UTERINE fibroids, medically known as leiomyomas and colloquially termed the tears of a weeping womb are benign growths in the muscle layer of the uterus.
Benign simple means a growth that is not cancerous. So yes fibroids are not cancerous. The uterus is a muscular organ found only in women and it has three layers namely the endometrium which is the inner layer where implantation occurs, the muscle layer which is the middle layer and the serosa which is the outer layer.
Uterine fibroids develop in the middle muscular layer but may grow to either stay in the muscle layer, into the inner layer (endometrium) or into the outer layer (serosa).
The location, size and number of the fibroid is what will determine whether the fibroid will give you symptoms or not and which symptoms you will have as well.
Fifty percent of women by the age of 50 years would have developed fibroids although not all of them will be symptomatic.
Fibroids that are mainly in the muscle layer without encroaching the endometrium (inner layer) and those encroaching onto the serosa (the outer layer) generally are asymptomatic (don’t have any symptoms).
Those that encroach onto the endometrium (inner layer) are the ones that largely give you symptoms.
The main symptoms of fibroids are excessive vaginal bleeding, lower abdominal pain, backache, pain during sexual intercourse and if there is severe bleeding you can have symptoms of anaemia like headaches, dizziness, and lightheadedness or evening episodes of collapsing.
The bleeding with fibroids is mainly during your period. What generally happens is that you will have prolonged days on your menses and you pass more than normal blood volume and at times with clots.
For instance if your period used to go for five days you end up going for say seven to eight days and you will be passing more blood on each day than normal. Normal period bleeding should be between three to seven days.
If you bleed for more than seven days, suspect there could be fibroids and visit your doctor as soon as possible. If left untreated fibroids in the long term have two main possible complications.
Firstly because they may affect the inner lining of the uterus they can cause subfertility (difficulty in falling pregnant) and ultimately infertility (failure to fall pregnant).
Secondly because of excessive bleeding you can develop anaemia which can complicate to heart failure and ultimately lead to death.
The mortality rate of fibroids (the number of people that will die from a particular condition) is very low at one in 1000 women. This means only 1 woman out of a thousand women diagnosed with fibroids will die.
The cause for uterine fibroids is unknown. Nonetheless there are risk factors associated with the development of fibroids. Some of the risk factors are modifiable and we would love to focus more on these ones.
Obesity is a major risk factor for the development of fibroids. Women who are obese have a higher propensity to develop uterine fibroids. Women who eat more fruits and vegetables have a less risk of developing fibroids compared to those who don’t.
Women who exercise have a less probability of developing fibroids compared to those who do not. There is also a genetic risk factor to the development of fibroids. If your mother had fibroids your risk of developing fibroids is approximately three times higher than someone whose mother never had fibroids.
We say Black women have a higher probability of developing fibroids compared to Caucasians. If you have a positive family history of fibroids you need to visit a doctor as soon as you see any of the above symptoms.
There is a hormonal effect to the development of fibroids. Estrogen and progesterone play a major part in the development of fibroids. Because of this we see that women who are post-menopausal generally are not affected by fibroids that much.
The term tears of a weeping womb comes about from the fact that fibroids mainly affect women who have never had children and normally during the early thirties.
So the narrative is that the uterus would have been waiting for a baby from the time menstruation begins and no baby is coming month in month out and eventually it starts crying for a baby and the tears are the fibroids.
To make a diagnosis of uterine fibroids we consider the clinical picture i.e. symptoms (what the patient tells us) and signs (what the doctor finds on physically examining the patient) and imaging results. We have already covered the symptoms in the second paragraph above.
The signs that we can find when we examine you include a distended abdomen with a mass in the lower abdomen.
I once had a patient who had a very huge fibroid and she actually thought she was pregnant because the abdomen was so distended and everyone thought she was heavily pregnant yet it was a giant fibroid.
When it comes to imaging, the mainstay of diagnosis is a simple ultrasound scan of the pelvis. Rarely do we need to do more extensive and more complex examinations like a CT or MRI scan.
On top of the imaging studies we will also need to do some blood tests. These are not to diagnose fibroids but to look for other complications like anaemia and also as a wake up to taking the patient to the theatre
Since most fibroids are asymptomatic, they don’t need any form of treatment. Only symptomatic fibroids require treatment. Treatment can be to relieve symptoms or to cure the fibroids.
Symptom relief could be for pain with pain medications like paracetamol or ibuprofen (brufen) or bleeding with hormonal contraceptives like the combined pill or to relieve the symptoms of anaemia with iron supplements.
Curative treatment modalities include medication that can shrink the fibroids e.g. carbergoline and danazol. Larger fibroids generally will need surgical resection to be fully cured. Surgery can either be open (laparotomy) or minimal access (laparoscopic).
The choice of treatment will depend on the patient’s symptoms, the patient’s plans and the available modes of treatment. For instance if a patient is still young and they still want to have a baby it would be prudent to do what we call a myomectomy (removal of the fibroids whilst leaving the uterus as intact as possible) yet if the patient is elderly and doesn’t want to have babies anymore and the bleeding is excessive with multiple fibroids we would consider a hysterectomy (removal of the whole uterus).
Remember a healthy you, a healthy me to a healthy world.
ν Chiripanyanga is a Harare medical doctor. He can be contacted at firstname.lastname@example.org)