Fibroids are common tumours of the uterus (womb) found in over 20% of young women. They are rare in women under the age of 20, most common in women in their 30s and 40s, and tend to shrink after the menopause.
There are firm ball like and may vary in size from pin point to very large. Fibroids are diagnosed by the history, gynaecological examination and sonography.
They are named according to their position in the womb and the symptoms and problems they cause, as well as their management, depend upon their location.
Although the exact cause of fibroids is unknown, they seem to be influenced by oestrogen. This would explain why they appear during a woman’s middle years (when oestrogen levels are high) and stop growing after the menopause (when oestrogen levels drop).
In the past, the contraceptive pill was thought to increase the risk of fibroids, but that was when the pill contained higher levels of oestrogen than it does today. Some studies suggest that the newer combined pill (oestrogen and progestogen) and the mini pill (progestogen only) may actually help prevent or slow the growth of fibroids.
Subserosal fibroids are those, which grow on the outer side of the uterus. These usually cause no problems unless they grow very big when they start causing pressure on the urinary bladder or intestines or start showing as a bulge in the lower part of the stomach.
Only the large serosal fibroids need to be removed. This surgery can be done by making a cut on the stomach (abdomen) which is usually a bikini scar or by the new method of keyhole, buttonhole (laparoscopic) surgery.
By both methods the tumour is removed and the gap on the womb is stitched. Nowadays even large fibroids are being removed by the laparoscopic route due to the availability of a new machine called morcellator, which reduces the tumor to small pieces.
The surgery is cosmetic as there is no large scar. Furthermore the patient has to stay in hospital only for 2-3 days.
Prevention of Fibroids
Since the exact cause of fibroids is still unknown, there are no clear guidelines to prevent them. However, there are some things you could reduce the risk:
You should keep your weight in control. This will check the oestrogen levels in your body.
You should eat plenty of green vegetables and fruit, and avoid red meat.
Some studies suggest the combined pill may protect against fibroids by keeping hormone levels from rising and falling. The pill comes with certain side effects, however, you should take it under supervision of a gynaecologist.
Symptoms of fibroids
Most of the women with fibroids do not have symptoms, therefore many women do know they have fibroids. Whether or not you have symptoms depends on the size of the fibroids and where they are in your womb. This also affects the types of symptoms you are likely to have. For example, a small fibroid in the wall of your womb probably won’t cause any problems, whereas a large fibroid growing outward from your womb might press against your bladder, causing bladder problems.
The most common symptom of fibroids is heavy and / or irregular menstrual bleeding and pain during periods. Other symptoms like abdominal pain or pressure, changes in bladder and bowel patterns and, in some cases, infertility. Recurrent miscarriages and preterm labour can happen with patients with submucous fibroids. Post menopausal bleeding may result in older ladies with submucous fibroids.
Heavy menstrual bleeding (menorrhagia)
Heavy bleeding may involve flooding (a sudden gush of blood), prolonged periods or passing large clots of blood. Heavy bleeding is not always due to fibroids, but when it is, it is usually associated with fibroids that are submuous. Although the cause of bleeding is not known it may be that the endometrial lining may be stretched creating more lining to be shred during the menses and the fibroids prevent the uterus from contracting and hence stopping the periods. Heavy bleeding can cause discomfort and hamper the day to day life.
Anaemia (iron deficiency)
Some women with fibroids and heavy bleeding develop anaemia as a result of blood loss. Anaemia can make you feel weak, dizzy and tired. If blood tests show that you have anaemia, you can take iron supplements and foods such as leafy green vegetables, dried fruit, liver etc can help increase your haemoglobin levels
Pain and pressure
Some women with fibroids experience painful periods, dull aches in their thighs, back pain or constant pressure in the abdominal area that feels like bloating or fullness.
Pain during your period may be due to large clots of blood pushing through your cervix. Cramps could also be caused by the womb trying to force out a submucous fibroid that is growing on a stalk in the cavity of the womb.
Large fibroids can make the womb big and bulky, which can lead to lower back pain or pelvic discomfort. Some women with fibroids feel a dull ache in their thighs or develop varicose veins in their legs. This happens when fibroids become so large they press on nerves and blood vessels that extend to the legs.
