Fibroids: Symptoms, complications and treatment
Fibroids is a benign, non-cancerous, tumour of the uterus (womb). It takes its origin from the muscle layer of the womb. Consider the Uterus as a football enclosed tightly in a thin waterproof. The waterproof would be the serous covering– the perimetrium; the leathery back of the ball would be the muscle itself– the myometrium; while the “inflatable balloon” inside the ball, in its inflated state, would represent the mucosal lining– the endometrium.
Fibroids arises from the myometrium and can remain confined within this layer constituting what is called an intramural fibroid. It can push outwards to lie immediately beneath the serous perimetrium to constitute a subserous fibroid. It can also grow inwards to lie immediately beneath, and adjacent, to the mucosa of the endometrium to become a submucous fibroid.
Risk factors of Fibroids
The risk factors for fibroids include the following:
- Age: Fibroids are Oestrogen-dependent tumours and are hence found only in women within the reproductive age group (from menarche to menopause) with a peak age incidence of 30 years.
- Race: Women of black ancestry is about 3 to 4 times more at risk of developing fibroid than their white counterparts.
- Family History: The presence of fibroid in a first-degree relative (sisters, mother) increases the risk exponentially.
- Parity: There is an inverse relationship between the number of times a woman has gotten pregnant and the risk of developing fibroid. It is more likely in women who have not borne a child than in those with many children. This so as pregnancy is “protective” against the effects of Oestrogen.
- Other Risk Factors: Obesity, alcohol, smoking, etc.
Signs and Symptoms of Fibroids
Fibroids are relatively common. Some studies have it that 1 out of every 4 women have Fibroid. While others have it that as many as 3 out of every 4 women will have fibroid at one point, or the other, in their lives.
However, it is not all of these women that have symptoms; most cases of Fibroid are without symptoms. The presence and type, of symptoms, depends on the size and location of the fibroid.
The symptoms may include any of the following:
- Abdominal distention (filling out of the tummy).
- Heavy or prolonged menstrual bleeds, which may, in turn, lead to dizziness. fainting spells, weakness, breathlessness, etc.
- Intermenstrual bleeds (i.e. bleeding in-between periods).
- Very painful periods (severe dysmenorrhea).
- Painful sex (dyspareunia).
- Pressure symptoms, such as Constipation, frequent urination, difficulty urinating, abdominal bloating, etc.
- Low back (“waist”) pain.
Complications of Fibroids
Depending on the location, size, and severity, the following may complicate Fibroid:
- Recurrent miscarriages
- Kidney Failure
- Red degeneration with excruciating pain, especially in pregnancy.
- Premature labour.
- Blocking of the birth passages leading to Caesarean delivery.
Fibroids and infertility: How big are the risks?
There have been stories where the presence of fibroids have scared an intending suitor off, the main reason being the speculated fear of infertility. Is there a risk of infertility with fibroid uterus? Unequivocally, the answer is yes.
Is the risk big enough to have a significant bearing on the all-important decision of choosing a life partner? I do not think so. In fact, the answer is an emphatic no!
Apart from fibroid being completely treatable, the risk of infertility due to fibroid is very minimal, so minimal that most women with fibroid, who are aware that they have fibroid, still go ahead to conceive, and deliver peacefully. Also, most women that we celebrate today as mothers may have had Fibroid at some point, or the other, without even knowing it.
Possible mechanisms of infertility due to fibroid
The possible ways fibroid can lead to infertility are as follows:
Genital Tract Obstruction
Large fibroids, or submucous fibroids in strategic sites, can distort or obstruct the tubes, or obstruct the lumen of the cervix– the entrance to the womb. This would prevent the sperm from getting to the ampulla of the fallopian tubes where it is supposed to fertilise the egg.
Submucous fibroids can sometimes prevent the fertilized egg from implanting into the endometrium of the womb. This is so as implantation requires thickened endometrial tissue in the secretory phase, whereas fibroid tissue is basically muscle.
Early Pregnancy Loss (miscarriage)
Fibroids can lead to early pregnancy loss by a variety of mechanisms including premature labour, and a mechanism similar to that described above and “starvation” of the conceptus as the fibroid mass competes with it for nutrients. It is important to note that each and every one of these mechanisms is PREVENTABLE! Or at least can be circumvented.
Treatment of fibroids
Fibroids seldom requires treatment. Treatment is only indicated when the fibroid is symptomatic. Another reason for treatment is aesthetics, as the society, and indeed women frown at tummies that are not flat.
The modality and type of treatment, when indicated (that is when treatment is necessary), depends on the particular symptoms the patient is manifesting: there is no general treatment for fibroid– treatment must be individualized.
The available modalities of treatment could be classified into Medical (or non-surgical) and Surgical interventions.
There are drugs for:
- Correcting anaemia. E.g. Haematinics
- Achieving good pain relief. E.g. NSAIDs
- Reducing bleeding. E.g. Combined Oral Contraceptive Pills, Tranexamic and Mefenamic.
- Shrinking the tumour. E.g. Hormone analogues
It is important that this– shrinking of the tumour, is not a permanent measure; it is only used to reduce the tumour bulk in preparation for a more permanent solution, such as surgery.
This abounds and depends on the clinical scenario. It includes:
- Uterine Artery Embolization
- Assisted Reproduction, in some cases of infertility