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.

Most Fibroids smaller than 4cm have no Symptoms

Some Fibroids can have the following Symptoms

❖ Heavy menstruation is the most common symptom
❖ Pressure on the 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?

Yes. Small fibroids (1-3cm) without symptoms can be left untreated.

When is surgery required?

Surgery is needed when fibroids
❖ are large (6-8cm or larger) or growing rapidly
❖ are causing symptoms or infertility
❖ have failed medical treatment.

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?

From large studies, it was found that the chance of finding cancer within a fibroid is around 1 in 2000-8300. (Pritts 2015).
Professor William Parker, a renowned expert on fibroid also found that rapidly growing fibroids is not a sign of cancer. (Parker 1994)
You can get more information on fibroid and cancer at www.fibroid.com.

Medical Treatment for Excessive Bleeding from Fibroids

❖ Ulipristal (Esmya) - a selective progesterone receptor modulator tablet made to "kill" fibroid
❖ GnRH injection - an injection to cause menopause for 1-3 months

Ulipristal is an oral tablet taken daily for at least 3 months. GnRH injection is given once a month. Both medications stop menstruation and heavy bleeding effectively.

Medical Treatment to Shrink Fibroids

Both Ulipristal and GnRH injection reduce fibroid size and volume, but will not make them disappear completely.
Only Ulipristal leads to a more sustained fibroid volume reduction even after treatment.

Medical Treatment for Bleeding & Pain from Fibroids

In a study of 1473 women with bleeding and pain from fibroids, Ulipristal has been shown to help up to 60% of women avoid surgery with just 3 months of treatment.

Medical Treatment - Side Effects

Ulipristal commonly causes hot flushes, headache and breast pain in about 5% of women.
GnRH injection will almost certainly lead to hot flushes, sweatings, some mood swings and possible sleep disturbances.

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.

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 the fibroid with strong ultrasound beam

Surgical Treatment for Fibroids

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 the 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