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Fibroids

Fibroids are very common in women of reproductive age. They are benign growths of smooth muscle that form in the wall of your uterus, either singularly or in groups. They can vary significantly in size – from being smaller than a seedling and invisible to the naked eye, to being as large as 20cm or larger in diameter.

They affect 40% of women over the age of 40 and are often only quite small (1-2 cm).

Many women with fibroids experience no symptoms and can go through life without even knowing they have them. Often, fibroids are detected incidentally during a routine gynaecological exam or while a pelvic ultrasound or surgical procedure is being performed for another condition.

If symptoms do occur, you may experience heavy, long and painful periods, spotting between periods, pelvic pressure, or discomfort during sex. The size and bulk of your fibroids may cause swelling in your lower abdomen and place pressure on your lower back, bladder or bowel. The most common problems are heavy painful periods, pressure symptoms (urinary and bowel symptoms), abdominal swelling, painful intercourse, and infertility. Whether or not you experience symptoms will depend on the size, number, position, and rapidity of growth of your fibroids.

Malignant transformation (turning into a cancer), although uncommon (1:500-1000 cases) is a problem and may not be obvious on conventional testing such as imaging with ultrasound, CT scans or MRI. Any increase in fibroid size after the menopause should be regarded as suspicious. It is important that any fibroid that is suspicious is removed without morcellation (chopping up) or spillage of the fibroid tissue into your abdomen, as abnormal cells can be spread and may grow back. This can be done in a contained bag to reduce the risk of spillage and Dr Desai offers minimally invasive surgery as an option for women with fibroid uteri.

Many fibroids do not cause symptoms and can simply be observed. Dr Desai will advise the follow-up that is necessary if surgery is not needed.

If surgery is required, conservative surgery in the form of myomectomy is when the fibroid is excised via hysteroscopy or laparoscopy and the uterus is conserved allowing further fertility. Where fertility is not an issue and fibroids are causing problems, a hysterectomy with or without the ovaries (depending on your age and wishes) may also be an option (either laparoscopic or open depending on size of the fibroid and your individual circumstances). Unfortunately, many patients are still undergoing laparotomy throughout Australia for procedures that could be performed safely and successfully as a laparoscopic procedure with all its inherent benefits.