Fibroids, medically known as myoma, are a common condition and occur in about 30% of women in their childbearing years. As many as 8 in 10 women may have fibroids by the time, they are 50 years old. These growths are generally harmless, but can cause problems if they grow larger, cause pain or lead to infertility. These non-cancerous growths result from excessive fibrous muscle growth in the uterus and range in size from ‘seedlings’ to large masses. They may grow larger or shrink in size but hardly disappear.
Although the chances of fibroids turning cancerous are very low, it is best to keep an eye on those that grow rapidly. It is advised that women undergo scans every 6-12 months to monitor the fibroids and detect any abnormalities.
No one knows what causes fibroids to grow, but female hormones are believed to play an important role in promoting their growth. They usually shrink after menopause when oestrogen levels fall. Women who are more likely to have fibroids include those who experienced early menstruation (before the age of 10), have never been pregnant or who have a family history of fibroids.
Fibroids can occur in several places in the uterus, and depending on size, number and location, can cause different problems. It is also possible to have more than one type:
- Intramural fibroids are the most common type. They grow within the wall of the uterus and are usually asymptomatic unless they are very large
- Subserosal fibroids grow on the surface of the uterus. If they grow larger, they can put pressure on nearby organs and cause pain or frequency of urination or constipation
- Submucosal fibroids grow underneath the uterine lining and can intrude into the uterine cavity. This can result in heavy painful bleeding and other complications such as anaemia and infertility
- Pedunculated fibroids grow on small stalks inside or outside the uterus and symptoms depend on size and location
Whether or not you intend to remove your fibroids depends on several factors. Those that do not cause symptoms may only require close monitoring, while problematic fibroids that cause heavy and/or painful periods, infertility, abdominal pain, frequent urination, urinary infection and constipation may require removal.
Types of treatment
Surgery is often recommended to remove symptomatic fibroids. There are two main forms: myomectomy to remove the fibroids only, or hysterectomy to remove the entire uterus, fibroids and all. It is recommended that women of childbearing age undergo a myomectomy, as it preserves the uterus. In rare cases, a hysterectomy may be needed if surgery reveals that the uterus is too overgrown with fibroids for a safe myomectomy. There are different forms of myomectomy:
- Laparoscopic myomectomy is a minimally invasive surgical operation that uses a laparoscope – a thin tube-like device through which a camera, cutting tools and other equipment can be inserted. This approach is suitable for removing pedunculated fibroids and small subserosa fibroids that do not grow too deeply into the uterus. During surgery, the fibroids are cut away, put into a bag and cut up into smaller pieces so that the fibroids can be removed through the small openings with the laparoscopic instruments. The total recovery time is usually faster than with open surgery as there is less pain from the smaller incisions.
- Laparotomy means open abdominal surgery which is recommended for fibroids that are very large or deeply hidden within the muscles or when there are numerous fibroids. The recovery time is usually longer as there is a bigger incision. However, repair of the uterus is made directly and thus is tight and possibly stronger functionally.
- Myomectomy is a generally safe operation, with very low risk of complications. However, as with all surgeries, there can be complications. In very rare cases, there may be infection of the uterus or scar tissue formation leading to pain or infertility. Rupture of uterine scars in late pregnancy or during delivery is a serious condition which can cause severe damage to both mother and child. A myomectomy should not be performed during a caesarean section as there is a risk of excessive bleeding.
After a myomectomy, the troublesome symptoms caused by your fibroids will likely go away. However, it is important to monitor for any recurrence. Because fibroids commonly regrow, women who have had myomectomies to increase their chances of conception should ideally start trying to get pregnant as soon as recovery from surgery is complete. Research indicates that the uterine lining and uterine size return to normal within 12 weeks and conception can take place after that. However, for maximal scar strength, a period of 6 months is usually advisable.