Gynaecology

The Science of Women

Fibroids


 

Fibroids (or leiomyoma or myomata) are the most common growth found in the womb. They resemble meatball like protrusions in the womb and in rare cases, can be found in the ovary. More than 99% of fibroids are benign and they do not become cancerous. The exact cause of fibroid is unknown but alteration in growth factors and blood flow may play a role. A family history of fibroids increases your chance of having fibroids whereas pregnancy reduces the chance. Surgery (called Myomectomy) is the mainstay of treatment for problematic fibroids.

 

 

Symptoms Of Fibroids

Most fibroids do not cause any symptoms
❖ Heavy menstruation is the most common symptom
❖ Pressure on bladder causing frequent urination or urinary blockage
❖ Pressure on rectum & lower back from larger fibroids
❖ Pain from fibroid degeneration
❖ Subfertility and pregnancy related issues

 

Can Fibroids be left alone? When is surgery required?

Yes. Small fibroids (1-3cm) without symptoms can be left untreated.
Surgical removal of fibroid is advised when fibroids
❖ are large (6-8cm or larger) or growing rapidly
❖ causing symptoms or infertility
❖ have failed medical treatment.

 

Non-Surgical Fibroid Treatment

These treatments cannot make fibroids disappear completely and there is no tissue biopsy available.
❖ Ulipristal (Esmya) - a selective progesterone receptor modulator tablet to "kill" fibroid
❖ GnRH injection - an injection to cause temporary menopause

Ulipristal is an oral tablet taken daily for at least 3 months. GnRH injection is given once a month.
Both medication stops menstruation effectively, to treat the heavy bleeding of fibroids.

     

 

Both Ulipristal and GnRH injection reduce fibroid volume.
Only Ulipristal enables sustained fibroid volume reduction even after treatment.

       

 

Ulipristal has been shown to help up to 60% of women avoid surgery in Real World Data.
Pregnancies after Ulipristal have been shown to be uneventful with no regrowth of fibroids.

     

 

There were a few cases of liver issues in patients taking Ulipristal.
Almost all of them had pre-existing liver conditions like cirrhosis and hepatitis.
Liver Function blood test is now advised for the first 6 months of Ulipristal Treatment.

    

 

❖ Uterine Artery Embolisation (UAE) - a procedure to block the blood supply of the womb and fibroids
❖ High Intensity Focus Ultrasound (HIFU) - a procedure to ablate the fibroid with strong ultrasound beam

    

 

Fibroid Surgery

Single Incision Laparoscopy is done with Just One Cut of 3cm at the belly button.
This is a more advanced laparoscopy with fast recovery and almost no visible scar of surgery.

    

 

Conventional Laparoscopy is done with 3-4 small abdominal cuts of 0.5 to 1 cm.
It also has a fast recovery but requires the use of the Power Morcellator.

     

 

Open Surgery or Laparotomy is done with an abdominal cut of 10cm or more.
It is good for complete removal of all fibroids, both small and large, but has a longer recovery period.

 

Transcervical Removal of Fibroid is reserved for fibroids arising in the menstruation area of the womb.
This surgery is a unique surgery done through the vaginal with no abdominal cuts.

 

You can get more information and Facts on Fibroids at
www.fibroid.com.sg
Pan-Malayan Online Medical - Fibroid Treatment Updates