Occasionally, fibroids can cause sudden severe pain in the pelvic area or lower back. This may be due to a fibroid on a stalk (pedunculated) that has become twisted. This kinks the blood vessels in the stalk and cuts off the blood supply to the fibroid.
If you feel sudden severe pain and also have a fever or feel sick, you should see your doctor. The fibroid may need to be removed or your doctor may recommend bed rest and painkillers until the pain stops on its own.
Pain during sex
Fibroids that press on the cervix or hang through the cervix into the vagina can make sex painful and can also cause bleeding during sex.
Bladder and bowel symptoms
Large subserous fibroids (on the outer part of the womb) can press on your bladder or bowel, leading to one or more of the following symptoms:
Bladder: frequent urination, urgent need to urinate, often passing only a small amount, difficulty or inability in passing urine, cystitis caused by trapped urine that becomes infected. A tube, called a catheter, will be put into your bladder to empty it in cases of severe retention.
Bowel constipation and haemorrhoids (piles)
Fibroids and pregnancy
Most fibroids do not get in the way of a pregnancy. They may cause discomfort, but they generally do not cause any other problems. Some fibroids may cause infertility or can cause miscarriage. Fibroids may press against, or block the fallopian tubes, hence preventing fertilization. Submucous fibroids that grow inwards can cause recurrent miscarriage.
A fibroid can also interfere with labour and birth if it blocks the passage to the birth canal. If such a case, delivery by a Caesarean section is necessary. Fibroids may increase your risk of bleeding heavily after birth, and can increase the time it takes for your womb to return to its normal size.
Just as fibroids can affect pregnancy, pregnancy can affect fibroids. It is thought that fibroids grow during pregnancy because of higher levels of oestrogen. Another effect of pregnancy on fibroids is ‘red degeneration.’ This happens when a fibroid’s blood supply is cut off, causing it to turn red and die.
It can also happen without pregnancy but it usually seen during pregnancy. Red degeneration can cause abdominal pains and contractions of the womb, which could lead to early labour or miscarriage. If you feel these symptoms, consult your gyanecologist. The pain and contractions usually stop on their own but you may need to take drugs to reduce the pain and stop the contractions.
Fibroids are usually not removed during a pregnancy because of the risk of haemorrhage (bleeding).
Fibroids are non-cancerous tumours which if large and placed deep inside the uterus (womb) can cause heavy menstrual bleeding, pain, infertility and abortions. There is no permanent cure with medicines and removal of fibroids is the only option in a young woman like you. This can be done by Keyhole surgery (laparoscopy) in which even large fibroids can be removed through a 1-2 cm cut on the stomach (abdominal wall). If the fibroid is on the inner side of the womb, it can be shaved off with the help of a hysteroscope and this can be done without any cuts or stitches. The recovery from these surgeries is very good and hospitalization is for 1-2 days only. Some cases may require an open surgery with a 3-4 inch cut on the abdomen.
What is the reason for the heavy bleeding? Does she have large fibroids or ovarian tumour etc., in which case hysterectomy may be necessary. Hysterectomy can be done either vaginally or by laproscopy ( Key Hole Surgery) or by open abdominal surgery. It is a major surgery and though quite safe, there is a slight risk of bleeding, infection or injury to the internal organs. Recovery takes a few weeks. However for heavy bleeding without any large tumours, there are now simpler, safer and quick methods for permanent treatment such as Uterine Ballon Ablation , Microwave ablation, or use of Hormonal IUCD. All of these can be done within 15 minutes, require no hospitalization and permanently cure the bleeding problem. However the suitability of each patient for a particular procedure has to be determined by the gynaecologist.
here is a chance that you may be having fibroids in the uterus. These are solid tumours which develop in the uterus (womb) and usually occur in young women. Depending on their size and location they can cause painful and heavy periods. The other common problem is that of endometriosis where blood accumulates in the ovaries or in the pelvis or adenomyosis where blood accumulates in the womb and causes it to swell in size. All these conditions can cause painful and heavy periods.
The diagnosis can be easily made by doing a pelvic sonography, and the treatment will depend on the cause. Almost always the treatment is surgical, nowadays laparoscopic (keyhole) surgery is done to treat these problems.