What is a fibroid?
A fibroid is a cluster of connective tissue in the myometrium of the uterus, i.e. in the muscle. It is considered as a benign tumor.
It can be single or multiple. As for the size, it can be less than a cm or several tens of cm.
Fibroids are very frequent and particularly after 40 years of age, from 20 to 50% of women depending on the study authors. Fibroids are more common in black women and appear younger in them. Family forms do exist.
Evolution, recurrence
Without treatment, a fibroid will tend to gradually increase in size.
The number and size of fibroids often increase with age.
There are only very rare cases of progression into a malignant tumor. The tumor is a benign one.
Nevertheless, a very large fibroid can have an impact on adjacent organs, for example a fibroid can constrict a ureter and damage the upstream kidney.
At menopause
Fibroids are sensitive to hormones. So, the progression stops with menopause.
It is commonly said that a fibroid dries out at menopause. That means it’ s not going to cause any more bleeding. But this does not mean that it will disappear even if a small decrease in its volume is sometimes observed. As a result, all symptoms related to the fibroid volume will persist.
Symptoms of the disease
Fibroids can be present without any discomfort.
Fibroids are most often detected through bleeding. These are either very heavy periods (menorrhagia) or bleedings outside the period (metrorrhagia).
Pain can also occur, either spontaneously, during menstruation or during sexual intercourse.
Sometimes, when the uterus becomes too large, there may be signs of compression. Most often it consists of constipation or urinary discomfort: difficulty urinating, the feeling of a need to push to urinate, 2-stage urination, numerous urinations, worsening urinary incontinence….
Diagnosis
Imaging tests are being conducted.
The ultrasound is the first examination. It can be done at the practice. Pelvic ultrasound will give the number, size and location of the fibroid(s). The report consists of a mapping, which is essential for the management of fibroids.
The use of an MRI (Magnetic Resonance Imaging) is sometimes necessary.
More seldom, a hysterosonography, i.e. an ultrasound with liquid inside the uterus, is performed.
Finally, a diagnostic hysteroscopy is sometimes performed, which consists of inserting a camera into the uterus.
Different fibroids
A classification of fibroids exists. It determines the position of the fibroid in the uterus. This is an important factor in the decision-making process for surgical treatment.
In the past, the terms intra-cavitary fibroids, sub mucosal fibroids, interstitial fibroids, serous fibroids and pedicle fibroids were used. Now there is a classification that goes from 1 to 7, from the inside of the uterus to the outside.
Evolution, recurrence
Fever and fibroid
The inside of the fibroid can become necrotic, i.e. “die”. This is called aseptic necrobiosis of a fibroid. This phenomenon is generally painful. Fever may also occur but does not require antibiotic treatment.
Medical treatments
Side effects of drug treatment
Esmya
The active ingredient is called Ulipristal.
It is a 5mg tablet which is taken daily. The treatments are three months long.
This drug sees its indications evolve regularly.
Initially it was only prescribed preoperatively. Now it can be offered as a sequential treatment to a woman of childbearing age with a fibroid.
The prescription of this drug is currently suspended.
Surgical Treatments
The fibroid(s) may sometimes need to be removed.
Depending on the location and size, different procedures can be carried out. It is called a myomectomy. In some cases, a complete removal of the uterus, called a hysterectomy, may be required.
It can be a surgical procedure directly into the uterine cavity by hysteroscopy.
If the fibroid is not too thick, it can be removed by abdominal surgery with laparoscopy. The use of a robot may allow for the removal of larger fibroids or a larger number of fibroids by video surgery. Finally, laparotomy is sometimes the only way to perform surgery.
The length of hospitalization may vary from one to a few days depending on the case.
Embolization
Family form
Infertility
Fibroids are sometimes diagnosed during an infertility check-up.
The presence of fibroids can in some cases reduce fertility, especially when it is located in the uterine cavity. In some situations, surgery may be necessary.
Pregnancy
One or more fibroids is not a contraindication to pregnancy.
In most cases, it will have no impact on the course of the pregnancy.
Hospitalization may be necessary in the event of aseptic necrobiosis.
Fibroids close to the cervix may in some cases interfere with delivery, in which case a C-section will be recommended.
Finally, during delivery, the bleeding risk is slightly increased.