Fibroids

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What are fibroids?

Fibroids are benign (non-cancerous) tumours that grow in, on or outside of the wall of the uterus. They usually range in size from as small as a pea to as large as a grapefruit.

Who can have fibroids?

About 20-25% of all women have fibroids, and they are very common in women over 30.

Women over the age of 35 have between a 20 and 40 % chance of having fibroids.

Black women are 3 times likelier than other women to have fibroids.

Fibroids are more common in women who are significantly overweight and in women who have never had children.

Fibroids are more common in women towards the end of their reproductive years, and they often shrink after menopause.

What causes fibroids?

Although no one knows the exact cause of fibroids, their growth seems to be related to estrogen production. If you are pregnant or taking birth control pills or menopausal estrogens, fibroids may grow more quickly because of the increased estrogen level in your body.

How do I find out if I have fibroids?

Your doctor might find one or more fibroids during a routine pelvic exam or prenatal ultrasound. If this happens, the doctor may simply note this in your file, and perhaps monitor this during your regular check-ups.

Most women who have fibroids are not aware of them. Most fibroids cause minor or no symptoms and don't require treatment.

However, you might be among the estimated 1 in 4 women who have fibroid problems that affect your quality of life and require treatment.

What kinds of problems can fibroids cause?

The common problems caused by fibroids are:

  • long, heavy menstrual periods with excessive bleeding which, in some cases, cause anaemia;
  • chronic pelvic pain;
  • problems with urination or constipation, caused by large fibroids crowding the bladder or lower intestine; and
  • pain during intercourse.

In more severe cases, fibroids may also cause:

  • problems with fertility; and
  • repeated miscarriage.

If I have fibroids, what should I be careful about?

If you have been diagnosed with fibroids that cause a lot of discomfort, you should discuss this with your doctor before taking any medication that contains estrogens, such as birth control pills or hormone replacement therapy. Your doctor will probably want to monitor you carefully.

What treatments are available for fibroids?

For women with small fibroids, some doctors may recommend treating the symptoms, such as discomfort or increased monthly blood loss, rather than treating the fibroids. To control growth of fibroids, the doctor may suggest stopping any medication that contains estrogen and may suggest alternatives. For women after menopause, fibroids usually shrink because the level of estrogens decrease, and the symptoms may decrease or disappear.

Until recently, doctors often recommended hysterectomy for women with fibroids that caused excessive bleeding. Fibroids are the reason given for an estimated one-third of the 60,000 hysterectomies performed in Canada each year.

Hysterectomy means removing the womb and sometimes the ovaries as well.

Now there are options for treating fibroids other than hysterectomy, such as:

  • Hormone therapy, such as Lupron or "GnRH agonist", mimics menopause to shrink fibroids temporarily. This method could help women near menopause who can follow the treatment until their natural menopause. The possible side effects are the same as in menopause.
  • Myomectomy is a procedure that removes fibroids while leaving the uterus intact. Depending on the size and locations of the fibroids, this procedure can be done through abdominal incision, with laparoscopy or through hysteroscopic resection. It is still major surgery and requires lengthy recovery time. The major drawback of this method is that fibroids often return.
  • Uterine fibroid embolization (UFE) is a process that involves shrinking the fibroids. The doctor uses fibre-optics to guide a tube to troublesome fibroids, and injects small plastic particles into the blood vessels that serve the fibroids. This blocks the blood supply to the fibroids. Although this technique is less invasive than surgery, little is known about its long-term effects, especially on future fertility.

While these different methods exist, it may be difficult to find a surgeon who can perform them in Canada. To find out if this procedure is available to you, speak to a fertility specialist or radiologist.

The good news for women with fibroids that cause them pain is that there are more treatment options now than before.