Fibroids or leiomyomas are benign smooth muscle tumors of the uterus that occur most often in women of childbearing age. Fibroids are very common and some series of studies have estimated their incidence at 5-7%. This means that out of every 100 women, 7 will have fibroids and 3 or 4 will require surgery.
The exact cause of fibroids is not known, but we know that estrogen plays a major role in the development and growth of fibroids. The absence of fibroids shows this in postmenopausal women. But we do not know it exactly how estrogen affects fibroid growth. Besides estrogen, we have also implicated genetic factors in the development of fibroids. We know little else about the development of fibroids.
These benign tumors arise from the smooth muscle cells of the uterus. A cross section of the fibroid is likely to show whorls of smooth muscle cells arranged in a circular pattern. Fibroids can range in size from a few millimeters to several kilograms.
The major symptoms of fibroids are
1. Abnormal vaginal bleeding: This can take many forms. Women may notice heavy bleeding during menstruation or inter-menstrual bleeding. They may also have prolonged bleeding for several days. In fact, bleeding is the most common presentation of fibroids.
2. Abdominal pain: Localized pain in the lower abdomen and pelvis is a very common symptom of fibroids. The pain is usually dull or dragging and is constant. Prolonged standing may aggravate it or lifting. Sometimes, fibroids can cause severe pain in the pelvis. This is especially true during pregnancy, when under the influence of estrogen, they increase in size and can degenerate with bleeding into the fibroid. This is known as red degeneration and is associated with severe abdominal pain, fever and signs of systemic infection. But there is no systemic infection.
3. Urinary symptoms: The fibroid may exert pressure on the bladder or ureters, causing frequent urination and urinary obstruction. Obstruction of urine flow may lead to recurrent URI.
4. A pelvic mass may be palpable if the fibroid is large enough. The medical history is replete with anecdotes of fibroids weighing up to 13 kilograms and extending into the abdominal cavity.
5. Infertility: Fibroids rarely cause infertility. This is exceptionally rare and we should never attribute infertility. We have ruled to fibroids alone unless all other causes out after careful examination.
6. Recurrent abortions: Submucosal fibroids can cause recurrent abortions. I only seen this in submucosal fibroids, as other types of fibroids do not cause recurrent abortions.
We base the diagnosis of fibroids on a combination of clinical and imaging data. Based on the history of complaints, the physician will want to perform a pelvic examination. The pelvic examination is mandatory to assess the size of the uterus and also to evaluate any other coexisting pelvic disease.
A pelvic ultrasound follows it.
Ultrasound is a simple, cost-effective and very accurate way to diagnose fibroids.
Ultrasound will tell us the number, size and position of these fibroids.
Ultrasound will also be able to assess the local pelvic anatomy and any distortion of the pelvic architecture because of fibroids.
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Once fibroids are diagnosed, management depends on the patient’s symptoms and level of distress. There is no medical management of fibroids. This means that there is no medication to reduce these fibroids, and that surgery is the only option. The need to preserve fertility therefore dictated management or not. If a woman does not wish to preserve her fertility, the best option is a hysterectomy. However, if there is a need to preserve fertility, conservative measures should be taken. The measure taken in these cases is a myomectomy in which the fibroid is surgically removed. This is only a temporary measure because these myomas grow back, but it is the best thing to do in these circumstances.
