Fibroids

Fibroids are hormone sensitive growths in the wall of the uterus. The uterus, also called the womb, is a female reproductive organ where a baby grows during pregnancy. Fibroids refer to noncancerous growths that can develop in the tissues of the uterus. This is a common health condition affecting women in the reproductive ages between 16 to 50 years. Rarely, these can be cancerous.

Benign fibroids that cause heavy menstrual bleeding, pelvic pain and pressure and sometimes infertility, are typically treated by minimally invasive approaches including hysteroscopic or laparoscopic myomectomy.

These procedures might be an alternative to a hysterectomy thereby preserving the uterus and allowing carriage of a pregnancy if desired.

Types of Fibroids

Fibroids are classified based on their location in the uterus. The different types of fibroids include:

• Intramural fibroids: These are embedded in the muscular wall of the uterus and are quite common.
• Subserosal fibroids: These extend into the outer uterine layer.
• Submucosal fibroids: These extend into the cavity of the uterus.
• Cervical fibroids: These develop at the entrance into the uterus called the cervix.

Causes

The exact cause of fibroid formation is not clear. However, it may be associated with:

• High estrogen levels in a woman’s body
• Genetic factors

Diagnosis

Fibroids may not cause any symptoms and are usually diagnosed during a routine pelvic examination.

Tests used to identify fibroids include:

• Abdominal ultrasound scan
• MRI scan
• Laparoscopy where a narrow tube with a camera is inserted through the abdomen to examine the outer surface of the uterus
• Hysteroscopy where a narrow tube with a camera is inserted through the vagina to examine the inside of the uterus

Treatment

Treatment depends on the location of the fibroids, the intensity of the symptoms and whether you are planning on pregnancy. You may not require treatment if symptoms are absent or mild. When treatment is indicated the different approaches include:

• Medications including non-steroidal anti-inflammatory drugs and birth control pills to control pain and reduce menstrual flow
• Placement of an intrauterine device or IUD which releases the hormone levonorgestrel that controls the growth of the uterine lining
• Surgery may be recommended for extreme cases where conservative options fail to provide relief.

The different surgical approaches include:

• Myomectomy: The removal of fibroids from the wall of the uterus. Depending on your fibroid location, this can be done vaginally with a hystereoscopy or abdominally via open or laparoscopic surgery. Dr Dunn may refer on if you require a laparoscopic myomectomy.
• Hysterectomy: Complete or partial removal of the uterus.
• Uterine fibroid embolization (UFE): A procedure to block the blood supply to the fibroid area – Dr Dunn can refer to an interventional radiologist for this Ultrasound surgery: high-energy ultrasound waves are used to shrink the fibroids. Dr Dunn can refer you to specialists in Sydney or Melbourne for this if this is your preference as currently this is not offered in Brisbane.
• MR guided focused ultrasound

Your doctor will discuss the various options available to you and recommend the most appropriate treatment based on your situation and if you wish to become pregnant in the future.