Part I of a five-part series on “Fibroids: What every woman should know”

Tara underwent a health checkup. She had an ultrasound of the pelvis done as part of the checkup. She was told she had fibroids. Till she could get an appointment to see her gynaecologist, she was anxious and jittery. She knew some friends and relatives who had had their uterus removed because of fibroids. Does she need to worry? Will the fibroid grow and cause complications? Tara must understand that most fibroids do not require surgery.

What are uterine fibroids?

Uterine fibroids are benign (noncancerous) tumours formed of connective tissue and smooth muscle. They grow slowly within the wall of the uterus or are attached to the uterine wall.

They are also known as leiomyoma or myoma.

A uterine fibroid may vary in size and be as small as a groundnut or as large as a coconut. As the fibroid grows, the uterus may become deformed and lose its original shape. Most fibroids are noncancerous (benign) and it is very rare for them to turn cancerous (malignant).

Fibroids have become a major healthcare problem across the world. This is not because they pose a major threat to the health of women but because they have become the cause for thousands of hysterectomies being done, many of them unnecessarily. For a condition that is non-cancerous, they are absurdly responsible for more gynaecological surgery than any other disease.

In India, people consider a hysterectomy such a major procedure that the woman may take time off from work for as long as six months (though it is not necessary). Families tend to force rest on women who have had a hysterectomy, leading to unnecessary weight gain. The cost of time lost in terms of work and productivity is enormous.

What causes fibroids to form?

The cause of uterine fibroids is not known. They are slow growing and may be present in the body for years before any symptoms occur. In some families, there may be a greater tendency for fibroids. Fibroids rarely occur in women younger than 20. They occur most frequently in women in their childbearing years. The growth of fibroids is influenced by the hormones estrogen and progesterone. In pregnancy, fibroids have a tendency to grow because of the enormous rise in these two hormones. It is important to know that when a woman goes through menopause, these tumours usually shrink due to the lack of the hormone estrogen.

Are there different types of fibroids?

Fibroids differ in their location and are classified according to their relationship to the muscular wall of the uterus. Since fibroids are formed of the same muscle tissue as the uterus, they arise in the wall of the uterus. When the fibroid is sitting on top of the wall of the uterus, it is called a subserosal fibroid. This kind of fibroid grows outwards. Sometimes a subserosal fibroid may form a thin stalk and may hang from the uterine wall. This is called a pedunculated fibroid. An intramural fibroid will grow within the wall of the uterus and can grow outwards or into the cavity of the uterus as it enlarges.

Occasionally a fibroid develops inside the cavity of the uterus. This is called a submucosal fibroid. A submucosal fibroid can form a thin stalk and may protrude outside the mouth of the uterus. This is called a fibroid polyp. Submucosal fibroids lie just beneath the lining of the uterine cavity and may result in heavy or irregular bleeding.

How are fibroids diagnosed?

Fibroids are most commonly diagnosed during a gynaecological examination. Many women find out they have fibroids for the first time, when they have a routine checkup. The uterus will feel larger than normal. Your gynaecologist may tell you that the uterus is the size of ‘a three months pregnancy' or ‘the size of a coconut'. This is just to give you an idea of how large the uterus is, not necessarily to alarm you.

Your gynaecologist will ask for an ultrasound to accurately determine the size, number and location of the fibroids. Though an ultrasound exam is fairly accurate at determining the sizes and positions of fibroids within the uterine wall, sometimes the exact position of the fibroids is hard to determine precisely.

A CT scan or MRI is not routinely required to diagnose fibroids.

The symptoms of fibroids will be discussed in detail in my next column.

GITA ARJUN

THE AUTHOR IS AN OBSTETRICIAN AND GYNAECOLOGIST PRACTISING IN CHENNAI AND HAS WR

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