Fibroids

"WOMEN'S HEALTH IS ABOUT CARING FOR ONESELF"

WHAT ARE FIBROIDS?

Fibroids are benign tumours of the uterus and are present on 30-50% of women. They occur in women of all races and backgrounds.

Fibroids arise from smooth muscle and connective tissue of the uterine muscle itself. They feel like a smooth lump in the lower abdomen just above the pubic bone.

They can occur in women as early as their late teens but are most commonly diagnosed when a woman is in her thirties or forties.

The majority of fibroids do not cause any real problem. However they are still responsible for 30% of all gynaecological hospital admissions and are the main reason for hysterectomies when they may cause heavy and irregular bleeding.

Fibroids are common in women who have hormone imbalances especially when there is too much circulating oestrogen. This can be counteracted by prescribing some natural progesterone, giving nutritional advice and counselling a woman about fibroids and reassuring them that they are benign and do not necessarily need to be removed surgically.

Very few lesions are or become malignant. Signs that a fibroid may be malignant are rapid growth or growth after menopause. Such lesions are typically a leiomyosarcoma on histology.

SYMPTOMS OF FIBROIDS

Fibroids, particularly when small, may be entirely asymptomatic. Generally, symptoms relate to the location of the lesion and its size. Important symptoms include:

Abnormal gynecologic hemorrhage
pain
Infertility
Dysuria and urinary frequency

During pregnancy they may be the cause of:

Miscarriage
Bleeding
Premature labor
Interference with the position of the fetus.

LOCATION OF FIBROIDS

Fibroids may be single or multiple. Most fibroids start in an intramural location,- that is the layer of the muscle of the uterus.

With further growth, some lesion may develop towards the outside of the uterus (subserosal or pedunculated), some towards the cavity (submucosal or intracavitary). Lesions affecting the cavity tend to bleed more and interfere with pregnancy.

Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes.

Less frequently, leiomyomas may occur at the lower uterine segment, cervix, or uterine ligaments.

FIBROID DIAGNOSIS

Diagnosis is usually accomplished by bimanual examination, better yet by gynecologic ultrasonography. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam.

In cases where a more precise assay of the fibroid burden of the uterus is needed, also magnetic resonance imaging (MRI) can be used to generate a depiction of the size and location of the fibroids within the uterus.

While no imaging modality can clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, the rarity of the latter and the prevalence of the former make it, for practical purposes, a non-issue unless evidence of local invasion is present, though more recent studies have improved diagnostic capabilities using MRI. For this reason, biopsy is rarely performed.

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