What are Fibroids?

Fibroids, also interchangeably referred to as uterine fibroids, fibromas, myomas, and leiomyomas in Singapore are a form of growth found on the wall of the uterus. Fibroids are usually non-cancerous growths occurring among pre- or perimenopausal women. The prevalence of fibroids is far more common than most perceive them to be, with an estimation of up to 60-80% of women having them.

The size and number of fibroids vary from one patient to another. Fibroids may manifest as the size of a seed, or as large as a fruit. They may also form as a singular tumour, or many, with one case study reporting 236 fibroids removed in a single operation.

The growth of fibroids is arguably one of the more mysterious occurrences in a woman’s body. 

Thus far, the fibroids growth patterns that have been identified are:

  • Increase in growth and numbers during pregnancy.
  • Tend to shrink when patients are administered anti-hormone medications.
  • Stop growing or may even shrink when women reach menopause.
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Additionally, fibroids are classified based on the location of growth.

Below are the types of fibroids and the regions of growth in the uterus:

  • Submucosal: fibroids that grow inside the uterine/endometrial cavity.
  • Intramural: fibroids that grow within the wall of the uterus.
  • Subserosal: fibroids that grow on the outer surface of the uterus.
  • Pedunculated: stalks of fibroid that grow from the surface of or into the cavity of the uterus.

What are the common causes of Fibroids in Singapore?

The exact cause of fibroids remains unknown.

Based on the behavioural patterns of fibroids growth some potential causes of fibroids include:

  • Abnormal genetic changes: genetic material in fibroids that are different from cells in the uterine muscle may show that genetic changes are responsible for the formation of fibroids.
  • Hormones: fibroids that grow during pregnancy and their diminishments during menopause indicate that oestrogen and progesterone levels may have an impact on fibroid growth.
  • Extracellular matrix and collagen: excessive accumulation of extracellular matrix (a form of protein network) and collagen may give rise to the formation of fibroids.

What are the usual symptoms of Fibroids in Singapore?

Most women (up to 50%) tend to be asymptomatic, however, in the event symptoms are present, fibroids may present issues such as:

  • Menstrual problems: menstruation problems such as heavy periods, frequently soaking through pads, long menstruation that last over a week could be symptoms of fibroids.
  • Pains: such as period pains, pain in the lower abdomen and/or lower back, or pain during intercourse may signify the presence of fibroids.
  • Genitourinary issues: frequent need to urinate, difficulties emptying bladder, or constipation may be symptoms of fibroids.
  • Reproductive issues: infertility, difficulties conceiving, disrupted pregnancy may be symptoms of fibroids.
  • Deep vein thrombosis (DVT) issues: these patients may present with leg swelling or even shortness of breath. This can be potentially dangerous if the clot from the lower limb dislodges and gets trapped in the lungs or heart. The reason behind DVT is that the large pelvic mass caused by fibroids compresses and slow down the blood flow in the major vein from the legs, leading to clot formation.

If you notice any of the symptoms stated above, make an appointment today to get an accurate diagnosis and effective treatment.

Are Fibroids painful?

Fibroids are not usually painful as it is rare that one experiences any symptoms at all. Where pain is present, patients tend to get diagnosed promptly after seeking medical intervention.

Who is at risk of Fibroids in Singapore?

Whilst the cause remains ambiguous, there are certain patterns to the occurrence of fibroids, these include:

  • Age: fibroids tend to grow in women in the age range of 30-40, while the activities of fibroids tend to gradually slow down through menopause.
  • Family history: statistically, it has been indicated that if one’s mother has fibroids, the chances of you having fibroids increase by 3 times.
  • Obesity: obesity increases the risk of developing fibroids by 2-3 times.
  • Diets: fibroids are more common among women who consume red meat in certain populations. On the other hand, the prevalence reduces among women with high fruit and vegetable consumption.
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How are Fibroids diagnosed?

Fibroids are easily identifiable, some tests that may be administered to confirm a diagnosis include:

  • Pelvic examination: your obstetrician/gynaecologist may attempt to physically feel/palpate if there are any lumps or masses in the pelvic region.
  • Imaging tests: an ultrasound would show if there is a formation of solid masses in the uterus which are usually sufficient for the diagnosis of fibroids. Magnetic resonance imaging (MRI) may be additionally requested to determine the exact region and dimension of fibroid growth.
  • Diagnostic laparoscopy: a laparoscopy would enable your obstetrician/gynaecologist to obtain a clearer image of the fibroids with a camera through incisions at the abdomen. A laparoscopy is usually conducted if a myomectomy is deemed necessary as treatment.

What are the treatment options available for Fibroids in Singapore?

Fibroids can be treated in the following ways:

  • Surgery: laparoscopic surgery is usually conducted to treat fibroids. A myomectomy procedure is performed during laparoscopy with the intention of removing fibroids whilst preserving the uterus. It may be worth noting that myomectomy does not stop fibroids from recurring. In more extreme cases, it is common for a hysterectomy (uterus removal) to be performed as treatment.
  • Pain medication: anti-inflammatory drugs are prescribed to alleviate pain. These, however, will not stop the growth nor shrink fibroids.
  • Hormone therapy and contraceptives: may be prescribed as treatment to reduce symptoms such as heavy menstrual flows. Additionally, hormone therapy encompassing injections may be administered to shrink fibroids.
  • High Intensity Focused Ultrasound (HIFU): this method focuses ultrasound energy to a concentric point to generate heat energy within the fibroid. This then causes protein coagulation/denaturation and the central part of the fibroid undergoes degeneration and shrinks.
  • Uterine artery embolisation: this is a radiological procedure whereby the main blood supply to the uterus is blocked. This starves and deprives the fibroids of blood supply and the fibroids undergo degeneration and shrinks. It may not be suitable for those who are looking to conceive/get pregnant as the blood supply to the uterus is affected.

Frequently asked questions

Can fibroids turn into cancer?

Fibroids are thought not to cause cancer or become cancerous. Fibroids are almost always benign growths. However, a fibroid-like cancer growth (leiomyosarcoma) in the uterus can be confused with fibroids because they look similar on ultrasound scans.

How fast do fibroids grow?

Current evidence suggests that fibroids may grow anywhere from 18-120% in size. They may also shrink during menopause and the second and third trimester of pregnancy.

Do fibroids recur after removing them?

Yes, fibroids do tend to recur after removal. The only way to stop fibroids from growing back is a hysterectomy (uterus removal) which isn’t a feasible option for many, particularly younger patients. Treatments such as uterine artery embolisation would be the next best prevention measure to take as it reduces the rate of recurrence.

Can fibroids affect fertility?

Fibroids account for 2-3% of infertility. While the likelihood is low, it is possible nevertheless. Fibroids may cause disruption in implantation or by blocking the fallopian tubes.

How can I treat fibroids at home?

Treating fibroids would either imply removing or shrinking them. Whilst one will not be able to remove fibroids on your own, one can attempt to reduce symptoms. This may involve dietary changes such as reducing red meat and increasing fibre consumption. Lifestyle changes such as avoiding or limiting alcohol and quitting smoking could also improve your condition.

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