SingaporeMotherhood | Pregnancy
July 2024
10 Things to Know about Uterine Fibroids, and How they may affect your Periods, Pregnancy, and Fertility
Whether they are as small as a grain of rice, or as big as a melon, hearing that you have fibroids can spark fear. Are they cancerous? What if I am pregnant? Will they make it harder for me to have a baby? Slow down, and take a breath. First of all, these growths of muscle cells and fibrous connective tissue in your uterus are non-cancerous, Dr Harvard Lin, Consultant Obstetrician, Gynaecologist and Urogynaecologist at the Asian Obstetrics & Gynaecology Centre (AOGC), assures us.
During your reproductive years, they will continue to grow into varying sizes, but will typically start to shrink when you reach menopause. In fact, you may not even know that they are there. While it is estimated that between 30 and 40% of women have uterine fibroids, many go symptom-less. Some women only learn that they have them during a pelvic exam, or a pelvic ultrasound.
But for some women, fibroids can cause problems, especially during pregnancy. Dr Lin tells us more.
(See also: I HAVE PCOS. HOW CAN I IMPROVE MY CHANCES OF GETTING PREGNANT?)
1. They are common
Uterine fibroids, also known as leiomyomas, are common, non-cancerous growths of the uterus that often appear during childbearing years. They are typically identified through symptoms such as irregular menstrual bleeding, symptoms such as pelvic discomfort, and signs of anaemia.
Occasionally, they are discovered in women who do not exhibit any symptoms during routine pelvic examinations, or by chance during imaging tests.
2. Symptoms vary in severity
Not all women experience symptoms, and the severity of symptoms can vary. Common symptoms include:
- Pelvic pain and pressure: Discomfort or pain in the pelvic region, including pressure on the bladder or bowel, leading to frequent urination, or constipation.
- Abdominal swelling or bloating: Larger fibroids may cause the uterus to enlarge, leading to a feeling of fullness or bloating in the lower abdomen.
- Pain during intercourse (dyspareunia): Discomfort or pain during sexual intercourse.
- Lower back pain: Lower back pain or discomfort.
- Urinary symptoms: Fibroids pressing on the bladder can lead to frequency in urination, or difficulty in emptying the bladder completely.
- Constipation: Fibroids pressing on the rectum can cause constipation or difficulty with bowel movements.
- Reproductive problems: Fibroids can sometimes lead to infertility, recurrent miscarriages, or complications during pregnancy or labour.
3. They can be treated
Treatment options depend on factors such as the severity of symptoms, the size and location of the fibroids, and whether you plan to have children in the future.
(See also: MIGRAINES Q&A: WHY IT’S (MOSTLY) A WOMEN’S CURSE)
4. Women at reproductive age are most at risk
Fibroids are most common in women of reproductive age, typically between the ages of 30 and 50 years. Older women are more susceptible but only up to a point, as fibroids tend to shrink after menopause when oestrogen levels start to decline.
Women who have never given birth, or who had their first child at a more advanced age, may also be at higher risk of developing fibroids.
Pregnancy, which elevates the hormone levels, and hormonal medications such as birth control pills, may also increase the risk.
A woman whose mother or sister has had fibroids is at higher risk of developing them. Studies show that 21.8% of East Asian women (women from China, Japan and Korea) are at higher risk than women of other racial groups.
Women who are overweight or obese are also at increased risk. For very heavy women, the risk is two to three times greater than average.
A diet that is high in red meats and low in fruit and vegetables can also increase the risk. Conversely, a diet rich in fruit, vegetables, and fibre may help lower it. Getting sufficient vitamin D has also been shown to lower the risk of getting fibroids.
5. You can still conceive and have a baby
Not all fibroids cause infertility. Many women can conceive and carry a pregnancy to term successfully, even with fibroids.
The impact of fibroids on fertility varies depending on factors such as their size, number, location, and type.
In some women fibroids can interfere with fertility by distorting the uterine cavity, blocking the fallopian tubes, or impairing embryo implantation.
