Dear Doctor,

Five months ago, I started experiencing pain in my pelvis and heavy menstrual bleeding. After consulting with my doctor, tests showed that I have fibroids. My husband and I have been trying for a baby but with no luck.

We have tried hormonal balancing medication as prescribed by our doctor but nothing has changed. I’m now worried, will I ever be able to have a child? Is there any other alternative method that I can use? Lastly, what exactly are fibroids? Agnes

Dear Agnes,

Fibroids are benign growths that grow inside the inner lining of the uterus. They are of the same type as the uterine lining but are thicker in texture. Mostly, fibroids are multiple in number.

Fibroids are one of the most common tumors affecting women and large enough to affect advanced pregnancy. Usually fibroids per se do not cause any symptoms directly but symptoms occur due to their location.

20-40 per cent of women above the age of 30 develop uterine fibroids. The prevalence is higher in African American women. African women have it at a younger age and with more severe intensity.

What causes fibroids is not known exactly. But clinical presentations and research point out the role of hormones like estrogen because it mostly occurs in the reproductive age of a woman.

They tend to shrink after menopause.

Fibroids tend to run in families; hence hereditary factors are also implicated. Starting menstruation at a younger age, eating diets rich in meat and less in vegetables, drinking alcohol particularly beer are also suggested to be responsible for causing fibroids. It can also occur due to frequent uterine infections and high blood pressure.

Symptoms caused by fibroids depend on their location and size. It can be as tiny as a pea or maybe large enough to affect advanced pregnancy. They can be inside the uterine wall, on it or externally. Common symptoms caused by fibroids are, painful menstruation, heavy prolonged bleeding, pain in legs and pelvic region, painful intercourse, frequency and urgency of urination.

Painful defecation can occur with or without constipation if the fibroid is located posteriorly and therefore putting pressure on the rectum. Heavy blood loss can cause anemia manifesting as weakness, palpitations and breathlessness on exertion.

If uterine fibroids are located inside wall of uterus, they can prevent implanting of the embryo, block tubes, prevent conceiving and can cause termination in early pregnancy.

Presence of fibroids is diagnosed clinically and can be confirmed by ultrasound examination. Taking a piece of tissue from the fibroid and examining it under the microscope helps to rule out malignancy.

If the fibroids are small in size and do not cause much symptoms, they are left as such.

Conservative hormonal treatment is tried in some cases. However if the size is large enough causing pressure or obstructive symptoms, they are removed by various interventions.

Selective removal of the fibroid, embolisation of the uterine artery to shrink the fibroid, high intensity focused ultrasound, cryosurgery, are some of the measures used to treat fibroids.

However if there are severe symptoms or the fibroids are many and large or they fail to regress with conservative measures, hysterectomy, i.e. removal of the uterus is contemplated.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.