Q
: What are uterine fibroids and what causes them ?
A
: Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years . Sometimes these tumours become quite large and cause severe abdominal pain and heavy periods .
We can ’ t identify the exact cause of fibroids , but their appearance is related to hormonal changes — when women reach reproductive age , they release oestrogen and progesterone hormones . The fibroids tend to grow during this time , but once the woman goes into menopause , they will shrink . That is why we believe they are hormone related , although no one actually knows the exact cause .
If your mother or sister has uterine fibroids , then your chances of getting them are higher . The earlier the onset of your menstruation , the sooner you are at risk . Black women are more likely to develop them , as are those who are overweight or obese .
Most times , there are no symptoms ; however , if the fibroid is in a location where it ’ s very near to the womb cavity , it will cause heavy menstrual bleeding . Sometimes , if it becomes too big and is at the front of the cavity , it will compress on the bladder and cause frequent urination or even difficulty in emptying the bladder . If it ’ s at the back , it might compress on the bowel and cause constipation or even backache .
Q
: How are they diagnosed and treated ?
A
: When a woman has symptoms or is pregnant , she should come for a pelvic ultrasound . That is usually when uterine fibroids are first detected . The fibroid itself will rarely cause pain . Most of the time , small fibroids will not cause any symptoms , and you will not require any treatment . In such cases , we will probably just monitor them . If the fibroid causes
bleeding and is very large — usually if it ’ s above 5cm — we might advise the patient to have it surgically removed . This is especially the case when the patient is trying to get pregnant . There are some other forms of treatment in terms of hormone injections , but those are usually just temporary and cannot be used for the long term because they will cause other side effects .
There is a new treatment called focus ultrasound that uses heat to destroy the fibroid . Another non-surgical option is uterine artery embolisation , which cuts off the blood supply to the fibroid , causing it to shrink . We don ’ t usually recommend this if you are trying to get pregnant .
Q
: What if there are undiagnosed fibroids when a woman is trying to conceive ?
A
: If she has a submucosal fibroid in the middle muscle layer , or myometrium , of the uterus , it might distort the cavity and make it difficult to get pregnant . Definitely you will need to surgically remove it in such cases . If you manage to get pregnant while there is a fibroid , usually it doesn ’ t cause symptoms . Very rarely , however , it can cause red degeneration of the fibroid when it is quite big , resulting in abdominal pain , vomiting and fever , and sometimes it might affect the position of the baby . If you are trying to achieve normal delivery , and the fibroid is very large , it might prevent the head from turning down and affect the chance of normal delivery .
Dr Tan Chong Seong
Dr Tan Chong Seong is a consultant obstetrician and gynaecologist and fertility specialist at Alpha IVF and Women ’ s Specialists in Kuala Lumpur .
8 JUNE 2021 GlobalHealthAsiaPacific . com