1. Uterine fibroids are abnormal growths of tissues originating from the muscles of the uterus (womb). They are classified based on the location: just beneath the uterine lining (submucous), within the uterine muscle (intramural) or on the exterior part of the uterus (subserous).
2. Uterine fibroids are pretty much common, affecting up to 40% of women in any given population and clinically symptomatic in 25% of affected women. The incidence is highest between the ages of 30 – 50 years.
3. The cause is largely unknown, but researches have shown the role of the excessive female hormones (estrogen and progesterone) in its development. Recognized risk factors for the occurrence of fibroids include:
-Early age at onset of menses
-Advanced age at first pregnancy (>35 years)
-Absence of pregnancy (in converse, carrying at least one pregnancy beyond 5 months is protective)
-Heavy caffeine intake (>500mg/day)
-Age 35 – 55 years
4. The incidence of fibroids reduces drastically after menopause. Pre-existing ones also tend to regress spontaneously. Interestingly, tobacco smoking is associated with reduced risk of having fibroids, but when you weigh in the worse consequences such as lung cancer, you wouldn’t want to smoke, would you?!
5. Most fibroids are asymptomatic. They just sit there and cause no harm. Most are incidental findings during ultrasound scan for entirely different reasons (like during pregnancy).
6. The commonest symptom is heavy menstrual bleeding. This can result in severe anaemia, need for hospitalization and/or blood transfusion, poor quality of life and psychological depression.
7. Other symptoms include:
– Abdominal swelling – massive fibroids can look as big as a full term pregnancy!
– Abdominal pain
– Pressure on the urinary tract, resulting in infections, urinary disturbances and kidney damage.
– Pressure on the bowels, resulting in constipation
– Problems with fertility: inability to conceive (very rare), miscarriages, preterm labour, difficulty during childbirth, etc.
8. Treatment depends largely on symptoms:
-Asymptomatic fibroids are best left alone. They will regress after menopause.
-Heavy bleeding must be corrected early to avoid the complications of chronic blood loss.
-Conservative management can be employed in younger women with mild symptoms. This includes a wide range of medications to control bleeding and shrink the fibroid.
– Surgical treatment is aimed at a total (or near total) cure in cases of life threatening symptoms. There are a wide range of options but the ultimate cure is the total removal of the uterus (hysterectomy).
9. Fibroids can recur. Again, the only sure way to avoid recurrence is to ‘yank’ out the uterus! However, this procedure is reserved for the severe, life threatening ones, in women who have completed their reproductive career.
10. Fibroids can become malignant (cancer). Fortunately, this only happens to <1% of fibroids. It’s more likely in postmenopausal women with fibroids.
11. Certain natural remedies can be used to reduce the risk of developing fibroids. Adequate fruits and vegetables intake, green tea, vitamin D are a few examples. Beware of fake herbal products and desperate quack doctors who claim to have some mysterious cure for fibroids!