The Facts
According to the National Women's Health Resource Centre an estimated 3 out of every 4 women have fibroids. 75% of women don’t display symptoms and thus don’t know that they have them.
Fibroids can cause discomfort ranging from mild pelvic pressure to quite severe pain, heavy menstrual bleeding, pain during sex, miscarriages and problems conceiving - problems that often cause significant emotional distress.
Fibroids are more common in women aged between 30-50 years of age and it is highly likely that patients will have more than one fibroid of various sizes.
What are Fibroids?
A leiomyoma of the uterus usually appears within the muscle and connective tissue of the uterus. They usually develop from a single smooth muscle cell that continues to grow. A patient may have one or several; sometimes they grow in clusters.
Many women find their symptoms are mild and not hard to cope with. Other women, however, may have more severe symptoms or problems associated with a leiomyoma of the uterus that make it worthwhile to consider some form of treatment. Some are conglomerate and are found in clusters of varying sizes while others develop a long pedicle and present themselves as polyps.
Women in their 30’s and 40’s are more susceptible to them. They can make the uterus bulky and irregular and some have been known to enlarge the cavity thus creating a greater area of endometrium to be shed during menstruation. During the initial stages of fibroid development, dysmenorrhea may occur as a result of the uterine’s efforts to dispel it. This could then result in the fibroid becoming necrotic, causing an offensive discharge and irregular staining, often found to be associated with cervical cancer.
Type of Fibroids
Fibroids are classified according to their location in the uterus. There are three types:
- Submucosal fibroid - grows from just underneath the uterine lining into the uterine cavity. These can cause bleeding, pain or infertility.
- Subserosal fibroid - grows from the uterine lining to the outside of the uterus and can create pressure on the bladder, bowel and intestine. These fibroids can cause bloating, abdominal pressure, cramping and pelvic pain.
- Intramural fibroid - this is the most common type of fibroid. It grows within the muscle of the uterus and can cause pressure-like symptoms and, occasionally, heavy menstrual bleeding.
Sometimes a fibroid grows from a stalk-like structure called a pedicle that sticks out from the uterus or into the uterine cavity.
Diagnosis
A leiomyoma of the uterus can be found during routine gynaecological exams. During the pelvic portion of the exam you can feel if the uterus seems larger than normal or if it extends into places it should not.
In order to rule out other uterine conditions that can be mistaken for fibroids (for example, ovarian tumours, bowel masses or early pregnancy), several diagnostic tests to help "see" the pelvic area can be performed:
- Ultrasound - High frequency sound waves are used to create a picture of the pelvic region. In a specialised ultrasound called sonohysterogram or saline infused sonography, a small amount of saltwater solution may be infused into the uterus, through the vagina and cervix, to improve visibility. Ultrasound can be performed without anaesthesia, and is an office procedure.
- Magnetic Resonance Imaging (MRI) - Is a type of imaging procedure that uses magnets and radio waves to create an image of the uterus.
- Hysterosalpingography (HSG) - Uses a special dye during an X-ray of the inside of the uterus and fallopian tubes to outline abnormalities. No anaesthesia is used. HSG is performed in a radiology suite.
- Hysteroscopy - Is a non-invasive surgical procedure that uses a thin, lighted instrument called a hysteroscope that can be inserted into the uterus through the vagina and cervix to view the uterus. Hysteroscopy can be performed as an office procedure under a local anaesthetic, or as an outpatient procedure using local or general anaesthesia. If fibroids are found, they can sometimes be removed during this procedure.
- Laparoscopy - Is a procedure that uses a camera on a thin, lighted telescope-like device, threaded through a small abdominal incision, to view the uterus, ovaries and fallopian tubes.
Treatment Options
Today there are many minimally invasive treatment options that can help patients gain control over this condition and improve their quality life. ETHICON™ Women's Health & Urology UK offer the following solutions for treating the different types of leiomyomas, which are listed on the right hand side at the top of this page.