Uterine fibroids are benign (not cancerous) growth that develop from the muscle tissue of the uterus. Uterine fibroids can occur in any location, size and shape. It can grow on the wall of the uterus, inside the wall of the uterus or attached to it by a stem- like structure. A woman may have more than one fibroids of varying sizes and it can grow rapidly, or slowly over a number of years. It presents in 30% of women in reproductive age groups and grows in response to estrogen and progesterone and may even shrink after menopause.
About 50% of women with uterine fibroids do not have any symptoms. The symptoms of uterine fibroid vary depending on size, number, and location of the fibroids. Most common symptoms of uterine fibroids is heavy menstrual bleeding leading to anaemia (from blood loss). Often large uterine fibroids can produce localised effects such as increased abdominal girth and pelvic pain, urinary symptoms such as increasing frequency, incontinence and urgency, bowel symptoms such as constipation, painful defecation and lower abdominal pain.
Other symptoms include painful menstruation (dysmenorrhoea) and painful intercourse (dyspareunia), infertility and complications during pregnancy such as miscarriage, breech presentation, preterm delivery, low birthweight foetus and increased risk of caesarean section.
Fibroids that are attached to the uterus by a stem may twist (torsion) and cause severe acute abdominal pain, nausea and fever. Large fibroids can also start breaking down and cause pain over the lower abdomen.
Large fibroids can cause local effect to the neighbouring organ such as the urinary tract symptoms causing obstruction leading to swelling of the kidney and ureter and may require immediate surgery. Very rarely, uterine fibroids are associated with cancer risks.
Doctor will need to perform a thorough history and medical examination including pelvic assessment. Occasionally, uterine fibroids can be detected incidentally during a routine pelvic exam. Your doctor may also perform pelvis ultrasound to confirm diagnosis of fibroid
For patient with fibroids that do not cause symptoms or mild symptoms, are small, or occur in a woman who is nearing menopause, regular surveillance ultrasound is adequate to monitor the size of the uterine fibroids.
In patient with symptoms, medications such as painkiller, oral contraceptive pills, hormonal IUD can be consider. In patient with symptoms and large size fibroid, removal of the fibroid ("myomectomy") can be cosider for patient who still desire fertility and wish to retain their uterus. However, there are risk of fibroids recur in the future. Removal of the womb ("hysterectomy") is the definitive treatment of fibroid mass.