Dear Doctor,

I have had fibroids for more than two years. I was advised to have an operation, however, due to financial constraints; I have not been able to do so. I have one child but no plans of having others, so I feel like I can have the operation when I get the money, which may not be soon. Does this pose any risks to my health?

Claire

Dear Claire

Uterinefibroids are benign tumours occurring in the uterus, either inside the wall or on the wall of the uterus. It is a fairly common problem in middle aged women. 70 to 80 per cent of middle aged women have fibroids, but many may have no symptoms due to it.

The exact cause of fibroids is not known. But it is said to be due to change in the balance of hormones and exposure to excess estrogen. Therefore, they tend to shrink after menopause. Fibroids can be single or multiple, large or small.

Obesity, African ethnicity, family history of fibroids, are some of the other risk factors.

As such, fibroids are benign tumours. But they do become a cause for sterility or early miscarriage. This happens because multiple fibroids located in the inner wall of the uterus, or a large fibroid encroaching upon the uterine cavity, prevent the implantation of the fertilised ovum and if implanted, can even dislodge it. These tumours can cause lower abdominal pain, swelling over abdomen, painful intercourse, excess or prolonged menstrual cycle or, inter-menstrual bleeding in affected women. They can also press on the urinary bladder or rectum, which are organs adjacent to the uterus. This would cause frequency of urination, difficulty in urination or defecation. 

Diagnosis of fibroids is based on clinical examination and abdominal/vaginal ultrasound.

Treatment depends on the number, location and size of fibroids, whether they are causing symptoms or not, the age of the affected woman and her overall health status. Small fibroids which do not cause any symptoms may be left untreated as they will shrink after menopause. However, if they grow in size and number, or cause symptoms, treatment is needed.

Treatment includes hormonal therapy. Gonadotropin releasing hormone is used to reduce the levels of estrogen and progesterone and induce menopause. Birth control pills help in controlling excess bleeding. Progesterone coated intrauterine device can also be used and pain killers can be used for relief in the pain.

However, in case of severe symptoms, or if medical treatment does not succeed, surgery remains the only option. In case of comparatively young women or those desiring to have children in the future, surgical removal of only the fibroids (myomectomy) may be carried out.

In women who are around menopause or do not wish to have more children, the entire uterus is removed.  The surgical procedures are safe and carry only the risks involved with any other surgery like excess bleeding, post-operative infection, adhesions or herniation at surgical site.

Newer advanced techniques for the removal of fibroids have come up, like electrolysis or laser rays for destroying the fibroids, ultrasound waves for ablation of the fibroids.

Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.