Large Fibroids

Uterine fibroids are benign tumours comprised of muscular and fibrous tissues that originally form in the womb.

Fibroids typically do not cause any symptoms, however if they do they cause: pain, anaemia due to bleeding, pregnancy complications and pressure on other internal organs due to pressing up against them.

It is unknown what directly causes the development of the tumours, however there has been correlation between the tumours forming and alterations in growth factor expression, tissue response to injury, genetic abnormalities and irregularities in the blood vessel system.

  • Fibroids tend to develop in women who have a family history of fibroids
  • Women of African heritage are two to three time more likely to form fibroids earlier in their lives (20s) in comparison to other women of other races who are more likely to develop fibroids later in their lives (30-40s).
  • Beginning your first menstrual period before the age of 10
  • Consumption of alcohol, beer in particular
  • Infections in the uterus
  • High blood pressure

Consequence of not receiving treatment:

The symptoms related to fibroids may cause anaemia due to heavy periods, fibroids pressing against other internal organs and pregnancy complications.

Some tests used to identify Fibroids are:

  • Magnetic resonance imaging¬†(MRI)
  • Ultrasound
  • Clinical examination.

There is no single best approach to uterine fibroid treatment, many treatment options exist. If you have symptoms, talk with your doctor about options for symptom relief.

Some options include:

Medication:

Medications used for uterine fibroids do not get rid of fibroids but may potentially shrink them. They can treat symptoms such as heavy menstrual bleeding and pelvic pressure as the medications targets the hormones that regulate the menstrual cycle. Medications include:

Gonadotrophin-releasing hormone (Gn-RH) agonists:

  • Block oestrogen production and progesterone therefore inducing a non-permanent postmenopausal state; in this postmenopausal state the fibroids shrink due to ceasing of mensuration, and if you have anaemic symptoms they tend to improve as well. Gn-RH is not taken longer than three to six months as it is a short term solution that raises further, more serious complications if continued longer.

Progestin-releasing intrauterine device (IUD):

  • This device only gives symptom relief caused by fibroids such as heavy bleeding, they do not cure fibroids.

Oral contraceptives or progestins:

  • May be recommended by your doctor due to their ability to assist in controlling menstrual bleeding. Your doctor may also advise you to take vitamins and iron, especially if you are experiencing anemia due to heavy menstrual bleeding.

Noninvasive procedure:

  • MRI-guided focused ultrasound surgery (FUS): is a treatment performed while you are in an MRI scanner, which provides the doctor with images of the exact location of the uterine fibroids. The treatment does not require an incision, instead the process uses sound waves to heat and eliminate small areas of fibroid tissue; the noninvasive nature of the treatment allows preservation of the uterus.

Minimally invasive procedures:

The following procedures eliminate fibroids without the need to surgically remove them.

Uterine artery embolisation:

  • Blood flow to the fibroids are cut off making them shrink and eventually die. The treatment is successful in relieving fibroid-related symptoms as well as shrinking fibroids, however complications may occur if your ovaries or other organs do not receive a rich blood supply.

Laparoscopic or robotic myomectomy:

  • A myomectomy involves the extraction of fibroids without removing the womb. For fibroids that are small and non-abundant your doctor may choose to conduct a laparoscopic or robotic procedure; small incisions are made in the abdomen in order to take out the fibroids in the womb. Robotic myomectomy allows the surgeons to have greater flexibility, precision and efficiency due to a 3D, enlarged view of the womb.

Hysteroscopic myomectomy:

  • This procedure involves your surgeon inserting surgical instruments through the vagina and cervix into the womb to remove fibroids; if the fibroids are inside the uterus (submucosal).

Endometrial ablation and resection of submucosal fibroids:

  • Surgical instruments are inserted into the womb to implement heat, microwave energy, electric current or hot water to denature the lining of the womb. This process either reduces your menstrual flow or ceases it. Only submucosal fibroids can be removed during hysteroscopy for endometrial ablation.

Traditional surgical procedures:

Options for traditional surgical procedures include:

Abdominal myomectomy:

  • Your surgeon may opt to use an open abdominal surgical procedure if you have large fibroids, deep fibroids, or an abundance of fibroids.

Hysterectomy:

  • A hysterectomy is the removal of the uterus. This procedure is a definite, permanent solution for uterine fibroids. However, the removal of the uterus means you are unable to have children.