Has a routine US-scan showed that you have benign nodes in your uterus? Most probably, these are uterine fibroids. Classification of fibroid types is based on locations of the nodule, its size, growth pattern, etc. Uterine fibroids treatment may involve conservative methods, as well as surgery. We will discuss in more detail uterine fibroids treatment options and diagnostics procedures below.
Fibroids (myomas or leiomyomas) are non-cancerous tumors of muscle tissue in the uterus. They may occur when a single muscle cell in the wall of the uterus multiplies and grows to form a noncancerous tumor. They may change the shape or size of the uterus and sometimes the cervix as well (lower part of the uterus). Women often develop more than one fibroid tumor but single fibroids are possible too. The location, size, and number of fibroids determine whether fibroids cause symptoms or require treatment.
FIBROID TYPES AND WHERE UTERINE FIBROIDS ARE FOUND?
They are normally found in or around the body of the uterus. Sometimes they can be found in the cervix.
There are 3 main types of fibroids based on where they are found:
- Subserosal: In the outer wall of the uterus (55%)
- Intramural: In the muscular layers of the uterine wall (40%)
- Submucosal: They protrude into the uterine cavity (5%)
Fibroids can also be connected to the uterus by a stalk or attached to nearby ligaments or organs (bladder and bowel). They are rarely found outside the pelvic cavity.
CAN FIBROIDS DECREASE FERTILITY?
Statistics show that approximately 5% to 10% of infertile women have fibroids. The size and location determines whether fibroids affect fertility. Some examples include fibroids that are inside the uterine cavity (submucosal) or very large fibroids (>6 cm in diameter) within the wall of the uterus (intramural). Most women with fibroids will not be infertile. Women who have fibroids and their partners should be evaluated by a fertility specialist to find other problems with fertility before fibroids are treated. A fertility specialist can also help assess if fibroids are affecting conception.
There are a few ways of how uterine fibroids can reduce fertility:
- Changes in cervix shape may affect the number of sperm that may enter the uterus
- Changes in the shape of the uterus may affect the movement of the sperm or embryo
- Fallopian tubes may be blocked by fibroids
- They can directly impact the size of the lining of the uterine cavity
- Blood flow to the uterine cavity maybe affected (this decreases the ability of an embryo to implant onto the uterine wall or to develop)
SYMPTOMS OF UTERINE FIBROIDS
- Heavy, prolonged menstrual periods and unusual monthly bleeding sometimes with clots (this can lead to anaemia)
- Pelvic pain and pressure
- Pain in the back and legs
- Pain during sexual intercourse
- Bladder pressure leading to a frequent urge to urinate
- Pressure on the bowel (leading to constipation and bloating)
- Abnormally enlarged abdomen
UTERINE FIBROIDS TREATMENT OPTIONS
DRUGS THAT BALANCE YOUR HORMONES
Gonadotrophin-releasing hormone analogues (GnRHas) can reduce the levels of oestrogen in your body. They work to shrink or temporarily halt fibroid growth. GnRHas can be taken as:
- A nasal spray
- A monthly injection
- An implant under your skin
One course of treatment usually lasts for about 3 to 6 months. This is due to the fact that the drugs can often cause menopause-like symptoms such as:
- Hot flushes
- Vaginal dryness
- Decreased bone density
As soon as the treatment stops, you may start trying for a baby. Once hormone therapy stops, fibroids often continue growing. However, they can be useful for shrinking fibroids before surgery. Hormone replacement therapy (HRT) may be administered alongside to ease the side-effects.
AN OPERATION TO REMOVE THE FIBROID
Myomectomy is a surgical operation to remove the fibroid. Keyhole surgery using a laparascope or hysteroscope can be carried out for small fibroids. The type of keyhole surgery used will depend on whether the fibroid is on the outer or inner lining of the uterus. For larger fibroids, open surgery is used and it involves a longer recovery time than keyhole surgery. Women who still plan to have children will be offered to use this treatment method because it leaves the uterus intact. With that said, about 1 in 4 women find that their fibroids grow back again after about 3 years. This procedure is not suitable for all women as it depends on the size, number and location of the fibroids.
REMOVING THE LINING OF THE UTERUS
Endometrial resection or endometrial ablation is a non-surgical procedure. This is suitable for the treatment of submucosal fibroids (which have grown in the inner layer of the uterus). The endometrial tissue will be removed from the inner lining of the uterus where the fibroid is growing. Your endometrial tissue will grow back and then you can start trying for a baby once the treatment has been completed.
CUTTING OFF THE FIBROID’S BLOOD SUPPLY
Uterine artery embolisation (UAE) is a procedure carried out by a radiologist. It is best performed using a magnetic resonance imaging (MRI) scan. This scan can show in detail where the fibroid is and the blood vessels that feed it. A plastic plug is injected into the vessel to cut off the blood supply to the fibroid which will shrink it (often to more than half its size and it may disappear altogether). One in 10 women need a repeat treatment at one year and this number rises to 1 in 4 within five years. If you’re planning to have children afterwards, myomectomy may be a better option for you. More research is required to ensure that UAE is suitable for women wishing to protect their fertility.
DESTROYING TISSUES OF THE FIBROID
Myolysis is the procedure carried out with keyhole surgery using a laparoscope or hysteroscope. The method used will depend on whether the fibroid is inside or outside your uterus. During this procedure, ultrasound or magnetic resonance imaging (MRI) scans are used to locate the fibroid. Needle probes or an electric current are sent into the fibroid and cauterises both the fibroid and the blood vessels around it.
DIAGNOSING UTERINE FIBROIDS
- History taking and physical examination: You will be asked questions about the symptoms that you have and family history by your doctor. You will also be checked-up for any irregularities or lumps in the uterus. According to your symptoms and results of the examination, your doctor may order further investigations.
- Ultrasound: This may help to find out location of the fibroids and differentiate them from cysts, tumours and other growths that you may have.
- Hysteroscopy: This enables your doctor to check the inside of your uterus through a viewing tube that will be inserted through your vagina. Submucosal fibroids can be detected during a hysteroscopy.