Treating fibroids

The treatment of fibroids depends on several factors, including whether the patient intends to have more children.
THE DOCTOR SAYS by DR MILTON LUM
THE symptoms, complications, diagnosis and assessment of fibroids were discussed a fortnight ago.
This article addresses the treatment of fibroids, which depends on the size of the growths, symptoms, the age of the woman, whether or not she plans to have more children and her preferences.
Regular assessment
Fibroids which are small and do not produce symptoms usually do not require treatment, especially if one is nearing menopause (average age 50).
If the fibroids are small and there is no pain, pressure symptoms or excessive menstrual bleeding, regular assessments are all that is needed.
The objective of these examinations is to determine if there is significant change in the size of the fibroids.
This is particularly necessary if one is planning to get pregnant, as the fibroids can grow and affect the pregnancy, or if one is approaching menopause, when the fibroids usually shrink in size.
It is important to keep the appointments with the doctor for these regular check-ups.
There is no need to limit any regular activities, including sexual intercourse, unless the fibroids cause pain during intercourse, in which case the doctor should be consulted.
Indications for treatment
The presence of certain signs and symptoms may indicate the need for treatment. They include heavy or painful periods; pelvic pain; bleeding between periods; rapid increase in the size of the fibroids; uncertainty about the nature of the growth (i.e. fibroid or another tumour, e.g. an ovarian tumour); infertility; or pressure symptoms (e.g. urinary or bowel symptoms).
Surgical treatment
Surgical methods of treatment are effective in treating fibroids.
The fibroids may be removed by myomectomy or hysterectomy. The choice depends on the patient’s preferences and medical advice.
a. Myomectomy is a procedure in which only the fibroids are removed, leaving the uterus in place. It is usually performed when there is desire for a future pregnancy or when a woman wants to retain her uterus.
Fibroids may recur after a myomectomy. If they do, more surgery is needed.
Sometimes when there is excessive scar formation following a myomectomy, fertility may be affected, especially if the scar tissue affects the ovaries and fallopian tubes.
The size and location of the fibroids as well as any other pelvic condition that may be present will determine the appropriate surgical approach.
Small fibroids are removed through less invasive hysteroscopy or laparoscopy procedures. Large, multiple or inaccessible fibroids and the presence of other pelvic conditions and/or adhesions usually require a laparotomy.
b. Hysterectomy is the surgical removal of the uterus, and is an effective cure for fibroids. It may be considered when there is persistent pain or abnormal bleeding; the fibroids are large; other methods of treatment are not possible; children are not desired; or it is the patient’s decision.
The hysterectomy can be carried out through the vaginal route or through a laparotomy.
After a total hysterectomy, contraception is no longer needed and the risks of cervical and endometrial cancer are removed.
The ovaries may or may not be removed at the time of hysterectomy, depending on the patient’s age, and whether there are any co-existing conditions in the ovaries. Again, the patient has to decide.
Uterine artery embolisation (UAE)
In this recently introduced procedure, particles are inserted into the uterine arteries, through a narrow tube inserted in the groin, to shrink the fibroids by blocking off their blood supply.
The procedure is done by an interventional radiologist after the patient’s suitability for such treatment has been assessed by a specialist team, which includes a gynaecologist. It must be emphasised that there are very few such teams in the country.
There is a need for more information about how well UAE works, how long it works, and how it affects a woman’s ability to get pregnant. In short, the jury is still out on this procedure.
Medical treatment
Medicines may be prescribed to treat the problems caused by fibroids, or to temporarily reduce the size of the fibroids.
Anaemia can be corrected with oral iron supplements.
Infection can be treated with antibiotics.
Antiprostaglandins or cyclo-oxygenase enzyme (COX) inhibitors are taken only during menstruation and are suitable for women trying to conceive or who have associated period pains.
GnRH analogues are used to temporarily reduce the size of large fibroids and to control bleeding, in preparation for surgery.
They act by stopping the hormones from the brain which control the production of ovarian hormones. Oestrogen levels decrease considerably, leading to a significant reduction in the size of the fibroids.
However, when treatment is discontinued, the fibroids will usually – within three to six months – return to their pre-treatment size.
Emotional aspects
The feelings of women with fibroids vary. Some feel that something is not right with their femininity as their reproductive organs are affected.
It is important to remember that there are many aspects to femininity and it is not confined to one part of the body.
The woman who has had a miscarriage may feel angry, guilty or anxious about future pregnancies. If she has to face the possibility of losing her uterus, especially when future pregnancy is desired, there may be anger and sadness.
It is important that you discuss your feelings and preferences are discussed with the doctor who will assist you in handling them and advise you on the treatment options.
Conclusions
Fibroids are common non-cancerous growths of the uterus. They may be small and cause no symptoms, thereby requiring no treatment.
When they are large or there are pressure symptoms or pain, or changes in menstruation, medical attention is necessary.
If you have fibroids now, or in the past, you should consult your doctor regularly for assessment.
There is no way to determine any abnormality until the doctor has examined you. Once the cause is found, you can be treated effectively.
Dr Milton Lum is chairperson of the Commonwealth Medical Trust. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
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