Fibroids are swellings of the uterus, or womb. The uterus, also called the womb, is the part of the woman’s body that holds a baby if she is pregnant.The uterus is made of muscle, and fibroids grow from this muscle. These fibroids, when they grow, can bulge from the inside of the uterus (part where the fetus grows from) or outside of the uterus. Fibroids are not cancerous and are not known to turn into cancer.

Fibroids are the most common pelvic tumors in women of reproductive age. Approximately 80 per cent of women have fibroids by the age of 50 years, although not all of these have related symptoms.

The exact cause of uterine fibroids is not known but evidence points to a number of factors such as genetic changes, hormonal imbalances; Estrogen and progesterone hormones stimulate increase in size of the uterine lining before menstruation in preparation for pregnancy. Fibroids have increased response to these hormones than the normal uterine muscle. Some fibroids shrink after menopause when the levels of these hormones decrease.

Risk factors for uterine fibroids

Every woman in reproductive age is at risk of developing uterine fibroids.

Black women have a two to three increased risk of developing uterine fibroids. They are also at an increased risk of developing them at an earlier age than white women.

Early onset of menstruation (

Significant consumption of beef and other reds meats is associated with an increased relative risk of fibroids, and consumption of green vegetables and fruit (especially citrus fruit) with a decreased risk.

Consumption of alcohol, especially beer, appears to increase the risk of developing fibroids.

Other factors such as hypertension, obesity, uterine infection and family history of fibroids are also associated with an increased risk of developing fibroids.

Fibroids can pose a health problem

Although the majority of fibroids are small and don’t cause any symptoms, many women with fibroids have significant problems that interfere with some aspects of their lives and require treatment. These symptoms are related to the number, size and location of the fibroids.

Abnormal uterine bleeding is the most common symptom. Heavy and/or prolonged menses is the typical bleeding pattern with fibroids and usually associated with a lot of pain. Heavy uterine bleeding may be associated with complications, such as iron deficiency anemia, social embarrassment, and can affect one’s working schedules.

Larger fibroids can cause a sense of pelvic pressure or fullness in the abdomen, similar to the feeling of being pregnant.The uterus with fibroids is irregularly shaped, in contrast to the pregnant uterus, and can cause specific symptoms due to pressure from the fibroids at particular locations, such as;urinary frequency, difficulty emptying the bladder, and, rarely, urinary obstruction can all occur with fibroids. Fibroids that place pressure on the rectum can result in constipation. Very large fibroids can compress on the blood vessels in the abdomen and increase the risk of clot formation. Fibroids can also twist or get infected causing serious pain among other symptoms.

Fibroids can have an effect on reproduction. Fibroids that distort the uterine cavity result in difficulty conceiving a pregnancy and an increased risk of miscarriage. In addition, fibroids have been associated with adverse pregnancy outcomes such as early separation of placenta from the uterus, fetal growth restriction, and preterm child birth all of which can affect the outcome of the baby.

Diagnosis of uterine fibroids

The diagnosis of uterine fibroids is made by thorough history taking, physical examination and investigations. Pelvic examination usually reveals enlarged uterus with irregular shape and an ultrasound imaging scan confirms presence of fibroids.

Management of uterine fibroids

Women who have no symptoms from their fibroids do not need to have treatment. Women with significant symptoms may try medical or surgical treatment. The best treatment depends on which symptom is most bothersome. The size, number and locations of fibroids also determine the most treatment option.

Medicines: The pills, patches, injections, and implants used for birth control can all reduce how much one bleeds during their period. A device known as the intrauterine device, or IUD, can also make one’s periods lighter. There are also other medicines that can reduce the amount of blood a woman bleeds during her period. If bleeding is the main symptom, birth control methods or medicines might help.

Surgery: There are various surgical options to help with fibroids, and the choice depends on the symptom and whether one still wants to give birth or not. Surgery to remove the fibroids is the best option for women who want children, although there are still chances of the fibroids growing back with this option.

Other surgery options include destroying the lining of the uterus which reduces uterine bleeding, cutting off blood supply to the fibroid(s) and shrinking them, and surgery to remove the uterus, but these are not for women who still want to bear children.

Dr Ian Shyaka is a General Practitioner based in Kigali