Dear doctor,

What are fibroids and what causes them?

Dear Becky,

Fibroids are benign tumors of the uterus. They occur due to abnormal growth of the uterine muscle cells forming a hard mass. Fibroids usually occur around 30 years of age or so. What causes them is not known exactly. But it is postulated that they occur due to the effect of estrogens

Ethnic African women have fibroids 2 to 3 times more than their white counterparts in the US. Women with early menarche, women on contraceptives, those taking diet rich in red meat and sparse in vegetables, those using alcohol regularly are more prone to develop fibroids. Women after menopause have much lower risk due to reduced levels of estrogen. Hereditary factors can also cause fibroids. A woman is more likely to have fibroids if any of her close female blood relatives like mother or a sister have fibroids.

Fibroid may be single or multiple. They may be present inside the uterus or in the wall of the uterus or may be embedded in the wall externally. At times fibroids present may cause no symptoms and pass unnoticed. Other times, symptoms may be produced depending on size, number and location of fibroids.

There may be chronic lower abdominal pain, prolonged menstrual bleeding, difficulty in urination or urinary incontinence, pain during sexual intercourse, etc. One or more of these symptoms may be present in varying severity. Fibroids are even implicated in causing infertility. The fibroid may impinge inside the uterine lumen thus preventing implantation of the fertilized ovum.

Diagnosis of fibroids is easy. Clinical features raise doubt of fibroid and ultrasound examination can confirm it.

Treatment is by hormonal therapy. If that fails, surgical removal is considered. Either the fibroids alone can be removed or the entire uterus.

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