Types

The three fundamental kinds of fibroids are: Subserosal fibroids - when they develop near the outer coat of the uterus and extend into the tummy. Intramural fibroids - when they develop within the muscle of the womb without extending predominately into the womb cavity or tummy. Submucosal fibroids - when they develop inside the womb.

Symptoms

• Abnormal uterine bleeding

• Compression of adjacent organs by large fibroids - this may cause symptoms including:

  1. Painful sex, pelvic pain, or discomfort.

  2. Constipation and abdominal cramps, or urinary symptoms (frequency, or retention).

  3. Very large fibroids may occasionally cause kidney damage.

• Infertility (low incidence):

  1. Submucosal fibroids - distortion of the uterine cavity causes a 70% reduction in pregnancy rates compared with women who do not have fibroids. 

  2. Intramural fibroids — may reduce pregnancy rates.

  3. Subserosal fibroids — do not appear to significantly reduce rates of pregnancy.

• Problems during pregnancy (rare) — this may include:  

  1. Acute pain — this is thought to be due to degenerative changes when the rapid growth of a fibroid, promoted by high levels of sex hormones, outgrows its blood supply. 

  2. Adverse pregnancy outcomes. These may include:

     1. Higher rates of caesarean delivery.

     2. Malpresentation.

     3. Pre-term delivery.

     4. Miscarriage.

• Torsion of a pedunculated fibroid (rare) — this may cause acute pelvic or abdominal pain, and it may become infected. 

  1. Pedunculated fibroids may prolapse through the cervix.

Causes

• Increasing age - the risk of fibroids increases progressively from puberty until menopause.

• Early puberty - the risk of fibroids is increased in women who experienced early puberty and decreased in women who experienced late puberty.

• Obesity - weight gain and central distribution of body fat increase the risk of fibroids.

• Black ethnicity - incidence is higher in black and Asian women than in white women, and multiple fibroids are more common. In addition, they tend to occur at an earlier age, are larger, and are more likely to be symptomatic.

• Family history - risk is higher in women who have first-degree relatives who have fibroids. 

• There is no evidence that combined hormonal contraceptives (CHCs) increase the risk of developing fibroids.

• Progestogen-only injectable contraceptives and oral contraceptives reduce the risk of fibroids.

Diagnosis

Ultrasound scan: A simple and useful test to locate the fibroids.

MRI scan: A special scanner that can accurately map the fibroids.

Hysteroscopy: Camera examination to check womb cavity

Treatment

Most fibroids don't cause any problems and don't need treatment. Truth be told, they frequently recoil or vanish after menopause.

A specialist may suggest various treatments relying upon the seriousness of the symptoms, and the location of fibroids.

Medical treatment:

Medical treatment aims at reducing blood loss, treating anemia, and buying more time until definitive treatment is performed. Medical treatment consists of contraceptive pills, Injectable contraceptives, Esmya, and GnRH injections which can shrink the fibroids.

Surgery

Serious fibroids may not react to more moderate treatment alternatives. In these cases, a surgical procedure might be the best therapy choice.

Myomectomy: Fibroids can be removed through minimally invasive routes like hysteroscopic and laparoscopic procedures.

Hysterectomy: This is an ideal treatment for patients who have completed their family and are looking for complete freedom from fibroids. There are other non-invasive treatments that can be offered like uterine artery embolization and High-Intensity Focused Ultrasound.

Uselful links:

www.nhs.uk/conditions/­fibroids/

http://fertilitynetworkuk.org/for-those-trying-to-become-parents/information/medical-conditions/fibroids/

www.britishfibroidtrust.org.uk/­whatis.php

ww.rcog.org.uk/en/guidelines-research-services/guidelines/consent-advice-13