Fibroid

To understand fibroid, one must know about the anatomy of the womb. It has mainly 2 layers; the inner lining (endometrium) which breaks down and discharges every month as menstruation; and the muscle layer (myometrium) which contracts during labour and delivery of a child.

Fibroid is a solid growth in the muscle layer. It is fairly common and is present in 20% of women of childbearing age.

The cause of fibroid is not well understood although it is known to grow quickly during pregnancy or when the woman is taking hormone tablets. It usually stops growing and starts to shrink during menopause.

Symptomatic Fibroid

Fibroid may cause symptoms such as heavy and irregular prolonged menstruation leading to lack of blood (anemia). It can also cause bleeding or spotting in between periods (intermenstrual bleeding). During period, it may cause backache or abdominal cramps which may last for days.

Large fibroid may present as swelling in the abdomen which may be felt by the patient as a lump. It may press on the bladder causing difficulty in passing urine or sometimes the frequent need to urinate. Pressure of fibroid on the intestine may cause constipation. Large fibroid may block up the fallopian tubes causing difficulty conceiving. Sometimes multiple fibroids may increase the risk of miscarriage.

Treatment of Symptomatic Fibroid

Treatment of symptomatic fibroid is usually by surgery. For younger woman who wishes to keep the womb for menstruation and to retain her ability to become pregnant, removal of fibroid (myomectomy) is usually preferred. However, there is the possibility that new fibroid may grow (recurrence). In older women who has completed the family removal of the womb (hysterectomy) is the treatment of choice. Myomectomy or hysterectomy can be done through the abdomen or the vagina. They can also be done by key-hole surgery (laparoscopy) or conventional way depending on the circumstances.

Recently, GnRH agonist, a new class of medication may be used to reduce the size of the fibroid and stop the menstruation so that the patient can improve her health before the surgery.

Another new approach to treat fibroid is to block the blood supply to the growth by introducing particles via the big blood vessel in the thigh using X-ray machine (Embolization method).