What are uterine fibroids?

What are the symptoms of fibroids?

How do I know if I needed treatment?

What are the treatments available for fibroids?

Can fibroids be malignant?

What are uterine fibroids?

Fibroids are common benign (non-cancerous) tumours in women. Up to 25% of women of reproductive age may harbour one or more fibroids. Not all women with fibroids suffer from symptoms. Between 10-40% women with fibroid develop symptoms and requires treatments.

Uterine Fibroid Embolisation

What are the symptoms of fibroids?

Symptoms of fibroids include heavy periods, a bulky uterus and period pain.

Fibroids may distort the inner lining of the uterus and cause heavy periods, requiring frequent change of pads and tampons. You might be concerned about soiling clothing. You might feel anxious about travelling, work and exercise, limiting your work and social activities. Prolonged heavy periods may lead to anaemia. You might feel tired, worn out, as if energy has been drained out of your body. Your GP might have suggested iron supplement. Severe anaemia can cause shortness of breath, palpitation and heart failure. Blood transfusion is needed if your haemoglobin is too low.

Fibroids can make your uterus bulky. You might feel a protrusion in your lower tummy, making you feel as you have put on weight. The uterus is sitting on top of the bladder and therefore limiting the bladder capacity. You might find that you urinate more often during daytime and start to wake up to pass urine at night. You often need to rush to a toilet and sometimes you might loose control with coughing, sneezing and exercise.

Fibroid can cause period pain as well. We did not realize this until we have treated a number of women with uterine fibroid Embolisation (UFE). Many women reported substantial relief of their period pain following UFE.

How do I know if I needed treatment?

Every one is different. A thin individual might find the fibroids more noticeable than a larger person. Someone who has a sensitive bladder may have bladder symptoms with quite average sized fibroids. Fibroids are benign tumours that require treatment only when symptoms are bothering you and affecting your quality of life. Of course if the heavy periods are causing anaemia you should consider treatment.

If you are not sure, make an appointment to see your doctor or Dr Liang to discuss further.

What are the treatments available for fibroids?

The choice of treatments depends on the type and severity of symptoms, as well as size and location of fibroids. Below is a general discussion of different treatment options. For detailed description of different treatments please see specific pages.

Your GP and gynecologist might have tried different medical therapies such as non-steroidal anti-inflammatory agents (eg. Naprosyn), birth control pills, or progesterone agents. If the above failed, the decision for further medical treatment depends on your age, the size of the fibroids, the desire for future pregnancy, and the severity of symptoms. In certain circumstances a Gonadotropin Releasing Hormone (GnRH) agonist may be used. However it may cause hot flashes and mood changes and osteoporosis. The use is usually limited to 6 months. Fibroids usually regrow after GnRH agonists are stopped.

Mirena IUD (Intrauterine Device) may be helpful for heavy period. However, it does not reduce the size of the fibroids.

Emdometrial ablation destroys the inner lining with heat energy and you may no longer have any more menstrual periods. The treatment however dose not shrink the fibroid and therefore will not relieve bulk related symptoms.

Small fibroids protruding into the cavity of the uterus can be removed by hysteroscopic resection (removal with the aid of using a camera through the vagina and cervix).

Traditionally when the above treatments failed or were unsuitable, hysterectomy (removal of the entire uterus) is offered to women. However, hysterectomy is a major surgery that requires 5-6 weeks of recovery. It carries the risks of a major surgery and is associated long-term adverse effects.

Myomectomy (removal of fibroid only) is offered to women who wish to retain the uterus and fertility. It is possible only for small number of fibroids in suitable locations. It is technically more demanding to the surgeon, takes longer time to perform and more likely that you will require a blood transfusion. Sometimes myomectomy is converted to hysterectomy if the surgeon is unable to control the bleeding or reconstruct the uterus. Like hysterectomy, abdominal myomectomy takes 5-6 weeks to recover. Laparoscopic (key-hole) myomectomy is quicker to recover then abdominal myomectomy, but is technically more challenging to the surgeons to perform.

Uterine fibroid Embolisation (UFE) is a non-surgical alternative to hysterectomy. It is minimally invasive, and highly effective in reducing heavy period, shrinking the fibroids and relieving period pain. Studies have shown that UFE is as effective as hysterectomy in improving the women’s quality of life.

Can fibroids be malignant?

Malignant (cancerous) fibroids are very rare. It is called leiomyosarcoma. It is found in 2-5 per thousand hysterectomies and 4 per thousand cases of uterine fibroid Embolisation. Fear of sarcoma should not be normally construed as a reason for hysterectomy. Hysterectomy itself has a mortality rate of 0.5-4 per thousand. Other adverse effects of hysterectomy significantly outweigh the very small risk of missing a sarcoma.(See also adverse effect of hysterectomy click here). Rate of growth, size of the fibroid, utrasound and MRI cannot reliably diagnose sarcoma. Failure to respond to Embolisation, especially continuing growth and pain, are warning signs. Therefore it is important to attend imaging follow-ups after UFE.