05 Mar 2018

It is estimated that 70 to 80 per cent of women of reproductive age (30 to 50) in Botswana experience fibroids, says Dr Lorato Matshitsa of Princess Marina Referral Hospital in the Obstetrics & Gynaecology Department.

Fibroids are abnormal growths that develop in or on a uterus (womb) also known as uterine myomas, leiomyomas or fibromas.

They are firm, compact tumors that are made of smooth muscle cells.    

She says fibroid could grow to be quite large and cause pain and/or heavy periods depending on their location.

However, most women do not have any symptoms at all.

They are typically not cancerous.

Dr Matshitsa says there are three types of fibroid and are usually described by their location.

Intramural fibroid - the most common type of fibroid appear within the wall of the uterus.

The second one known as subserosal fibroid form on the outside of the uterus, also called the serosa.

The last, submucosal fibroid develop in the inner lining (endometrium) of the uterus.

Submucosal tumors are not as common as other types, but when they do develop, they may cause heavy menstrual bleeding and trouble in conceiving.

Regarding the cause, Dr Matshitsa said it was unclear why fibroids develop, but several factors may influence their formation such as hormones.

Female hormones may stimulate the growth of fibroids and fibroids may run in the family.

If the mother, sister, or grandmother has a history of this condition, there is a chance one of the family member may develop it as well.

She said Pregnancy also increases the production of estrogen and progesterone in the female body and fibroids may develop and grow rapidly while one is pregnant.

This rapid growth may cause severe pain during pregnancy  called Red Degeneration.

Dr Matshitsa says symptoms usually depend on the location, size and the number of fibroids in the body.

Small fibroids may not cause any symptoms and they may shrink during and after menopause.

Symptoms of fibroids include heavy and prolonged bleeding during monthly periods sometimes with clots and/or flooding which may lead to anaemia.

She said other symptoms include bleeding in between periods, increased menstrual cramps, pelvic pain, backache, pain during sexual intercourse and depending on location fibroid, may cause pressure on the bladder with frequent or even obstructed urination, as well as pressure on the rectum with painful or difficult defecation, fullness, swelling and bloating of the abdomen.

Dr Matshitsa says some of the complications caused by fibroids include iron deficiency and anaemia if there is heavy bleeding, impaired fertility, especially with sub-mucosal fibroid, which increases the risk of miscarriage. She however, said fibroids do not interfere with ovulation and lastly said effect on pregnancy depends on exact location within the uterus and size, hence miscarriage, pre-term labour and foetal mal-presentations.

She says fibroids are diagnosed through pelvic exam, ultrasound to detect location, size and number of fibroida and Magnetic Resonance Imaging.

Dr Matshitsa says treatment is tailor-made depending on individual needs, age, the size of fibroid(s), and their effect (if any) on one’s life and said medications may be used to regulate the patent’s hormone levels to shrink fibroids.

She said gonadotropin-releasing hormone agonises, such as Zoladex (Goserelin) will cause the estrogen and progesterone levels to drop.

This will eventually stop menstruation and shrink fibroids.

Effect is limited to duration of treatment and the fibroid will grow back eventually.

This method may be used for large fibroid prior to surgery.

Dr Matshitsa says  other options that could  help control bleeding and pain, but will not shrink or eliminate fibroids include Mirena-Levonogesterel releasing intrauterine system birth control pills, contraceptive injection and Over-the-counter anti-inflammatory pain relievers while surgery to remove large or multiple growths (myomectomy) may be performed.

She said hysterectomy may be indicated if complications arise during myomectomy if no other treatment works for you or in older women who do not desire fertility.

Dr Matshitsa says other minimally invasive technologies include  forced ultrasound surgery and the relatively new Uterine Artery Embolisation, as well as Myolysis, where fibroids are shrunk using an electric current or laser.  Cryomyolysis, which freezes the fibroid, applies to sub-mucosal fibroid. ENDS