

Non-steroidal anti-inflammatory drug (NSAID) therapy may be used to assist with pain control, but there is no direct evidence to show that NSAIDs relieve fi broid specifi c pain. Birth control hormones can assist with lightening menstrual bleeding as well as preventing pregnancy. An intrauterine device may also assist with mitigation of heavy bleeding. Iron supplements may also be used to correct anaemia associated with heavy bleeding.

For patients experiencing severe fibroid symptoms, approaches vary from attempting to shrink the fibroid to total removal. Hormone therapy using a gonadotrophin releasing hormone analogue puts the body in a state of menopause and shrinks both the uterus and the fibroids.

Surgical removal of fibroids is known as a myomectomy and can be performed by either removing the fibroid itself or the entire uterus, known as a hysterectomy. Other surgical approaches, too detailed to mention here are available and can be discussed with your Gynaecologist.

The symptoms of uterine fibroids can be non-specific and it is important that it is differentiated from something more serious.

You should see your Gynaecologist if you experience any of the following:

• Pelvic pain that doesn't go away

• Overly heavy or painful periods

• Spotting or bleeding between periods

• Pain consistently with intercourse

• Enlarged uterus and abdomen

• Difficulty emptying your bladder

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.