What is fibroid?
Tumors that grow in the uterus, the organ that houses a growing baby in women, also known as the womb.
Other names for fibroid include: uterine myoma, leiomyoma,fibromyoma.
Is fibroid a type of cancer?
No, in more than 99% of cases it is not cancerous and does not increase the chances of cancer but a few may undergo some changes and become cancerous (leiomyosarcoma), however, this is rare.
How common is fibroid?
Very common especially among Nigerian women.
Most commonly seen tumor of the female reproductive system.
More than 80% of women over 25 years have fibroid even if it is as small as a seed.
What Causes fibroid?
Increased amount of oestrogen, one of the hormones in women responsible for development of female secondary sexual characteristics like breast development and fat distribution in the breast, hip, etc.
What are the risk factors?
Genetics-commoner in Africans.
Hormonal imbalance-which favours increased oestrogen.
Exogenous oestrogen- use of synthetic (artificial) oestrogen, e.g.hormone replacement for women undergoing menopausal symptoms.
Heredity- higher risk if one’s mother or sister has fibroid.
Early age at starting menstruation-longer period of exposure to natural oestrogen.
Types of fibroid
It may be as small as a seed or very large that it mimics pregnancy.
It can be single or multiple.
Based on location;
Subserous type-beneath the outermost layer of the womb (serosa), this means this type attaches to the outside of the uterus.
Interstitial-within the muscle of the womb itself.
Submucus- beneath the inner layer of the womb (mucosa). This is the mostly implicated in uterine bleeding and infertility.
What Are the likely symptoms?
Heavy or prolonged menstrual bleeding.
Abdominal swelling or mass.
Symptoms from pressure of the mass on close structures e.g.
Constipation – from compressing the rectum (a part of the intestine).
Oedema-swelling of the leg.
Varicose veins-distension of veins on the legs.
Back pain- compression of nerves at the back.
Do fibroids cause infertility?
It can increase the chances of infertility; many women have been seen to become pregnant despite having fibroid.
How do fibroids affect fertility?
It may block the path sperms will swim through to fertilize the egg.
It may compete for space with the fertilized egg for implantation (submucus type).
Can fibroid affect pregnancy?
It does not ususally cause problems in pregnancy especially if small. However, it may cause the following;
Increased risk of malpresentation-this is when a baby is not in head down position during labour usually in large fibroids such that there is little or no room for a baby to turn.
Abnormal location of placenta.
Bleeding after delivery.
Reduced growth of the baby while in the womb.
How is the presence of fibroid confirmed?
Abdominopelvic examination-the doctor examines the abdomen for any swelling or mass
Magnetic resonance imaging.
Hysteroscopy-direct visualization of the cavity of the womb to see the fibroid.
Endometrial biopsy-surgical removal of part of the tumor and sending it to pathologists who confirms it is fibroid by looking at it under a microscope.
Blood tests- to detect if there is anemia (reduced blood level) from heavy menstrual bleeding.
Is fibroid treatable?
Yes, but small and symptomless ones need no treatment.
Options of treatment includes medications and/or surgery.
How does medication help?
By reducing level of estrogen thus reducing the size of the fibroid (oestrogen makes fibroid grow bigger).
Some relieve the pain associated with fibroid.
Some help in reducing the amount of bleeding.
What Are the available medications?
1.GnRh analogues-e.g. leuprolide.
Stops menstrual cycle.
Does not affect fertility once stopped.
May cause menopause-like symptoms (hot flushes, increased sweating, vaginal dryness, reduced bone density and increased risk of fractures;the latter two are rare).
2. Intrauterine devices that releases the hormone progestin.
Decrease the thickness of the lining of the womb and hence reduce bleeding.
Can cause irregular bleeding, headaches and breast tenderness.
3. Anti-inflammatory drugs e.g. mefenamic acid.
Decrease heavy bleeding.
Helps to reduce pain.
Do not affect fertility.
Help to reduce bleeding from fibroids.
what are the surgical options?
· Myomectomy- removal of the fibroid (s) while preserving the womb.it can be done via the abdomen or vagina
· Hysterectomy -removal of the whole womb usually in women who no longer desire to have children or in those whose bleeding is uncontrollable during myomectomy to save the woman’s life
· myolysis-use of electric current in laser to destroy the fibroid
· Crymolysis-destroying the fibroid by freezing it
· Uterine artery embolization- artificially blocking the blood supply to the womb thereby killing the fibroid forced ultrasound surgery-use of high energy and high frequency sound waves to destroy the fibroid
Can the fibroid recur after surgery?
Yes, but this is rare especially with the newer techniques.
Are there supplements that cure fibroids?
Seeking medical care is the best option for fibroid treatment, advertised supplements and herbs are rarely of help.
Be careful not to be extorted by people and companies that want to take advantage of you.
Dr. Yinusa Maryam Motunrayo
68 Nigerian Army Reference Hospital
Yaba, Lagos State