What are uterine fibroids?

Uterine fibroids, known as leiomyomas, are non-cancerous growths within or on a woman's uterus. They may be minuscule (the size of a pea) or occasionally similar to a large grapefruit.

The ovaries produce oestrogen, the female reproductive hormone. Fibroids typically form during a woman's reproductive years, from approximately age 16 to 50, when oestrogen levels peak.

These growths tend to diminish in size when estrogen levels decrease, as seen after menopause, when a woman's menstrual cycles cease.

What are the types of uterine fibroids?

Fibroids can appear anywhere within the uterus and can vary significantly in size, ranging from being as small as a pea to as large as a melon. They can be categorised into three main types:

1. Intramural fibroids: The most common type of uterine fibroid that forms within the muscular wall of the uterus.
2. Subserosal fibroids:These fibroids develop on the outer wall of the uterus, extending into the pelvic area and sometimes growing quite large.
3. Submucosal fibroids: These fibroids originate in the muscle layer beneath the inner lining of the uterus and can protrude into the uterine cavity.

Additionally, some subserosal and submucosal fibroids are connected to the uterus by a slender stalk of tissue, and these are referred to as pedunculated fibroids.

What are the risk factors for uterine fibroids?

The exact cause of uterine fibroids is not fully understood. However, several risk factors may increase the risk of developing uterine fibroids.

• Early menarche: Below the age of 10 years old.
• Endocrine factors: Exposure to diethylstilbestrol during pregnancy.
• Obesity: Being overweight or obese may increase the risk of developing fibroids.
• Diet: Excessive consumption of beef and other red meat.
• Alcohol: The consumption of beer seems to be linked to a higher likelihood of developing fibroids.
• Genetics: There is evidence suggesting the existence of specific susceptibility genes that may play a role in the development of fibroids.

What are the symptoms of uterine fibroids?

Many women with uterine fibroids are asymptomatic (have no symptoms), although certain symptoms may be experienced, for example:

• Heavy or prolonged menstrual bleeding
• Painful periods
• Painful sexual intercourse
• Frequent urination
• Constipation

Fibroids are more likely to cause symptoms when they are large, when multiple fibroids are present, or when located in specific areas within the uterus. The symptoms associated with fibroids often improve when a person reaches menopause and no longer experiences menstrual periods.

How are uterine fibroids diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

• Ultrasound: This is the most common test used to diagnose uterine fibroids. This is a non-invasive imaging procedure that utilises a probe emitting high-frequency sound waves to generate a visual representation of the inside of your body.
• Hysteroscopy: This procedure involves inserting a small camera into the uterus through the cervix to look for fibroids.
• Magnetic resonance imaging (MRI): This is the most effective imaging technique for accurately visualising the size and location of all uterine myomas. It also can differentiate between various uterine conditions, such as leiomyomas, adenomyosis, and adenomyomas, providing valuable diagnostic information.

How are uterine fibroids treated?

Treatment for fibroids may not be required if you are asymptomatic (do not experience any symptoms) or if you only have mild symptoms that do not significantly disrupt your daily activities.

Nonetheless, if fibroids persist, your doctor might recommend some of the following treatment options.

Medications for symptoms

• Antifibrinolytic medication such as Tranexamic acid tablet: This medication helps blood to clot in order to reduce blood loss. It is not advisable to take antifibrinolytic medications concurrently with hormonal birth control without the approval of your doctor or nurse. Combining these medications may heighten the risk of blood clots, stroke, and heart attack.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen may also be taken from the first day of one's period until the bleeding stops or reduces to manageable levels. These work by lowering one's body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods.

• Levonorgestrel intrauterine system (LNG-IUS): A small device that is placed in your womb to slowly release the progestogen hormone levonorgestrel, which stops the womb lining from growing quickly.

• Hormonal birth control: Encompass options such as the birth control pill, skin patch, vaginal ring, contraceptive shot, hormonal intrauterine device (IUD), and implant. These methods are effective in reducing menstrual bleeding, alleviating cramps, and mitigating menstrual pain. Additionally, they can help correct anaemia associated with heavy periods. It is worth noting that it may take up to three months after initiating hormonal birth control for menstrual bleeding to improve.

• Gonadotropin-releasing hormone analogues: It can cause the ovaries to temporarily stop producing estrogen and progesterone. This reduction in hormonal production can help reduce heavy menstrual bleeding.

Surgery

Surgery may be suggested if your symptoms are severe and medication has been ineffective. The main surgical procedures used to treat fibroids include:

• Hysterectomy: A procedure to remove the uterus. It may be recommended if one has large fibroids or severe bleeding and does not wish to have any more children.

• Myomectomy: A myomectomy is a surgical procedure to remove fibroids from the uterine wall. It is often considered an alternative to a hysterectomy, especially if you desire to preserve your fertility and have children in the future.

Non-surgical procedures

Non-surgical procedures are also available to treat fibroids. They include:

• Uterine artery embolisation (UAE): A procedure done to block blood supply to the fibroids.

• Endometrial ablation: A procedure done to destroy the lining of the uterus, but it does not shrink the fibroids. It may help to reduce heavy menstrual bleeding due to fibroids.

What will happen if fibroids are left untreated?

While most uterine fibroids do not cause significant health problems, it is crucial to seek medical attention if you suspect you have uterine fibroids or are experiencing symptoms.

The probability of complications depends on various factors, including the location and size of the fibroids. Large fibroids may be a cause for infertility.

Fibroids may cause complications during pregnancy, such as premature labour, preterm birth, and foetal malpresentation. They may also increase the risk of miscarriage.

Read more: Fibroids vs Cysts: How Do They Differ?

Make an appointment at Pantai Hospitals

Discussing the best treatment option with your healthcare provider is essential to determine what is most appropriate for you.

A dedicated and expert team of Obstetricians and Gynaecologists at Pantai Hospital is available for consultation to provide the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions regarding your reproductive health.

For health screening appointments, please contact the Health Screening Centre at your nearest Pantai Hospital.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.