Fibroids are common, non-cancerous tumours that grow gradually within the muscular wall of the uterus. They consist of muscular and fibrous tissue. Usually found in women of childbearing age, they may occur singly or in groups and can vary in sizes from as small as a pea to as big as a grapefruit. Small ones may not cause problems. However the larger ones may create troubles related to uterus, as they can affect the menstrual cycle as well as fertility of a woman.
Although the main cause of formation of fibroids in uterus is unknown, they are thought to be related to an abnormal response by the uterus to the female sex hormone – oestrogen. They do not occur before puberty and usually form when the ovaries begin to increase oestrogen production. They stop growing after menopause. It has been observed that their size increases when there are increased levels of oestrogen in the body. Such a situation occurs during pregnancy, although they do not seem to be affected by the combined contraceptive pill or hormone replacement therapy.
Small fibroids rarely show any symptoms. However, the common symptoms of the presence of a larger one are:
- Abdominal pain during periods
- Prolonged menstrual bleeding
- Heavy bleeding during periods
Heavy blood loss may lead to anaemia, which may result into pale skin and tiredness. Large fibroids may distort the uterus, which can sometimes result in infertility and sometimes even miscarriages. During pregnancy, a large fibroid may cause the foetus to lie in an abnormal position. Large ones may also create pressure on the bladder, causing a need to pass urine often, or on the rectum, resulting in severe back pain. Rarely, a fibroid may become twisted and cause sudden pain in the abdomen.
Diagnosis & treatment
An examination of your abdomen and internal pelvic area is done to detect the presence of any fibroids in your uterus. Also, the doctor may ask you to get an ultrasound scanning of your uterus (hysteroscopy) done. In this process, a viewing instrument is inserted into the uterus through the cervix. A sample of the fibroid may be taken during the hysteroscopy to check whether the cancerous or not.
Small fibroids do not create much trouble, as they do not require any treatment. However, it is important for your doctor to do a regular check up to avoid any further growth. If at they need treatment, they should be removed during a hysteroscopy or by a laparoscopy. These examinations are usually conducted under general anaesthesia. Large fibroids can be removed through an incision in the abdomen. It is important that the fibroids shrink before the surgery, and thus doctors may prescribe you hormones that suppress the production of oestrogen. If you have persistent large fibroids and do not want children, you may consider the option of hysterectomy. Once they are removed, you may regain your fertility, but there are rare chances that the fibroids may recur (1 in 10 women). Usually, they sink after menopause, when oestrogen levels in the body fall.