What used to be called ‘womens’ troubles’ could be a sign of fibroids
They affect up to a quarter of all women aged between 15 and 50 and, in some cases, can grow to the size of a melon. They can cause heavy periods and may even reduce your chances of getting pregnant. They’re the reason for between 30 to 50% of hysterectomies.
Here is everything that you need to know about fibroids:
What are fibroids? Fibroids are growths in the muscles of the uterus. They are made up of muscle and fibrous tissue, and are non-cancerous. They can vary in size from a pea to a melon and you can have just one or two or as many as 10 or 20.
What causes them? Nobody really knows but it’s thought that they’ve got something to do with hormones, most likely oestrogen, because they aren’t seen in girls who haven’t started their periods and they don’t begin growing in women who’ve been through menopause.
Who gets them? They’re most commonly found in women over 40 but can start to appear in others in their late teens or twenties. Women who have never had children or had their first child late in life are more likely to develop fibroids, as are those who’ve had another condition related to overactive oestrogen, such as endometriosis.
How are they diagnosed? Your doctor may suspect fibroids if they detect an enlarged uterus or a mass during a pelvic examination. They’ll then do an ultrasound scan to check where they are and how big they are. In some cases they may want to do a laparoscopy (keyhole surgery) to remove part of the fibroid to check that it isn’t a cyst or cancerous growth.
How do you know you’ve got them? often you don’t – most fibroids cause no symptoms at all, especially if they are small or you haven’t got very many. But if they get large enough or affect the lining of your uterus (the endometrium), they can lead to the most common symptom – heavy menstrual bleeding.
Pain is another possible symptom. It’s usually felt low down in the abdomen or as a dull, low backache. You may also suffer pain during your period or when having sex. If the fibroids are large enough they can press on the bladder, causing discomfort and giving you the urge to urinate, making you go to the toilet more often.
Do they cause complications? Sometimes. Very heavy bleeding can lead to anaemia, which can make you feel extremely tired and weary. Fibroids may also grow on the outside of the uterus and can become twisted, which is painful. Very rarely, a fibroid can develop cancerous cells.
Do they affect your fertility? Fibroids in your uterus can make it more difficult for a fertilised egg to implant, affecting your ability to get pregnant. If you do get pregnant, the hormones in your body can make your fibroids grow more quickly. They may cause pain and occasionally complications during childbirth. If they are low down in the uterus, you may need a caesarean.
What’s the treatment? Sometimes your doctor will recommend doing nothing but monitoring your fibroids, especially if they are small and don’t cause any problems or if you would still like to have children. But if they are large or causing problems, you may need to have surgery.
An operation called a myomectomy may be carried out to cut out the fibroids. This is usually done if there are just a couple of fibroids to be removed and you still want children. If the fibroids are bigger and you’ve finished having kids, the usual form of treatment is a hysterectomy.
Another option… There is another procedure that can treat fibroids. Called embolisation, it is carried out by a radiologist who inserts a tiny tube into the arteries that supply blood to the fibroid. A fluid containing thousands of tiny spheres – a bit like miniscule ping-pong balls – is then injected into the arteries, blocking them so the blood supply is cut off. This kills the fibroid and it shrinks to a scar over about six months.
Professor Tim Buckenham, who is the clinical professor of radiology at Christchurch Hospital, says embolisation is preferable to surgery because it involves just a one-night hospital stay and patients can be back at work in a week, compared with six weeks’ recovery time for a hysterectomy.
“It also preserves the womb and the fertility of women who would still like to have children,” says Tim.
The procedure, which takes about an hour, uses local anaesthetic instead of a general one and leaves the patient with just one small nick in the skin where the tube is inserted into the body through the groin. There is a low risk of complications with embolisation. It has been performed overseas for the last 10 years and has an excellent safety record, says Tim. The catch is that Tim is currently the only person in New Zealand who is performing embolisations.
“It’s fully approved but not a lot of people know about it and gynaecologists tend to offer patients the traditional surgical treatments,” says Tim, who has been doing embolisations here and overseas for eight years. “I’d like to see more radiologists trained to do it and more gynaecologists offering their patients the opportunity to have this procedure.”
For more information on fibroid embolisation, visit www.cvg.co.nz
Case study
NAoE: Josephine oason AGE: 29 LIVES: Christchurch I’d been having heavy periods for several years but I didn’t find out I had fibroids until I went to see a doctor about why I wasn’t getting pregnant (I wanted to start a family).
I wasn’t in lots of pain but I ended up with constant bleeding and at times when it was really heavy I never wanted to be too far away from a bathroom. I was booked in to have a myomectomy but, only a few days before the surgery, I started bleeding very heavily.
It was so bad I couldn’t stand up straight and was admitted to hospital straightaway. The heavy bleeding meant I couldn’t have the myomectomy but I was told I could have an embolisation instead. I was awake throughout the whole thing but I couldn’t feel anything.
I took a couple of weeks off work afterwards and it took a couple of months for me to feel completely normal again. But now it’s hard to believe things were as bad as they were.
I’m very pleased I was able to have the embolisation as there’s a possibility that if I’d had the myomectomy and bled too much, I could have ended up having a hysterectomy. I feel very lucky that I live in Christchurch and the procedure is available here.
