A B C D E F G H I J K L M N O P R S T U V W

FIBROIDS

What are Fibroids ?

The uterus, or womb, is found at the top of the vagina in the pelvis. It is the size of a large pear and is hollow with a thick wall of muscle. Fibroids are benign growths of this muscle wall. They can vary in size between a cherry and a large melon or even bigger. We speak of fibroids in the plural because it is more common to have a number of fibroids. As many as a hundred fibroids have been recorded at one operation. If a woman has only one fibroid, it is usually quite large. Many women do not know that they have fibroids until they are found when a smear test or check-up is done. Fibroids may cause heavy periods because they increase the size of the womb so there is a bigger area to bleed. If they grow into the hollow cavity of the womb they may cause miscarriage. They may reduce fertility. They may grow large and cause pressure on the bladder or the rectum. Sometimes they grow so big that a woman notices her clothes no longer fit properly. If a woman does get pregnant, fibroids may grow bigger during the pregnancy and give rise to pain. This may mean going into hospital for a short time but always gets better without an operation. It is very rare indeed for a fibroid to turn into cancer.

How do Fibroids occur ?

Fibroids are common and occur in about 1 in 5 women. They are more frequent as women get older but never start after the menopause. They are more common in women of African or West Indian origin and tend to occur at a younger age. They are made mostly of muscle fibres but also contain tough fibrous tissue. They sometimes grow on a stalk and project into the cavity of the womb. They may grow in the wall of the womb or they may grow through the outer surface of the womb. Fibroids only grow during the years when a woman is having periods. This suggests that the growth of fibroids has got something to do with hormones. It is not clear exactly what the relationship is.

Why do Fibroids occur ?

We know that fibroids are more common in women who have not been pregnant or only have small families. They are not caused by any particular type of birth control, although women who use the oral contraceptive pill are less at risk of getting them. There is nothing that women can do to prevent getting fibroids except avoiding delay in starting a family and perhaps using the pill for contraception.

Treatment Involved for Fibroids

Fibroids are usually first suspected because the womb feels enlarged and nobbly when a pelvic examination is carried out. An ultrasound scan is usually used to confirm the diagnosis and to check that the ovaries are normal. They can be difficult to feel because of the fibroids. If there is a fertility or miscarriage problem a x-ray or a laparoscopy may help make the diagnosis. A blood test for anaemia will be done especially if the periods are heavy. If fibroids are not causing trouble they do not have to be treated; the risk of a fibroid becoming cancerous is extremely small (less than 1 in 1000). HORMONE TREATMENT There are drugs called GnRH (gonadotrophin-releasing hormone) analogues which may prove helpful in shrinking fibroids. These drugs stop the periods completely. Once the drugs are stopped, the fibroids start to grow again. At the present their main use is to shrink fibroids prior to surgery to make surgical treatment easier. Heavy periods due to fibroids can be treated with the same drugs that are used to treat heavy periods in women without fibroids. SURGICAL TREATMENT HYSTERECTOMY (REMOVAL OF THE WOMB) This is the best treatment if there are unacceptable symptoms and one's family is complete. Even then, some women do not want to lose their womb. It is most important for you to discuss the operation with the GP and gynaecologist before the final decision is made. The ovaries do not need to be removed to cure fibroids. MYOMECTOMY This operation removes the fibroids and preserves the womb. It is the ideal operation for the woman who has to do something but wants to stay fertile. It is as big an operation as hysterectomy, but it is possible to have a baby normally later although there is an increased risk of needing delivery by Caesarean section. Occasionally small fibroids may be removed by laparoscopy (telescopic examination through the navel) or hysteroscopy (telescopic examination through the neck of the womb). A more recent treatment involves trying to block the blood supply to the fibroids by injecting small particles into the blood vessels near the fibroid under x-ray control. Once the blood supply is blocked the fibroid dies, although this may cause quite severe pain for a few days. This provides an alternative to surgery in women who want to keep their womb but the long term value and safety of this treatment is not yet known and it is only available in a limited number of hospitals at present.

During Treatment for Fibroids

HORMONE TREATMENT Patients may experience menopausal symptoms such as hot flushes and vaginal dryness. HYSTERECTOMY / MYOMECTOMY It may be necessary for a blood transfusion during the operation because quite a lot of blood may be lost. A slight fever may occur for a few days after the operation. As with any major surgery there are small risks from the anaesthetic and of developing blood clots in the leg veins. The first period should come in 4 to 6 weeks.

After Treatment for Fibroids

HYSTERECTOMY/ MYOMECTOMY Women should feel back to normal in 6 to 8 weeks. It is possible that more fibroids may grow in a few years' time. This is not the fault of the patient or the surgeon. You can start trying to conceive 6 months after the operation. If pregnancy occurs, the doctor must be told about the operation. In some cases it might make a Caesarean birth more likely.

If Fibroids are Left Untreated

If fibroids are not causing any trouble, it is quite possible that they will never do so. If there are symptoms, they may well get worse, and the fibroids may enlarge, until the menopause. Then fibroids stop growing or even shrink and the symptoms will go away. If fibroids start to grow rapidly or become painful you should see your doctor.

Effects on Family of Fibroids

Following surgery, you should not go back to work for 6 to 8 weeks. The patient's family must understand that work also means housework! There is no greater risk of daughters of patients getting fibroids.