6. But you should be more careful when pregnant
If you get pregnant with a fibroid present in your uterus, the presence of the foetus diverts blood supply from the fibroid, to the baby. This results in a change in the architecture (kinking) of the blood supply to the fibroid.
This can cause it to undergo degeneration of tissue or necrosis (death of tissue), leading to sudden severe pain, fever, and other symptoms that require medical attention.
Pain is the most common complication of fibroids in pregnancy, and is seen most often in women with large fibroids.
Fibroids may also increase the risk of miscarriage, preterm birth, or complications during pregnancy and labour.
However, most women with fibroids have uneventful pregnancies, albeit with careful monitoring, as most fibroids are asymptomatic.
7. They can affect your periods
There is a chance that fibroids could cause abnormal periods. This is especially so if you experience the following symptoms:
- Heavy bleeding: Heavy bleeding is defined as bleeding that lasts for more than seven days or bleeding that saturates a pad or tampon within two hours.
- Prolonged periods: These can last more than seven days.
- Irregular periods: This can make it difficult to plan for events or activities, which could then cause anxiety or stress in some women.
- Painful periods: Fibroids can cause painful menstruation or dysmenorrhea as they exert pressure on the surrounding organs or tissues, causing discomfort or pain.
8. They can be treated
Treatment options range from conservative measures to surgical interventions. The choice of treatment depends on the size and location of the fibroids, the severity of symptoms, the patient’s age, and their desire for future fertility.
If fibroids are small and not causing significant symptoms, your doctor may recommend monitoring them over time without the need for immediate intervention. This approach is often suitable for women who are approaching menopause, which is when fibroids typically shrink, and symptoms improve.
Medications
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, can help relieve menstrual cramps and pelvic pain.
Hormonal medications, such as birth control pills, gonadotropin-releasing hormone (GnRH) agonists, or progestin-releasing intrauterine devices (IUDs), can help regulate menstrual bleeding and reduce the size of fibroids. They are often used as short-term treatments to manage symptoms before surgery or during the pre-operative period.
However, while hormone therapy can provide relief, it does not eliminate the fibroids. Its effectiveness also depends on factors such as the size, location, and characteristics of the fibroids, as well as the patient’s preferences and medical history.
Surgery
If fibroid symptoms do not improve with medication, surgery is the next treatment option. The main technique used is morcellation, where the fibroid is cut into smaller pieces, and removed through small incisions and minimally invasive surgery.
Uterine artery embolisation (UAE) involves injecting tiny particles (about the size of a grain of sand) into the blood vessels that supply the fibroids, cutting off their blood supply and causing them to shrink.
Myomectomy is a surgical procedure to remove fibroids while preserving the uterus. It treats bleeding, infertility, pain, and pressure caused by fibroids. This is an option for women who want to retain their fertility or avoid a hysterectomy.
Hysterectomy involves the surgical removal of the uterus, sometimes along with the ovaries. This permanent solution may be recommended for women who have large or multiple fibroids, or have severe symptoms that do not respond to other treatments, or in rare cases, women who develop fibroids after menopause. Women who undergo a hysterectomy can no longer become pregnant.
9. Untreated fibroids can lead to adverse health effects
If left untreated, fibroids can cause heavy menstrual bleeding (menorrhagia), leading to anaemia due to blood loss.
Large fibroids pressing on the bladder can increase frequency or urgency in urination, or difficulty emptying the bladder completely. This can lead to urinary tract infections (UTIs), kidney infections, and other urinary problems.
Fibroids pressing on the rectum can cause constipation, difficulty with bowel movements, or a sensation of rectal pressure or fullness.
10. At the end of the day, seek medical advice and get treatment if necessary
Fibroid-related symptoms such as heavy menstrual bleeding, pelvic pain, and urinary problems can significantly affect your quality of life, leading to physical discomfort, emotional distress, and limitations in daily activities. It is important to seek medical evaluation and appropriate management as soon as possible to prevent or mitigate potential risks and complications.
Featured image: freepik
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