What are uterine fibroids?

Uterine fibroids, also known as leiomyomas, are non-cancerous tumours that grow on the wall of the uterus. Uterine fibroids are a common condition, occurring in up to 80% of women. They are not associated with an increased risk of uterine cancer and almost never progress to cancer.

What are the causes and risk factors for uterine fibroids?

The exact cause of uterine fibroids is not exactly known. However, some factors such as gene mutations and hormones (estrogen and progesterone and growth factors) have been implicated.

Risk factors include :

• Heredity
• early start of period
• obesity
• vitamin D deficiency
• diet higher in red meat and lower in green vegetables and fruits
• alcohol consumption

What are the most common symptoms caused by uterine fibroids?

The symptoms of uterine fibroids can vary depending on their size, location and number. Some women may have no symptoms, while others may experience one or more of the following:

• Heavy or prolonged menstruation
• Painful menstruation
• Pelvic pain or feeling of pressure
• Pain during sex
• Co-occurring urine
• Difficulty in urination
• Constipation
• Anaemia due to heavy bleeding
• Infertility or difficulty conceiving
• Miscarriage or premature birth

How are uterine fibroids diagnosed?

→ Clinical examination: During a gynaecological examination, your doctor will check the size and shape of your uterus and may palpate any large fibroids.

→ Imaging testς: Imaging tests such as ultrasound, MRI or CT scans can help diagnose uterine fibroids and determine their size, number and location.

→ Hysteroscopy: A thin camera is inserted through the vagina and cervix to check the inside of the uterus for fibroids, which can be removed at the same time.

How are uterine fibroids treated?

Treatment options for uterine fibroids include:

→ Conservative treatment: If the fibroids are small and do not cause symptoms, simple monitoring can be done.

→ Medication: Hormonal medications such as birth control pills, intrauterine devices (IUDs) such as Mirena and gonadotropin-releasing hormone (GnRH) agonists can help shrink fibroids, reduce bleeding and relieve pain.

→ Non-surgical invasive treatment: Embolization of the uterine artery can shrink or destroy fibroids without surgery.

→ Surgery: If the fibroids are large, cause symptoms, affect fertility or increase in size during menopause (suspected malignancy) surgery may be needed. Surgical options include fibroidectomy with preservation of the uterus and hysterectomy which is the surgical removal of the entire uterus, using open, hysteroscopic, laparoscopic or even robotic approaches.

Do fibroids affect pregnancy?

Fibroids usually do not affect pregnancy. However, it is possible that fibroids (especially submucosal fibroids) can cause infertility or miscarriages. Fibroids can also increase the risk of certain complications of pregnancy, such as placental abruption, restriction of fetal growth and premature delivery.