Uterine fibroids: Expert insights and advice

Uterine fibroids, also referred to as leiomyomas or myomas, are benign tumours that form in or around the uterus.

What are uterine fibroids?

Uterine fibroids are benign tumours composed of smooth muscle cells and fibrous connective tissue that originate from the muscular layer of the uterus. They are prevalent, affecting up to 70% of women by the age of 50. They can develop as a single nodule or in clusters, and can grow within the wall of the uterus, protrude into the uterine cavity, or extend outward from the uterus.

The exact cause of uterine fibroids is unknown, though several factors are thought to contribute to their development. These include hormonal fluctuations (particularly in oestrogen and progesterone) as well as growth factors that regulate cell proliferation. Family history and lifestyle factors such as obesity and diet may also influence the likelihood of developing uterine fibroids.

How are uterine fibroids diagnosed?

Uterine fibroids are often discovered during a routine pelvic examination when a gynaecologist feels an irregularity in the shape of the uterus. However, many women with uterine fibroids are often asymptomatic, meaning they don’t present symptoms.

When symptoms do present, these may include:

• heavy menstrual bleeding
• extended periods (lasting over a week)
• pelvic pain or pressure
• frequent urination or trouble fully emptying the bladder
• constipation

If uterine fibroids are suspected, several diagnostic tests can then confirm their presence and assess their characteristics, including:

• Ultrasound: This imaging test uses sound waves to create a picture of the uterus and can reveal the size, shape, and location of fibroids.
• MRI: This scan provides a more detailed image of uterine fibroids and is particularly useful in complex cases or when planning surgical treatment.
• Hysterosonography: This procedure involves injecting saline into the uterine cavity to enhance ultrasound images, helping to identify submucosal fibroids that protrude into the uterine cavity.

Can uterine fibroids impact fertility?

Uterine fibroids can impact fertility, although not all fibroids cause problems. Submucosal fibroids, for example, are most likely to cause fertility issues by distorting the shape of the uterus, interfering with embryo implantation, or blocking the fallopian tubes.

Uterine fibroids can also cause complications during pregnancy by increasing the risk of miscarriage, preterm labour, abnormal fetal position, and heavy postpartum bleeding.

What treatment options are available for uterine fibroids?

The treatment of uterine fibroids depends on the severity of symptoms, the size and location of the fibroids, the woman's age, and her desire to maintain fertility.

For women with mild symptoms or asymptomatic uterine fibroids, a watchful waiting approach may be recommended. This regular monitoring through pelvic exams and imaging tests can help track the growth of fibroids and detect any changes.

For other uterine fibroids, medications and certain gynaecological devices can help manage symptoms and potentially shrink fibroid size. Common management options include:

• Hormonal treatments: Gonadotropin-releasing hormone (GnRH) agonists can reduce oestrogen and progesterone levels, causing fibroids to shrink. These medications are typically prescribed short-term.
• Progestin-releasing intrauterine device (IUD): This device releases a synthetic hormone called progestin (a form of progesterone) directly into the uterus, helping to reduce heavy menstrual bleeding caused by uterine fibroids.
• Non-steroidal anti-inflammatory drugs (NSAIDs): These medicines can help manage the pain associated with uterine fibroids.

What are the different surgical options?

When uterine fibroids cause significant symptoms or they impact fertility, surgical treatment may be necessary. Surgical options encompass minimally invasive procedures such as:

• Uterine artery embolisation (UAE): This procedure involves injecting small particles into the arteries supplying the uterus, blocking blood flow to the fibroids and causing them to shrink. UAE is effective in reducing symptoms and preserving the uterus, but it may not be suitable for women planning to conceive.
• MRI-guided focused ultrasound surgery (FUS): This non-invasive procedure uses high-intensity ultrasound waves to heat and destroy fibroid tissue. FUS is performed under MRI guidance to precisely target fibroids and preserve surrounding tissue.
• Laparoscopic myomectomy: During this procedure, small incisions are made in the abdomen, and the uterine fibroids are removed using specialised instruments. Laparoscopic myomectomy preserves the uterus and is a good option for women who wish to maintain fertility.

A hysterectomy, which involves the removal of the entire uterus, is the only definitive cure for uterine fibroids. This surgical procedure is recommended for women with severe symptoms who don’t wish to retain their fertility, and can be performed through the abdomen, vagina, or using minimally invasive techniques such as laparoscopy or robotic surgery.

With advancements in medical and surgical therapies, there are now many ways to treat uterine fibroids while preserving a woman’s quality of life and reproductive health.