Fibroids

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Fibroids are non-cancerous growths that develop in the uterus. One in 5 women will have one or more of these tumours, which range in size from as small as a pea to as large as a melon. Most women have small fibroids which have no symptoms and do not need treatment. Symptoms of fibroids may include:

Heavy menses
Some women with fibroids experience excessive menstrual bleeding with passage of blood clots. If the heavy menses continue unchecked, the woman may develop anemia (low blood count) that can cause fatigue or light-headedness.

Pelvic pressure or discomfort
Women with large fibroids may have a sense of heaviness or pressure in the lower abdomen or pelvis. This discomfort is similar to pregnancy when the enlarging uterus presses against surrounding structures.

Bladder changes
The most frequent bladder symptom associated with fibroids is the need to urinate more frequently. This is due to fibroids pressing against the bladder, reducing its capacity to hold urine. In some women whose fibroids are pressing against the bladder neck, they may experience difficulty passing urine.

Pelvic pain
A less common symptom is severe pain. This occurs when a fibroid goes through a process called degeneration, usually because it outgrows its blood supply. This typically happens during pregnancy.

Low back pain
Fibroids that press against the muscles and nerves of the lower back can cause back pain.

Rectal pressure
Fibroids also can press against the rectum and cause a sense of rectal fullness, difficulty having a bowel movement or pain with bowel movements.

Diagnosis
Fibroids can be diagnosed in a number of ways, the most common of which are: Pelvic examination — During a routine gynaecologic exam, a doctor can feel the size and shape of the uterus. If the uterus is enlarged or irregularly shaped, fibroids may be present. Ultrasound scans – Sound waves are used to create an image of the uterus and ovaries.

Treatment
Treatment for fibroids can range from no treatment at all to surgery. Unless fibroids are causing excessive bleeding, discomfort or bladder problems, treatment often is not necessary. Women with fibroids should be evaluated periodically to review their symptoms, as well as the size of the fibroid and uterus.

Surgical treatments include hysterectomy or myomectomy. The former is the removal of the whole uterus together with the fibroids in it. The latter refers to the selective removal of just the fibroids, leaving the rest of the uterus in place. The main problem with myomectomy is the possible re growth of new fibroids in future. Hysterectomy would mean cessation of menses and fertility.

Depending on the size and location of the fibroids, there are numerous routes to perform myomectomy and hysterectomy. Myomectomy can be done via the conventional abdominal incision, laparoscopy (key-hole method) or transcervical (through the cervix with no abdominal incision). Hysterectomy can be done via the conventional abdominal incision, laparoscopy (key-hole method) or transvaginal (through the vagina with no abdominal incision).

Incorporated in 2005, Singapore Medical Group (SMG) is a private specialist and primary healthcare provider with a network of more than 20 medical specialties. The Group is committed to its promise of providing patient centred medical care and experience to every individual. SMG has more than 27 clinics and a growing network of SMG Associates clinics all across the island.