Dealing with Uterine Fibroids

By Dr Brigid Monda

The uterus, a pear shaped, muscular organ found in the pelvis, provides a warm and secure home for every baby before it’s born and helps in its delivery. Like any other organ in the human body, several problems can arise in it.

Take uterine fibroids for example; most women know so little about them or have such misconceptions that they are devastated when they are diagnosed with fibroids. And of course, there is always the fear of it being cancer.

All women are at risk of developing fibroids but they occur three to nine times more frequently in black than in white women. The actual cause for this is not known. Fibroids start to grow once menstruation begins at puberty but no one knows what triggers this. Their growth depends on the female sex hormone estrogen because they increase in size during the reproductive years when estrogen levels are high and then stop growing and shrink after menopause when estrogen levels dip.

Related to number of children

They are also more common in women who have few children or none at all because the uterus remains exposed to high estrogen levels without the interruption of pregnancy for long periods. Most fibroids do not grow during pregnancy.

Fibroids are not cancerous. They grow from the muscle cells that make up the walls of the uterus and look like the stuff cutting boards are made of. They may be very tiny or grow to the size of a football, weighing several kilos. The symptoms they present depend on their position and size.

Intramural fibroids grow within the muscular wall of the uterus and are the commonest type. Subserosal fibroids grow outwards from the wall while Submucosal fibroids grow within the uterus protruding into the uterine cavity. The latter are least common but they cause the most severe symptoms. Pedunculated fibroids grow on a stalk and hang within the cavity of the uterus or outside it.

Most women develop symptoms in their late 30s or 40s but this can happen as early as a woman’s 20s. Not all women with fibroids will have symptoms. In fact most women only discover that they have fibroids when they start causing trouble or when they have gone in to see the doctor for something totally different.

Common symptoms

Heavy bleeding is the most common problem caused by fibroids and, thus, severe anaemia requiring transfusion. They cause heavy bleeding by interfering with the muscular contractions of the uterus that help it control bleeding during a woman’s period. Fibroids also dilate and engorge the veins in the uterine walls making the bleeding heavier with clots and severe cramping.

Large fibroids cause heaviness, bloating, and discomfort in the pelvis and may compress nerves, causing pain in the legs, flanks and back. Fibroids can also block the outflow of urine from the bladder, forcing the woman to empty her bladder frequently, especially at night. If this obstruction is not relieved, it can eventually cause kidney damage. Fibroids can also cause pain when passing stool, constipation, and even intestinal obstruction if they are large enough.

There’s severe pain if the stalk of a Pedunculated fibroid gets twisted, cutting off its blood supply, or if a fibroid degenerates or gets infected. Submucosal fibroids can also cause miscarriages and infertility.

Treatment options

When fibroids are small, no treatment is required. The woman can be seen by her doctor regularly just to ensure that the fibroids are not growing and they will shrink when she gets to menopause. It is only when fibroids cause severe bleeding; interfere with fertility, cause severe pain and pressure symptoms or when they start growing rapidly that something has to be done.

There are NO drugs that can cure fibroids. The only absolute cure for fibroids is their surgical removal. The fibroids alone may be removed if the woman still wants to have children or wants to preserve her uterus because the uterus has great psychological significance for many women, especially in some cultures.

A myomectomy is the surgical removal of only the fibroids from the uterus, but fibroids can grow again after this. A hysterectomy is the surgical removal of the whole uterus with the fibroids and is the treatment of choice if the woman has had her family.

There are some hormonal preparations available to shrink fibroids and make them easier to remove, and these are usually prescribed for women preparing for a myomectomy because the fibroids immediately start growing once these drugs are stopped and attain their original size within four months of stopping the hormonal treatment. There are no natural remedies for fibroids.