Managing fibroids

Fibroids are a common yet often misunderstood ailment that affects many women worldwide during their reproductive years, especially.

Here, Dr Mirka Slavska, renowned obstetrics and gynaecology consultant, provides a comprehensive overview of fibroids, exploring symptoms and the latest treatment options available.

What are fibroids?

Fibroids, also referred to as uterine fibroids or leiomyomas, are benign growths originating from the muscular tissue of the uterus. Comprising muscle and fibrous tissue, they exhibit a range of sizes and positions within the uterus, spanning from small pea-sized nodules to larger growths capable of distorting the uterine shape.

Studies suggest that around two-thirds of women will develop at least one fibroid during their lifetime, with the most common occurrence around the age of 40. Though the precise cause of fibroids remains elusive, they are associated with oestrogen hormone levels, typically emerging during reproductive years when oestrogen levels peak. Not all women are aware they have fibroids, as more often than not, they don’t cause any symptoms.

Distinguishing fibroids from conditions like endometrial hyperplasia (abnormal thickening of the uterine lining) or malignancies (cancers) is crucial for accurate diagnosis and appropriate management.

What are the symptoms of fibroids?

Fibroids typically develop during the reproductive years when oestrogen levels are at their peak. As oestrogen levels decline during the perimenopause and the menopause, fibroids often shrink, but they don’t always disappear completely. The symptoms of fibroids can vary based on their size, number, and location within the uterus.

Common symptoms include:

• heavy menstrual bleeding
• prolonged menstrual periods
• pelvic pain or pressure
• frequent urination due to bladder pressure

Additionally:

• difficulty emptying the bladder
• constipation due to bowel pressure
• backache or leg pains
• pain during intercourse
• enlargement of the lower abdomen

What are the treatment options for fibroids?

Treatment options for fibroids will depend on several factors, including symptom severity, fibroid size and location, the individual’s fertility desires, overall risk factors, and general health. Preservation of fertility often guides treatment decisions for younger women, while perimenopausal and post-menopausal women typically have a wider array of treatment choices, given that fertility concerns are less pertinent.

Available treatment modalities include:

• Medications aimed at symptom management, such as pain relief and reduction of heavy bleeding with non-hormonal therapy: Tranexamic acid and Mefenamic acid
• Hormonal management options: Mirena coil, Prostap injection with add back HRT, Ryeqo (replacing historical Esmya)
• Non-invasive procedures: Uterine artery embolisation (UAE) or Sonata ablation
• Surgical interventions: Myomectomy (fibroid removal while preserving the uterus) or hysterectomy (uterus removal)

Surgery is not always necessary for all women with fibroids, typically being recommended only when fibroids cause significant symptoms that don’t improve with other treatments.

Fibroids and HRT

Women taking hormone replacement therapy (HRT) while dealing with fibroids may face unique considerations. HRT effectively alleviates menopausal symptoms and provides health advantages, such as reducing cardiovascular risk and supporting bone health. However, for women with fibroids, the reintroduction of oestrogen through HRT can prompt the regrowth of fibroids that had previously shrunk as natural oestrogen levels declined. Consequently, some women may experience a resurgence of fibroid symptoms.

Abnormal uterine bleeding is a common symptom of fibroids, which could be exacerbated by HRT. Therefore, for women with known fibroids, the potential impact of initiating HRT should be thoroughly discussed, especially if symptoms reappear. Adjustments to the HRT regimen may be necessary, potentially involving a lower oestrogen dose or adjusting the progestogen dosage to counteract the oestrogen's effects on the uterus.

Closer monitoring may be required for women with fibroids who are undergoing HRT, particularly if symptoms resurface. This monitoring regimen may encompass regular pelvic examinations and ultrasounds to assess fibroid size and any changes in symptoms.

It's essential to recognise that the response to HRT can vary significantly among women. While some women with fibroids may experience heightened fibroid symptoms with HRT, others may not perceive any changes.

Since fibroids are benign, will they ever turn cancerous?

Typically, fibroids are benign (non-cancerous) growths that don’t pose an increased risk of uterine cancer. However, in rare instances, a form of cancer known as leiomyosarcoma can develop within a fibroid. Leiomyosarcoma is exceptionally rare and represents less than 1% of all types of uterine cancers. Reported incidence is 3 to 6 cases in 1 000 000 women.

If you would like to schedule an appointment with Dr Mirka Slavska, head on over to her Top Doctors profile today.