JULY IS FIBROID AWARENESS MONTH

 Uterine fibroids are a common and yet misunderstood condition that affects many women. They are noncancerous muscle and fibrous growths in the uterus that can cause heavy bleeding, pelvic pain, and urination problems. They are more common in women over 30 and in African women. There is uncertainty as to why certain women are more prone to developing fibroids. According to the Fibroid Institute Texas, 61% of women are not aware of treatment options for fibroids! This highlights the importance of spreading awareness, especially considering that around 2 in 3 women will develop at least one fibroid at some point in their lives according to NHS.

Taking a good history of women presenting to gynaecology clinics is very important. Whether they are experiencing heavy menstrual bleeding, pelvic pain, or infertility. Another category of women is the ones who find out about the uterine fibroids as an accidental finding on a pelvic ultrasound and seek gynaecology advice, in which if they are asymptomatic they can benefit from conservative management.

Another important step in assessing the fibroids is to do an ultrasound and locate their position (subserosal, submucosal, or intramural), size, and number. The subserosal fibroids grow on the outside of the uterus and the submucosal types are the least common they grow inside the uterine cavity, and are associated more with infertility and heavy menstrual bleeding. An MRI can provide more accurate information to map the fibroids. Once the diagnosis is confirmed we can offer women various treatment options.

The treatment options vary from conservative management in asymptomatic women. Medical management to control heavy menstrual bleeding such as NSAIDs and iron supplements to prevent anemia. Hormonal treatment to control the heavy menstrual bleeding in women who are eligible and do not desire fertility. HIFU (high-frequency focused ultrasound) is a minimally invasive medical procedure that uses ultrasound waves to treat uterine fibroids. We have a HIFU unit in Bara Hospital.

Surgical treatment such as myomectomy is reserved for women who still desire fertility. Counseling is essential in such cases so women are aware that the chances of pregnancy after a myomectomy are not 100%, the fibroids may grow within a few years and there are risks of bleeding, infection, blood transfusion, and even life-saving hysterectomy with surgical intervention.

 Women who have completed their families and do not desire fertility may benefit from a hysterectomy or a uterine artery embolization. The latter is a procedure performed by interventional radiologists by embolizing the uterine arteries through catheterization, and this leads to a significant decrease in fibroid size and bleeding.

The key to successful treatment of women is good history taking, accurate location and sizes of the fibroids, and counseling women in terms of all the treatment options.

 

Below is the photo of me doing a hysterectomy for a large 30-week fibroid uterus





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