What is a Fibroid?

You probably just found out you have fibroids (myomas). What you may not yet know is that fibroids are very common and treatable. Fibroids are round growths of muscle in the wall of your uterus-and are almost always noncancerous (benign) and harmless. They start as pea-sized lumps, but can grow steadily during your reproductive years. Many fibroids just need to be monitored. Others may require treatment if they become too large or cause symptoms. Although fibroids tend to run in families, no one really knows why some women have them and others don't.

Symptoms

Many fibroids cause no symptoms at all. But a fibroid that grows rapidly in your uterus can cause one or more of the following problems:
1. Abnormal uterine bleeding
2. Difficulty urinating or having bowel movements
3. Achiness, heaviness, or fullness
4. Back pain
5. Difficulty getting pregnant
Only rarely, if fibroids are allowed to grow unchecked, will they lead to serious problems such as cancer.

Where can they Grow?

Medical Evaluation
When fibroids are suspected, a medical evaluation can determine whether you have fibroids, rule out other problems, and help you and your doctor decide which treatment, if any, is best for you. Before a diagnosis is reached, your doctor will ask you questions about your medical history and perform a pelvic exam. Your doctor may also suggest that you have one or more diagnostic tests, which can help provide details on the size and location of any fibroids.

Medical History
To look for signs of fibroids and to begin to plan your treatment, your doctor may ask you about one or more of the following:
1. The pattern of your menstrual bleeding.
2. When, if ever, you experience pelvic pain
3. Your birth control method, if any
4. Your family history of fibroids
5. Your plans to have children

Pelvic Exam
During a pelvic exam, your doctor examines your reproductive organs. The tenderness, texture, and overall size of your uterus are checked. If you have abnormal bleeding, your doctor will also check your vagina and cervix for signs of infection or small breaks in the skin. Samples of cervical cells may be taken for closer examination (a Pap test) to check for infection or cancer. Since fibroids can grow on the back wall of your uterus, your doctor may also do a rectal exam.

Diagnostic Tests
Three common tests can provide close-up views of the inside or outside of your uterus and confirm the size and general location of fibroids. Ultrasound is quick and painless. Hysteroscopy and laparoscopy are slightly more involved procedures.

1. Ultrasound is often used to monitor the growth of fibroids. An instrument is placed on your lower abdomen or inserted into your vagina. Sound waves bounce off your reproductive organs, creating a picture on a video screen.

2. Hysteroscopy is used to evaluate fibroids that extend into the uterine cavity. During hysteroscopy, your doctor looks directly at the inside of your uterus through a hysteroscope, a thin "telescope" with a light attached.

3. Laparoscopy allows your doctor to check for fibroids by providing an outside view of your reproductive organs. Your doctor inserts a laparoscope, another type of "telescope," through a small incision near your navel.

Treatment Options
You and your doctor may choose one of three types of treatment: simply monitoring the fibroids, removing the fibroids, or removing your entire uterus. Your decision will depend partly on the severity of your symptoms. It will also depend on the size and condition of the fibroids and how fast they're growing. If your doctor recommends removing your uterus, you will also need to consider your plans for future children and how important it is to you to keep your uterus. Your doctor can describe the risks and benefits of all your treatment options.

Monitoring the Fibroids
1. Waiting and watching the fibroids with regular pelvic exams or ultrasound may be a good option if the fibroids are small or if you're nearing menopause (the end of menstrual cycles). At menopause, fibroids often shrink naturally due to decreasing levels of estrogen, a hormone that makes fibroids grow.
2. If you are taking hormones, your fibroids may require special monitoring. Your doctor may recommend that you try another birth control method if you are taking birth control pills and the fibroids are growing. If you are on hormone replacement therapy, you may need to try a lower dose.
3. If you are pregnant, the fibroids may grow rapidly, but most don't cause serious problems. Surgery to remove fibroids is usually not done at this time. However, you may need a cesarean (surgical delivery), especially if the fibroids are large or block the vagina, or if you've had previous uterine surgery.

Removing the Fibroids
Fibroids can be removed either through the vagina with hysteroscopy (if inside the uterine cavity) or through an abdominal incision with abdominal myomectomy (open outdated surgery) or laparoscopically (latest technology - tiny key hole incisions) . These procedures preserve your uterus and your ability to have children, but fibroids may later return. Your doctor may prescribe anti-estrogen medications to shrink the fibroids before surgery. During surgery, you'll have general anaesthesia (which allows you to sleep during the procedure).

Removing Your Uterus
Having a hysterectomy (removal of the uterus) guarantees that fibroids will never return: But it also means you won't be able to have children. For women with large or many fibroids or unbearable symptoms, hysterectomy may be the best solution. The uterus and cervix may be removed either through a small abdominal incision or through the vagina, under general anaesthesia. The ovaries are often kept in place to allow the continued production of hormones.

Endometrial ablation
Endometrial ablation may be an alternative for women with heavy bleeding who have a few small fibroids. During this procedure, the uterine lining and any fibroids extending into the uterine cavity are destroyed with electric or laser energy. Afterward, uterine bleeding usually decreases or stops. Recovery from ablation is rapid. However, if fibroids continue to grow, you may later need a hysterectomy.

Recovery
Treating your fibroids is likely to relieve your symptoms. But your doctor will want to schedule regular checkups to monitor your progress and make sure your fibroids don't return. If you have had surgery, ask your doctor about any additional follow-up visits you might need.

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