Dr. Marion Gluck
Fibroids are benign tumours of the uterus and are present in 30-50% of women. They occur in women of all races and backgrounds.
Fibroids arise from smooth muscle and connective tissue of the uterine muscle itself. They feel like a smooth lump in the lower abdomen just above the pubic bone.
They can occur in women as early as their late teens but are most commonly diagnosed when a woman is in her thirties or forties.
The majority of fibroids do not cause any real problem. However they are still responsible for 30% of all gynaecological hospital admissions and are the main reason for hysterectomies when they may cause heavy and irregular bleeding.
Fibroids are common in women who have hormone imbalances especially when there is too much circulating oestrogen. This can be counteracted by prescribing some natural progesterone, giving nutritional advice and counseling a woman about fibroids and reassuring them that they are benign and do not necessarily need to be removed surgically.
Very few lesions are or become malignant. Signs that a fibroid may be malignant are rapid growth or growth after menopause. Such lesions are typically a leiomyosarcoma on histology.
Fibroids, particularly when small, may be entirely asymptomatic. Generally, symptoms relate to the location of the lesion and its size. Important symptoms include:
During pregnancy they may be the cause of:
Interference with the position of the fetus.
Fibroids may be single or multiple. Most fibroids start in an intramural location - that is the layer of the muscle of the uterus.
With further growth, some lesions may develop towards the outside of the uterus (subserosal or pedunculated), some towards the cavity (submucosal or intracavitary). Lesions affecting the cavity tend to bleed more and interfere with pregnancy.
Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes.
Less frequently, leiomyomas may occur at the lower uterine segment, cervix, or uterine ligaments.
Diagnosis is usually accomplished by bimanual examination, better yet by gynecologic ultrasonography. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam.
In cases where a more precise assay of the fibroid burden of the uterus is needed, magnetic resonance imaging (MRI) can also be used to generate a depiction of the size and location of the fibroids within the uterus.
While no imaging modality can clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, the rarity of the latter and the prevalence of the former make it, for practical purposes, a non-issue unless evidence of local invasion is present, though more recent studies have improved diagnostic capabilities using MRI. For this reason, biopsy is rarely performed.
The presence of a fibroid does not mean that it needs to be treated, many lesions are treated with ''expectant management''. Treatment of uterine fibroids that cause problems can be accomplished by:
Surgery: Hysterectomy or myomectomy can be performed. Based on the size and location of the lesion, different approaches can be considered: laparotomy, laparoscopy, or hysteroscopy.
Uterine artery embolization (UAE): Using interventional radiology techniques, the Interventional physician occludes both uterine arteries, thus reducing blood supply to the fibroid(s).
Medical therapy: This involves the use of medication to reduce estrogens in an attempt to create a menopause-like situation. Gonadotropin-releasing hormone analogs are used for this. Selective progesterone receptor modulators, such as Progenta, are under investigation as therapeutic agents. (2005)
HIFUS: High frequency focused ultrasound sonography is a targeted application of external sonographic waves to destroy fiboid lesions
MRgFUS : Magnetic Resonance guided Focused Ultrasound Surgery is a non-invasive surgical procedure (requiring no incision) that uses high-intensity focused ultrasound waves to ablate (destroy) tissue in combination with Magnetic Resonance Imaging (MRI), which guides and monitors the treatment.