Fibroid Treatment

Fibroid Treatment

Uterine fibroids, also known as leiomyomas or simply myomas, are muscle tumors that grow in the uterus or womb. Ninety-nine percent benign, fibroids are not commonly linked to cancer, nor do they increase one’s risk of developing cancer. These growths range in site, size and number. Some may have multiple pea-sized myomas that are almost undetectable with the naked eye while others have a single grapefruit-sized one that commonly distorts the shape of the uterus.

Uterine fibroids are very common, but many women are not aware they have these growths because often there are no symptoms. If left undiagnosed and untreated, however, fibroids may cause heavy bleeding, menstrual changes, fertility problems, pelvic pain and pregnancy complications.

Because fibroids do not always cause symptoms, the most effective way to check for tumors is through a routine and thorough pelvic and/or abdominal examination and a pelvic ultrasound scan. (Sound waves are used to capture images of the uterus to detect and measure fibroids. The probe can be passed over the abdomen or inserted vaginally)

Occasionally other tests may identify these tumours as well include:

  • X-rays – Some fibroids calcify and become visible on abdominal X-rays.
  • Computed tomography (CT) scan – Images of the pelvis in various angles are captured to produce a cross-sectional version of the organ.
  • Magnetic resonance imaging (MRI) – A combination of magnetic fields and radio waves are used to capture the size and location of the tumor.
  • Hysterosalpingography (HSG) – A special dye is injected to highlight the uterus and fallopian tubes to observe the organs in real time through an X-ray process called fluoroscopy.
  • Hysteroscopy – A lighted viewing instrument is inserted into the uterus to examine the organ in real time for fibroids and polyps.

Blood tests such as Full blood count (FBC) may be requested to determine if anaemia and heavy menstrual bleeding are caused by fibroids, and not other bleeding disorders or thyroid conditions.

Most uterine fibroids have been observed to stop growing and even shrink after menopause. Some symptoms are also unnoticeable and give little discomfort. This is the reason why gynaecologists advise “watchful waiting”, whereby symptoms are only observed for significant changes.

For women who have developed multiple or large fibroids that cause severe symptoms, immediate medical attention is required. Treatment options will depend on the patient’s overall health, tolerance for prescribed medications and procedures, size and extent of the myoma, and desire for future pregnancy.

  • Gonadotropin-releasing hormone agonists (Gn-RHa) – These are prescribed to block the production of estrogen and progesterone, causing fibroids to shrink and anaemia to improve. While on Gn-RHa, the patient’s menstruation is temporarily stopped, and she may experience symptoms commonly associated with menopause such as hot flashes.
  • Intrauterine device (IUD) – Some IUDs release progestin, which help to stop heavy bleeding. However, it does not reduce fibroid size. It is also designed to prevent pregnancy.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These can be bought over-the-counter or prescribed to manage pain, but they do not reduce heavy bleeding or shrink fibroids.

For women who wish to retain the uterus and remove the fibroids which are causing them problems, they can avail themselves of either laparoscopic or laparotomy myomectomy. The choice of key hole versus ooen surgery would really depend on the site size and number of fibroids one wishes to removed. Where a pregnancy is desired, closure of the uterus needs to be very secure and open myomectomy may be preferred

For those who choose a total hysterectomy, the procedure would render the woman instantly menopausal. The operation can be done laparoscopically for less scarring and quicker recovery, or via the traditional open method. If fibroids are present in the ovaries and cervix, these organs may be removed as well. Hysterectomy is a major and permanent procedure, preventing any future pregnancies through open surgery, depending on the size and location of the myoma.

Aside from hysterectomy and myomectomy, there is a minimally invasive procedure that can help to destroy the fibroids instead of removing them through surgery. These are:

  • Uterine fibroid embolization (UFE) – Embolic agents are injected into the blood vessels that supply the fibroids, causing the myomas to eventually shrink and die.
Anti-hormonal medications are also to control the unwanted symptoms caused by fibroids and a patient may opt for these if surgery is not possible or undesirable.

Women Fertility & Fetal Centre specializes in the diagnosis and treatment of gynaecological conditions such as ovarian cysts, endometriosis, breast cancer, infertility and uterine fibroids in Singapore. To make an appointment, call +65 6734 8188 or send a message at mail@dranntan.com


Dr Ann Tan
Dr Ann Tan, PBM
Obstetrician & Gynaecologist
MBBS (S'PORE), FRCOG (LONDON),
M MED (O&G) FAM (SINGAPORE)
Dr Ann Tan is the first Singaporean to hold the Diploma of Fetal Medicine from the Fetal Medicine Foundation. She presently serves on the Women’s Health Advisory Committee at the Health Promotion Board. Dr Ann Tan was a Public Service Commission Scholar, and has won several prestigious awards in her field of specialization.
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