Fibroids

It is estimated that between 20-50% of women of reproductive age have fibroids. Some estimates result to 30-77% of women will develop fibroids sometime during their child bearing years, although only one-third of those are large enough to be detected.

No. In 99% of cases fibroids are benign. They are not associated with cancer and do not increase the risk for uterine cancer. On very rare occasions, a fibroid, which has increased a lot in size, may be a sarcoma, which is an aggressive but extremely rare type of uterine cancer.

Fibroid may develop in a woman with no risk factors at all. Women who are obese and of African heritage seem to be at high risk. When approaching menopause women are at greatest risk of fibroids, because of their long exposure to high levels of oestrogen.

Fibroids may be asymptomatic and found on clinical examination or ultrasound scan coincidentally. Symptoms depend on their position and size. If fibroids protrude inside the lining of the womb, they can cause heavy periods or abnormal bleeding between the periods. If they increase in size they can also cause pelvic pain. Depending on their position can cause frequent urination, low back pain or pain in intercourse. Fibroids that protrude inside the lining of the womb, block the tubes or increase a lot in size can also cause subfertility. They have also been related to miscarriages and preterm deliveries or Caesarean section.

Fibroids can be treated with:
• Symptom relief measures like anti-inflammatory drugs;
• Conservative measures, like GNRH analogue injections which lower oestrogen levels, trigger an artificial menopause and shrink fibroids. GNRH agonists can sometimes be used before surgery to make it easier;
• Surgical removal called myomectomies. Most of the myomectomies can be done laparoscopically or hysteroscopically depending on the position. This way, recovery is much quicker. Rarely when a fibroid is too big we need to proceed with a big abdominal incision;
• If fertility is not an issue then hysterectomy (subtotal or total) can be the final solution;
• Anti-hormonal agents or uterine artery embolization are alternative ways of treatment depending on the case;

Laparoscopy offers lots of advantages in comparison to open surgery. Our opinion is that If a surgery can be done laparoscopically, there is no point in doing an open incision. Hospital stay is only one day, whereas with a big incision it is 3 days. Recovery is much quicker. Incisions are really small, offering a much better aesthetic result, less blood loss, as well as minimum post operation pain and adhesion formation.

Fibroids that are placed inside the lining of the womb need to be hysteroscopically removed, irrespective of their size in women who are planning for a pregnancy. It is clear that they can cause subfertility, miscarriages and premature labour. These fibroids need to be removed either to enhance natural fertility or before an IVF treatment.