Fibroids, or leiomyomas, are benign tumours of the muscle that form the uterus. They are common and develop in up to 30% of women though are more common in African and Asian women. Most are asymptomatic, often identified only when a pelvic ultrasound is performed, and grow slowly up until the menopause is reached. Once a woman becomes menopausal they tend to shrink though will never disappear entirely.
Large uterus about to have a fibroid removed
Fibroid being removed from the uterus during an open myomectomy
Although most are asymptomatic, they may be the reason for a woman seeking the advice of a gynaecologist. Fibroids may cause heavy periods, pelvic discomfort, a feeling of pressure on the bladder and bowel, painful intercourse and infertility. On extremely rare occasions they may become malignant.
The majority of fibroids do not need treatment but if they do then several options are available. If the fibroid is not too large and is altering the shape of the uterine cavity (endometrial cavity) it may be possible to resect (cut out) it from inside using an electrical loop – a trans-cervical resection. A fibroid can also be removed using laparoscopic surgery (a laparoscopic myomectomy) or by making a larger cut in the abdomen as was traditionally done (open myomectomy). Both of these operations aim to preserve the uterus. Should a woman not wish to retain her uterus then a hysterectomy may also be performed via these routes, as well as vaginally if the fibroid is not too large.
Under some circumstances, a radiologist may be able to shrink a fibroid by blocking it’s blood supply by occluding the artery suppling it with a non-dissolving material. This technique can avoid the need for surgery but may result in considerable discomfort over the following week or more and prolonged vaginal bleeding / discharge. Radiologists in some centres have equipment that may use a focused beam of ultrasound to treat the fibroid.
A fibroid may be shrunk using drugs called gonadotrophin releasing hormone (GnRH) agonists. Unfortunately, the reduction in size is often temporary and many gynaecologists believe makes future surgery harder should it be needed. If the fibroid is causing heavy periods then a prescription medication called ulipristal acetate may greatly reduce the volume of bleeding but it has not been approved for use within Australia by the Therapeutics Goods Administration (TGA)