Fibroid is the common term for a Uterine Fibromyoma ( also called myoma or leiomyoma ). They occur in the female uterus. The wall of the uterus is made of a powerful thick muscular wall which can contract in an involuntary manner when pregnancy is complete and the baby is being born to expel the baby on its way down the vagina.

Fibroids are balls of muscle and fibre that grow within this wall.

The cause of fibroids remains unknown but we do know that female hormones accelerate growth. Hence if a woman has fibroids they do their growing most during the reproductive years, pregnancy or when a woman is on the Pill ..

It is estimated that between 30-50% of women between 35 –50 will have one or more fibroids Fibroids mostly develop towards the later part of a woman’s reproductive years although they may also be present earlier. After menopause growth slows with the drop off in natural Oestrogen production. HRT may cause them to continue to grow.

Fibroids are not usually dangerous however some result in heavy menstrual bleeding which can lead to anaemia. Only in very rare cases (1 in 800) do they become they cancerous. Mostly they are just a nuisance or cause no problem at all. They can vary in size from a pea to a grapefruit or even larger.

There may be no symptoms. Some women are not aware they have and this is not necessarily a problem.They may be picked up during a routine gynaecological examination.

When a woman has symptoms are usually related to the fibroid or fibroids’ size. They usually don’t cause much in the way of symptoms until they result in the uterus growing to the size of a about a 14 week pregnancy

Bleeding – Being in the wall of the uterus means they tend to stretch the uterus lining and result in heavier than normal menstrual bleeding. Sometimes a woman may present to her doctor with tiredness due to anaemia from heavy bleeding and the fibroids are found later after a full history and examination is performed

Pressure effects – Fibroids can press against other structures and if large enough they may cause abdominal swelling

However it is important to note that these symptoms are not diagnostic of fibroids and any or all of them may be due to something other than fibroids.

Commonly fibroids are suspected when an enlarged uterus is detected during physical examination in a non pregnant woman. The diagnosis is generally confirmed by an ultrasound .

What treatment is available for fibroids ?

Treatment depends on many factors. If the fibroids are not causing any symptoms and the woman is not planning a pregnancy a watchful approach may be taken. This involves having regular ultrasounds to keep an eye on progress of growth.

Medication : Some times hormone preparations like Depoprovera are used to turn off periods and so give some relief from the heavy periods .There are also other treatments available that cause fibroids to shrink. Women close to menopause may opt to take drugs which induce a temporary false menopause – they literally turn the ovaries oestrogen production completely off while the woman takes the drug and this tends to cause the fibroids to shrink. However the drug can only be taken for 6 months because of potential side effects like loss of bone density ( osteroporosis) and after this time the fibroids usually regrow anyway. However this drug may be of benefit once a woman has decided to have surgery and it may shrink the fibroid to make the operation easier.

Currette – or a "D&C" as its known, can sometimes be offered to women who don’t want surgery to remove the fibroids but want to see if a currette may help reduce her menstural flow. The mechanism isn’t entirely clear but it seems to follow that if the endometrium ( the lining of the uterus the builds up each month ) is removed under anaesthetic as you might imagine removing the pulp from the inside of a pumpkin ( the seeds don’t fit the analogy here but it’s the best I can think of ! ) these women seem to get some temporary relief from heavy periods. This relief doesn’t usually last though.

Surgery: For decades women had been told their only option was hysterectomy, and then only via a sizeable surgical cut on their abdomen. Not so any more ! Now days with the development of fibreoptic endoscopic surgical techniques ( laparoscopy ) not only has this reduced the discomfort and size of scar and also length of stay in hospital but also highly skilled surgeons are offering women conservative surgery where they have the fibroids removed but keep their uterus ( myomectomy) . This latter surgery has been especially welcomed by women who still have troublesome fibroids yet have not completed their family and wish to avoid hysterectomy.

Vaginal hysterectomy reduced the size of cut needed in the abdomen and use of a laparoscope to assist this procedure reduces the cuts even further ! In this procedure a ring incicsion is made round the base of the uterus and it is passed out through the vagina. The top of the vagina is then sewn over. These days surgeons some surgeons leave the cervix and some don’t. It is important to discuss this with your surgeon because if you still have your cervix you will need to continue have pap smears while it is suggested that following hysterectomy you may stop having them if you have no cervix. Even methods of hysterectomy are changing rapidly. These days laparoscopic techniques allow removal of uterus and /or even quite large fibroids in many cases

Not all gynaecologists are skilled in laparoscopic techniques and it is very important that a woman feel confident that if she has been recommended to have a certain procedure that the recommendation has been based on her clinical needs and not the skill level of the surgeon. Certainly here in Australia every woman has a right to a second opinion before committing to surgery of this kind.