What are the options for getting rid of fibroids?

Dear Doctor,

I am 30 years old and have recently been diagnosed with multiple fibroids which are causing heavy bleeding. I am not sure how to get them treated as I am also planning to conceive.

Answer

Nearly every woman of reproductive age in our part of the world is likely to have heard of fibroids. They are compact growths, or tumours in medical terms, that develop in the uterus (womb). It is estimated that nearly 50 per cent of women of reproductive age have fibroids, though some may never get diagnosed. Fibroids may range in size from a pea to the size of a baby’s head. They may occur singly, or in multiples within the uterus. It is important to appreciate that fibroids are considered as benign (non-cancerous).

The mere presence of fibroids does not in itself justify any treatment. Many women with fibroids experience no significant symptoms, and will usually have had incidental diagnosis of fibroids whilst being imaged for other reasons. However, some experience various symptoms that may include abnormal bleeding, pain and pressure symptoms within the lower abdomen. Rarely, there may be an association with delayed conception or miscarriages.

Treatment of fibroids must be individualised to take into account age, symptoms and future reproductive wishes. There are many treatment options that include hormonal or non-hormonal medication, surgery, interruption of blood supply to the fibroids (known as embolisation), and newer approaches that destroy the fibroids using sound waves energy.

What you immediately require is a thorough evaluation by your gynaecologist. A detailed review of the sizes of the fibroids, and where they are located, will guide treatment recommendations. As you are already experiencing heavy bleeding, some form of treatment is required. An initial trial of medications to control the bleeding is justifiable.

If hormonal medication is used, this may interfere with the timing of conception. In the course of time, it may be that surgery will be the most appropriate option for you. This involves removing the fibroids, and sparing the uterus to allow the maintenance of reproductive potential.

As women grow older and approach menopause, fibroids may stop growing and may even shrink. Those in advanced age groups may choose to wait and see rather than subject themselves to interventions that may not really be necessary. Minor symptoms can be controlled with simple measures. It is unusual for fibroids to enlarge during the menopause, or new ones to be diagnosed. If this happens, it may imply a more serious diagnosis and a thorough evaluation is usually required.

Many ask what causes fibroids and if they can be prevented? The exact cause is not known, but there appears to be a genetic influence. They also thrive under the influence of female reproductive hormones. You may not therefore completely shield yourself from ever getting fibroids.

Dr Alfred Murage is a Consultant Gynaecologist and Fertility Specialist. [email protected]