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Common in women in their childbearing years, fibroids are abnormal growths of tissue in the muscles of the womb. While the exact cause of fibroids is unknown, they are linked to high levels of the female reproductive hormone, oestrogen. This is why a high proportion - about one-third - of women get them in their peak reproductive years. They typically get larger over time until menopause and then shrink with falling levels of oestrogen.
The growth of fibroids
Uterine fibroids typically develop after puberty and after the age of 30. The smooth muscular tissue of the uterus starts to grow excessively to develop a firm, rubbery mass. Fibroids can vary in number and size, ranging from tiny ‘seedlings’ that are undetectable by visual examination to large masses that enlarge and distort the uterus. Some grow rapidly and others disappear over time.
In many cases, they do not often cause overt symptoms. However, excessively large or numerous fibroids can cause prolonged, heavy and/or painful periods. Fibroids that are very large can also lead to infertility if they prevent a fertilised egg from attaching to the lining of the womb. Large fibroids that grow on the front wall of the uterus near the bladder may also cause urinary symptoms, such as urgency and frequency or urinary retention. Surgery may be required to remove these problematic fibroids. Other common symptoms of uterine fibroids include:
Risks and diagnosis
Factors that increase the risk of fibroids include:
An ultrasound scan is used to detect fibroids and if spotted, to monitor their growth. An ultrasound is a painless, noninvasive procedure that uses sound waves obtain a ‘picture’ of the uterus. It may be done transabdominally over your abdomen or transvaginally via the vagina. Blood tests may be ordered to determine your iron levels and rule out other bleeding disorders or thyroid problems. While there is a very low chance (less than 1%) of a fibroid turning cancerous, women should undergo regular scans every six to 12 months to detect any abnormities.
Treatment options range from conservative management and observation to checking that they remain stable and spotting any abnormal growth. Medication may be prescribed to relieve symptoms such as heavy or painful menstruation. There are also several surgical options to treat fibroids.
A myomectomy may be used to remove uterine fibroids while leaving the uterus in place. Though the fibroids are removed, new uterine fibroids may take their place over time, so this procedure is ideal for women who plan to have children. For women with numerous uterine fibroids and who have passed their childbearing years, a hysterectomy may be recommended. This surgery involves removing the entire uterus and all the fibroids.