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Fibroids

What are Fibroids
Fibroids affect up to 40% of women over the age of 35. They are non-cancerous tumours that grow in the uterus and range in diameter from the size of a pea to the size of a grapefruit. The most common fibroids are intramural (growing within the muscular wall of the uterus).

Subserosal fibroids grow just under the outer layer of the uterus and submucosal fibroids grow under the inner layer of the uterus known as endometrium. Fibroids, even large ones, may cause no symptoms in some women. However, most women present with one or more of the following:

• Irregular vaginal bleeding or an increase in menstrual bleeding (menorrhagia), sometimes with blood clots.
• A pelvic mass.
• Pressure on the bladder, which may cause frequent urination and a feeling of a sense of urgency to urinate.
• Pressure on the rectum, resulting in constipation.
• Pelvic pressure, “feeling full” in the lower abdomen and lower abdominal pain.
• Increase in size around the waist and change in abdominal contour.
• Subfertility.

Why do fibroids occur
Fibroids are stimulated by the hormone oestrogen, which is produced naturally in the body. These growths can present from the beginning of reproductive age and shrink after the menopause. Women from an African and Afro-Caribbean ethnic background women have a higher prevalence of fibroids as compared to Caucasian women.

Treatment of Fibroids
Before planning the most appropriate treatment, some diagnostic tests are usually arranged. A transvaginal or pelvic ultrasound scan identifies the number, size and position of the fibroids. A hysteroscopy can effectively investigate the presence of fibroids distorting the uterine cavity.

Very small fibroids and fibroids are unlikely to cause a great deal of symptoms. Therefore, it is not necessary to remove them as the risk of complications outweighs the potential benefits. Sometimes it might be appropriate to treat the symptoms only, but this very much depends on other factors including age, history of subfertility and miscarriage.

Hormonal treatment
Gonadotrophin Releasing Hormone (GnRH) analogues can be given for a period of a few months to treat symptoms while awaiting surgery. When given in a continuous dose, GnRH analogues prevent the ovary from producing
oestrogens and induce a state similar to the menopause. They are usually given as monthly long acting injections.
Menopausal side effects can include mood swings, hot flushes and night sweats.

Surgery
Surgery for fibroids is not without risks and should be carefully considered. Myomectomy is the surgical removal of fibroids. This can be accomplished through hysteroscopy, laparoscopy or an open procedure which involves an incision in the abdomen. The surgical approach depends on the size and location of the fibroids. Myomectomy is normally
carried out in women who wish to conserve their uterus and to improve their fertility and pregnancy potential.

Hysterectomy is the surgical removal of the uterus and fibroids. Depending on the size of the fibroids, hysterectomy can be performed either through the vagina or an open incision in the abdomen or with ‘keyhole’ surgery (laparoscopy). The risk of hysterectomy at the time of myomectomy is approximately 1%.