Uterine fibroids are the most common tumours in women of reproductive age group with a prevalence of approximately 30%.

They are benign growths of smooth muscle and connective tissue anchored in the muscular wall of the uterus, whose growth rate is influenced by oestrogen, growth hormone, and progesterone.

Uterine fibroids are the most common tumours in women of reproductive age group with a prevalence of approximately 30%.

There are four different types of fibroids,

• Submucosal fibroids- These protrude into the uterine cavity
• Subserosal fibroid (distort the contour of the outer surface of the uterus and project outside of uterus

• Pedunculated submucosal/subserosal fibroids (are attached to the uterus by a stalk)
• Intramural fibroids (are entirely within the wall of the uterus)

The incidence of fibroids increases with age , fibroids develop during reproductive years, they have tendency to enlarge during pregnancy and reduce in size by once women reach menopause

Not all women with fibroids are symptomatic. Fibroids can impact fertility and often cause problems in pregnancy.

What do uterine fibroids feel like when you have them?

In majority of women, symptoms are minimal and no treatment or intervention required.

In women, who are symptomatic, it can cause significant burden to their quality of life.

How fibroids affect women?

When symptomatic, majority of the time fibroids cause significant burden to quality of life. They include following,

How fibroids affect women?

When symptomatic, majority of the time fibroids cause significant burden to quality of life. They include following,

1. Heavy menstrual bleeding
2. Urinary frequency or difficulty in passing urine
3. Difficulty in emptying bowel
4. Symptoms secondary to low iron levels (anaemia)
5. Abdominal pain
6. Subfertility
7. Cosmetic disfigurement because of large fibroids

When symptomatic, uterine fibroids can be linked to at least three problems

• Uterine bleeding complaints (heavy menstrual cycles, irregular bleeding, abdominal or pelvic pain and anaemia)

• Effects due to fibroid volume and bulk
• Pregnancy complications, including difficulty to conceive, increased risk of miscarriage, and complications later in the pregnancy, such as preterm birth

Diagnostic modalities

If fibroids are massive, then they can be easily determined by simple clinical examination

The understanding of exact location can be achieved by

– Pelvic ultrasound
– MRI scanning
– Rarely CT scan

Treatment options

The main objective of treatment is to relieve symptoms, if subfertility is attributable to fibroids (submucous), then its removal may be required.

Once uterine fibroids have been diagnosed the choice of treatment depends on the age of the patient and her desire to preserve fertility and avoid surgical interventions such as hysterectomy.

The mainstay of therapy for uterine fibroids is surgery (with hysterectomy as the most invasive option); other interventional procedures are myomectomy, uterine artery embolisation,

Currently, therapeutic modalities are intended to reduce or eliminate uterine fibroid symptoms through the following options

• Reduction of the amount of uterine bleeding
• Reduction of the size of fibroids
• Removal of the uterine fibroids or uterus

The choice of therapy is influenced by the patient’s symptom severity, tumour characteristics (e.g. volume and localisation), age, uterine preservation wishes, and fertility preservation wishes.
An array of various therapies is available to manage uterine fibroids.
These fall into two main categories

• Medical treatments
• Surgical treatments

Medical treatments

Anti-inflammatory medications

Reduce the production of prostaglandins, which are linked to heavy periods, so bleeding becomes lighter

Tranexamic acid

Help blood to clot in the tiny womb vessels, so that the bleeding becomes lighter

Combined oral contraceptives

Contain the hormones, oestrogen and progestogen which slow the growth of the womb lining, so bleeding becomes lighter.

Gonadotropin releasing hormone analogues (GnRH agonists)

Injections which suppress the hypothalamic-pituitary-gonadal axis and so shrink fibroids and reduce menstrual bleeding.

Levonorgestrel-releasing intrauterine system (LNG-IUS)

A small, plastic device is placed in the womb and slowly releases a progestogen-based hormone (levonorgestrel) stopping the lining of the womb from growing quickly, so bleeding becomes lighter

Ulipristal acetate

Tablets that reduce the size of fibroids by preventing their cells from multiplying – and causing these problems cells to self-destruct. These tablets shrink fibroids and bleeding becomes lighter

Surgical treatments
Myomectomy
A surgical operation to remove fibroids from the wall of the womb:

• May be considered instead of a hysterectomy, particularly for women who still wish to have children
• May be performed via a small cut in the abdomen (‘keyhole surgery’)
• Not always possible – depends on the size, number and position of the fibroids

Uterine artery embolization (UAE)

A non-surgical alternative to hysterectomy and myomectomy for treating fibroids

• Here small particles are injected with the help of X-rays into the blood vessels that take blood to the uterus
• This blocks blood supply to the fibroids, causing them to shrink

Latest techniques

The latest techniques use magnetic resonance imaging (MRI) to guide small needles into the centre of the fibroid being targeted

• Laser or ultrasound energy is passed through the needles to destroy the fibroids
• Cannot be used to treat all types of fibroids

Long-term benefits and possible risks are still being investigated

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