Uterine Fibroids

Fibroids are common in the African population, with studies estimating occurrence in every 1 in 4 women. They are ‘golf-ball’ like swellings found in the body of the womb (uterus). It is important to be aware that fibroids are not cancer, and can be left alone for the lifetime of the woman. The cause of fibroids is not known, though there appears to be a genetic link.

Common symptoms attributable to fibroids include: heavy periods, heaviness or swelling in the lower abdomen and pressure symptoms with large fibroids compressing other structures in the pelvis, like the urinary bladder. Many women with fibroids however experience no significant symptoms.

There is a common misconception that fibroids cause infertility. This is rarely the case, and other causes of infertility must first be excluded before attributing the cause to fibroids. Majority of women with fibroids will conceive spontaneously, and have normal pregnancies.

If any woman experiences symptoms attributable to fibroids, they should always consult their Gynecologist. This is because such symptoms may overlap with other conditions that may need to be excluded. A diagnosis is made following typical symptoms, in combination with a clinical examination and subsequent tests.

Confirmation of the diagnosis is made by pelvic imaging, almost exclusively done by ultrasound. Those with heavy periods require blood tests as well, and often need iron replacement.

There are various treatment options, but the mere presence of fibroids in absence of symptoms does not warrant any treatment. The choice of treatment is guided by the predominating symptoms, age, desire for future fertility and women preference. Treatment cost varies widely, and must be weighed against the desired effect of the proposed treatment.

Non-hormonal tablets can be given at the time of periods to reduce the amount of bleeding, without affecting the chances of conception. This is especially suitable in young women also trying to conceive.

Hormone treatments are very effective, and come in various forms. They may interfere with ovulation, and are therefore unsuitable for those trying to conceive. The common contraceptive pill is quite effective in controlling bleeding, but its use may be limited by unwanted side effects. An intra-uterine hormonal device, called Mirena, was developed specifically for heavy periods and is very effective in controlling bleeding. It contains a hormone which acts locally on the lining of the uterus. It also causes some shrinkage of the fibroids as well. Once placed inside the uterus, Mirena remains active for 5 years, and also provides contraceptive benefits. Though initially expensive, it’s now more affordable. There are also injectable options that temporarily relieve symptoms, but associated menopausal side effects are undesirable. This option is mostly used in preparation for surgery in especially large fibroids.

Newer novel techniques for the treatment of fibroids are expensive and not readily available in Kenya. These include Uterine Fibroid Embolization (UFE), which disrupts blood supply to the fibroids thereby causing their shrinkage or disappearance. Another technique involves using focused ultrasound energy to destroy the fibroids. Both these techniques are minimally invasive, with quick recovery times.

Removal of the fibroids (myomectomy), or simply removing the whole uterus (hysterectomy) are the surgical options. Most women however undergo unnecessary surgery when more conservative measures may have been applicable. Surgical risks and cost must always be weighed against other options. As with any benign medical condition, doing nothing is always an option.

There is a risk of recurrence following any treatment modality, hence symptoms may recur. Fibroids shrink after the menopause, therefore long term follow-up is rarely required. Caution is however advised if fibroids are diagnosed in the menopausal period as this may imply a more serious condition.