Fibroids

Fibroids are lumps of muscle, like meatballs, growing within the womb.

Fibroids are very common; detected in up to 75% of women attending health screening.
In 3000 – 14,000 women, 2000 – 8000 women may have fibroids detected.

More than 50% of these fibroids do not need treatment.
More than 99% of fibroids are benign and do not become cancers.

Fibroid cancer (Leiomyosarcoma) is very rare; occurring in 1 in 2000 to 1 in 8000 women.

The exact cause of fibroid is unknown.
Hormones may cause fibroid to grow.
A family history of fibroid increases your chance of having fibroid

Surgery (called Myomectomy) is the mainstay of treatment for problematic fibroids.

Fibroids are classified based on their position in the womb

What are the Symptoms of Fibroids?

Most Fibroids smaller than 4cm have No Symptoms.
When Fibroids cause symptoms, the common ones are
1. Heavy menstruation
2. Pressure on bladder causing frequent urination or incomplete urination
3. Bloating, fullness or dull ache in the pelvis
4. Feeling a lump in the tummy

Can Fibroids affect Fertility?

Small fibroids (1-3cm) Not Causing Symptoms
DO NOT NEED Treatment

What happens to untreated Fibroids? What is the Natural History of Fibroids?

The usual behaviour of fibroids is that they grow in size with age until menopause, when they start to shrink.
From the Fibroid Growth Study, looking at 262 fibroids in 72 women, it was found that most fibroid grow at the rate of 9% every 6 months.
It was also found that, some fibroids within the same woman can grow at different rates, while other fibroids may shrink at the same time.

Can Fibroids become Cancerous?

Fibroid cancer is called Leiomyosarcoma
Leiomyosarcoma is very rare; accurate data is best obtained by analysing many large studies.
In 2015, an analysis of 134 studies that included 30,193 was done. (Pritts 2015)
The chance of Leiomyosarcoma is calculated as 1 in 2000 – 8300 women.

With regards to rapidly growing fibroids, Professor William Parker, a renowned expert on fibroids found that such fibroids are not more likely to be cancers. (Parker 1994)
You can get more information on fibroid and cancer at www.fibroid.com.

When do Fibroids need Treatment?

Treatment is needed when fibroids are
❖ causing heavy menstruation, pain or pressure sensation
❖ large (6-8cm or larger) or growing rapidly
❖ contributing problems to fertility and pregnancy.

Is there Medical Treatment for Fibroids?

❖ For Bleeding – Tranexemic Acid and Menopausal Injection (GnRH) are effective. Birth control pills, birth control injections (DepoProvera) or hormonal implants (Mirena) may also be helpful. However such hormones may encourage some fibroids to grow while stopping the bleeding problem.

❖ For Pain – Panadol, Ponstan, Synflex, Nurofen, Arcoxia, Tramadol.

❖ For Size Reduction – Menopause Injection (GnRH) can shrink the fibroids. However, the fibroid will grow back in size after treatment. Hence GnRH injections are mainly used to shrink fibroids in preparation for surgery.

Ulipristal (Esmya) is an oral tablet taken daily for at least 3 months. It is very effective in reducing heavy bleeding caused by fibroids. It also shrinks fibroids over 3-6 months of treatment.
However in Sept 2020, the European Medicines Agency revoked the use of this medication because of the rare (<0.1%) but unpredictable risk of liver injury associated with its use.

Is there Non-Medical Non-Surgical Treatment for Fibroids?

❖ 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 or burn the fibroid with a strong ultrasound beam
❖ These treatments are effective in reducing heavy bleeding caused by fibroids. They also shrink the fibroid size by 1-2cm over 6-12 months.

What is the Surgical Treatment for Fibroids?

Surgical treatment to remove fibroids is called Myomectomy.
Myomectomy can be done by
1. Single Incision Laparoscopy
2. Conventional Laparoscopy
3. Transcervical Resection – Surgery from the vagina
4. Open Surgery – Laparotomy

Single Incision Laparoscopy is done with Just One Cut of 3cm at the belly button.
This is a more advanced laparoscopy surgery that has the benefits of a fast recovery and a surgical scar that is barely visible.
Anthony Siow first started Single Incision Laparoscopy in 2009.
He now carries out more than 95% of his fibroid surgery through this method with Just One Cut.

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.
Power Morcellator used without a containment bag is now discouraged because of the possibility of the spread of fibroid bits within the abdomen.

Transcervical Removal of Fibroid (also called Transcervical Resection of Myoma TCRM) is a special surgery for fibroids found inside the womb cavity.
It is surgery done through the vaginal and cervix and requires advanced surgical dexterity and special instrument (called Resectoscope) to perform.
Recovery is within 1-2 days and heavy menstruation from submucosal fibroids is effectively treated.

Open Surgery or Laparotomy is done with an abdominal cut of 10cm or more.
It is a good procedure for the complete removal of all fibroids, both small and large. It is also the preferred procedure for very large fibroids.
As with all open surgery, recovery can take between 2-4 weeks or longer.

What is Recovery from Fibroid Surgery like?

Almost all patients recover from surgery by Anthony Siow as follows:-

Day1 – is the surgery day. You will be resting in bed and can take some clear fluids. As you will not be mobile, a small urine tube is placed to help you pee.

Day2 – is 12-24hr after surgery. Most patients will have a marked reduction in pain. The urine tube will be removed and you should be able to walk around. You can start normal diet and take a shower.

Day3 – is when most patient feel almost recovered from surgery and are generally well enough to go home.

Day4-10 – is the first week after surgery at home. Pain and discomfort from surgery starts to disappear. Most patients are well enough to go outdoors for half the day. Some do not need anymore pain medication.

Week 2 after surgery is the usual time for postop review. Many patients feel normal and fine enough to go without pain medication. At the review, details of the surgery and biopsy results will be discussed. The surgical incision will be checked and the dressing changed.

Week 3 after surgery is the time most patient bounce back to normal. Some are able to start light exercises and gym training. Some can work from home if needed. You can start driving this week.

Hospitalisation leave of 4 weeks is usually given. A final postop review is done to ensure recovery is complete. Where needed, the hospitalization leave can be extended.

Visit www.fibroid.com.sg for more Information and Facts on Fibroid