Fibroid Treatment

• 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.