Uterine Fibroids

Depending on their size and location, uterine fibroids can cause:       

• Menstrual changes: heavy periods, long periods, painful periods, bleeding in between periods
• Anemia (low blood count)
• Pressure symptoms: difficulty passing urine or motion
• Abdominal bloatedness
• Miscarriages
• Infertility

Some fibroids do not cause symptoms and are only discovered during a gynaecology check.

A pelvic exam can pick up large fibroids. Tests commonly performed to detect fibroids include:

• Ultrasound scan: repeat scans can be done over time to monitor growth 
• Hysteroscopy: where a camera is inserted through the cervix to visualise fibroids inside the uterine cavity (submucous)

Fibroids that are small and do not cause symptoms can usually be observed. Uterine Fibroids that cause the above mentioned symptoms may require treatment. Submucous fibroids are less likely to respond to medical treatment due to its location. Women who cannot take or have failed medical treatment usually require surgery.

Medical treatment include:

• Non-hormonal medications to reduce the pain and blood loss associated with periods (painkillers and tranexamic acid). These do not shrink or make the fibroids disappear.
• Hormonal medications (e.g. birth control pills). Mirena IUD is an option for women with fibroids that are not disturbing the womb cavity. These do not shrink or make the fibroids disappear.
• Gonadotropin-releasing hormone (GnRH) agonists – this is sometimes used before surgery to temporarily shrink fibroids so that surgery is easier or can be done laparoscopically. Due to its side effects, it is not recommended beyond maximum 6 months of use.  

Surgical (invasive) treatment include:

• Myomectomy: surgical removal of fibroids – this is suitable for women who are keen for fertility or conservation of uterus. Depending on the size of fibroids, this can be done laparoscopically or open. There is a risk of fibroid recurrence in the future.
• Hysterectomy: surgical removal of uterus – this is suitable for women who are not keen on conserving their uterus. Depending on the size of womb, this can be done laparoscopically or open. They will not have any more periods and will not be able to have children after this. The ovaries may or may not be removed.
• Hysteroscopy: hysteroscopic resection is suitable only for fibroids inside the womb cavity 
• Others: Uterine artery embolization/ High intensity focused ultrasound (HIFU) –  these are suitable only for women with specific size/location of fibroids, who are keen to conserve their uterus and wish for a less invasive treatment compared to surgery. Data on long-term effectiveness is limited.