Pearl obstetrics | gynaecology


Fibroids

  • fibroid womb uterine
    Fibroids
    Several different types - several ways of managing fibroids

Fibroids

Fibroids are benign muscular growths in the wall of the womb. They can be single or multiple, small or large. Half of women develop fibroids by the age of 50 years. They are often symptom-free if they are small. Women who have 1 or 2 small fibroids and have no symptoms probably don’t need anything more than observation (with yearly examinations to check they haven’t grown.)

 

Who gets fibroids?

  • Age. Fibroids become more common as women age. After menopause, they shrink.
  • Family history. Having a family member with increases your risk.
  • Ethnic origin. Black women are much more likely to develop fibroids.
  • Obesity. Women with higher BMIs are at higher risk.

 

Where do fibroids grow?

Most grow in the wall of the womb, although some are attached on stalks. Their position varies:

  • Submucosal fibroids grow into the cavity of the womb.
  • Intramural fibroids grow in the wall of the uterus.
  • Subserosal fibroids grow on the outside of the womb.
  • Pedunculated fibroids grow on stalks that grow out from the surface of the womb, or in the cavity of the womb.

 

Fibroid symptoms

Many small fibroids do not cause any symptoms. However, some symptoms are:

  • Heavy periods or painful periods
  • Feeling of fullness in the pelvis
  • Swelling of the tummy
  • Frequent peeing caused by the fibroid pressing on the bladder
  • Pain during sex
  • Lower back pain
  • Infertility
  • Problems during pregnancy and labour – the fibroid can get in the way of the birth and there can be heavier bleeding afterwards

 

What causes fibroids?

No one knows for sure.

  • Hormonal effects definitely cause pre-existing fibroids to grow or shrink.
  • Genetic predisposition.
  • Age – as you get older, fibroids are more likely. They do shrink after the menopause.

 

Can fibroids turn into cancer?

Fibroids are almost always benign. Rarely a cancerous fibroid called a sarcoma occurs. These sarcoma cancers are probably not from an already-existing fibroid. Fear of cancer should not be a reason for having surgery when there are fibroids.

 

Pregnancy and fibroids

Women with fibroids are more likely to have problems during pregnancy and birth. The most common problems seen are:

  • Cesarean section or C-section. The risk is increased greatly, for the reasons below.
  • Baby is breech or transverse because the fibroid blocks the pelvis.
  • Labour fails to progress.
  • Premature delivery.
  • Bleeding after the birth – this is because the womb can’t contract down properly.

 

Diagnosis of fibroids

  • Pelvic examination
  • Ultrasound or 3D ultrasound
  • Magnetic resonance imaging (MRI) – the gold standard
  • CT scan
  • Sonohysterogram
  • Laparoscopy
  • Hysteroscopy

 

How are fibroids treated?

For women who do have symptoms, there are treatments that can help. Factors influencing the decision are:

  • Symptoms
  • If you might want to become pregnant
  • Size
  • Location
  • Age and how close to menopause you are

 

If you have small fibroids but no symptoms, you are likely not to need treatment. Regular checks to see if they have grown are a good idea. This can be done with ultrasound or simple examination using the hands to assess size.

 

Medications

  • Ibuprofen, paracetamol and other painkillers.
  • Tranexamic acid to control any heavy periods.
  • Iron if you’re anaemic.
  • Low-dose contraceptive pills can be useful.
  • Mirena is useful to control periods, if the cavity of the womb is regular. It may also inhibit fibroid growth in some cases.
  • Zoladex injections are used short-term to shrink fibroids before surgery to make surgery safer. Expensive.
  • Ullipristal is a new medication that shrinks fibroids short-term before surgery. It’s not available in Australia yet.

 

Surgery

  • Myomectomy Surgery to remove fibroids, leaving the womb in place, for women who want to get pregnant. You would usually need a Cesarean section (C-section) to deliver your baby when you get pregnant. Myomectomy can be performed with an open incision, by laparoscopy or by hysteroscopy.
  • Hysterectomy Removal of the uterus. This can be a total hysterectomy or subtotal hysterectomy which conserves the cervix. This surgery is used when the fibroids are large, the woman is near or past menopause, or the woman does not want children in the future. 
  • Endometrial Ablation The lining of the womb is destroyed to control heavy bleeding. Minor surgery. Half of women who have this procedure have no more menstrual bleeding.
  • Uterine Artery Embolisation (UAE) A thin tube is threaded through the blood vessels in the groin into the vessels that supply blood to the fibroid. Plastic particles are injected, blocking the blood supply to the fibroid, causing it to shrink. It’s painful, but will shrink the fibroid by 30-50% over a period of several months. It’s only suitable for fibroids buried within the wall of the womb. Submucous or subserosal fibroids that are embolised may “rot off”, leading to severe complications with sepsis & death reported. Pregnancy is not recommended afterwards as there can be major complications resulting such as invasive placenta, severe fetal growth retardation & pre-eclampsia. UAE is not a “simple” option, despite often being presented as such. Myomectomy is the only suitable procedure for women who want to conserve their fertility and have a safe pregnancy.

Uterine | womb fibroids

Call us for assessment of fibroids, or removal using keyhole surgery.


PEARL obstetrics | gynaecology

Our office is situated opposite Glengarry Private Hospital in Perth. We provide easy free parking. We're easily accessible from Joondalup, Hillarys, Stirling, Currambine, Ocean Reef, Beldon, Connolly, Edgewater, Wanneroo, Burns Beach, Sorrento, Padbury, Marmion, Watermans Bay, North Beach, Karrinyup, Gwelup, Carine, Balcatta, Westminster, Mirrabooka, Malaga, Hamersley, Koondoola, Girrawheen, Marangaroo, Greenwood, Warwick, Madeley, Darch, Wangara, Kallaroo, Craigie, Heathridge, Woodvale, Scarborough, Doubleview, Innaloo, Osbourne Park, Wembley Downs, Tuart Hill, Trigg, North Beach. The Western suburbs (Cottesloe, Claremont, City Beach, Floreat, Swanbourne) are all within easy reach.