Uterine fibroids also known as leiomyomas, and myomas, is among the most common tumours in women living in Anguilla affecting as many as three out of four women. Fortunately for the vast majority of women their fibroids produce no symptoms and they do not require any treatment. Uterine fibroids are not associated with an increased risk of uterine cancer and almost never develop into cancer.

What are uterine fibroids?
Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus (womb). Fibroids usually do not develop until between the ages twenty and thirty five. Some uterine fibroids tend to shrink after menopause. Fibroids are more common in black women than any other racial group.

What causes fibroids?
We really do not know what causes uterine fibroids. Oestrogen and progesterone, two hormones produced by the ovaries, appear to promote the growth of fibroids. Recently, gene mutations have been discovered in fibroid cells so it is possible that fibroids may be due to a genetic defect. Hereditary probably plays a role as well. If your mother or sister has/had fibroids, you are at an increased risk of also developing fibroids. There is no evidence that fibroids turn into cancer.

What are the symptoms and signs of fibroids?
The vast majority of women with fibroids do not have any symptoms or signs. If they do they include the following:
• Heavy menstrual bleeding
• Prolonged menstrual periods
• Pelvic pressure or pain
• Frequent urination or urine retention
• Constipation
• Backache

When to seek medical advice
Women should see their gynaecologist if they have the following:
 Pelvic pain that doesn’t go away
 Overly heavy or painful periods
 Spotting or bleeding between periods
 Pain with intercourse
 Difficulty emptying the bladder
 Difficulty moving the bowels
They should seek urgent medical care if they have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.
Diagnosis
A detailed history and physical examination, including a pelvic examination, are required. Most fibroids are diagnosed during a pelvic examination. Other investigations may be required such as an ultrasound scan of the uterus. Other more expensive tests like a MRI scan is rarely required to diagnose fibroids. Your gynaecologist should exclude other conditions, that may have symptoms-like fibroids, such as adenomyosis and uterine polyps.

Treatment
Only a very small percentage of women with uterine fibroids need surgical treatment. There are many treatment options available and your doctor should discuss the pros and cons of all treatment options. Treatment options include the following:
Watchful waiting (expectant management). If the woman has no signs and symptoms then herr doctor may decide to review her over a period of time. Many fibroids grow very slowly and many shrink after menopause. In some women this approach may be considered.
Medical therapy.Various drugs are available but they do not eliminate the fibroids, they may shrink the fibroids. Often these drugs are used for large fibroids prior to surgery.
Uterine artery embolization. Small particles are injected into the arteries supplying the uterus causing the cutting off of the blood flow to the fibroids thus causing them to shrink.
Myomectomy. This is a surgical procedure where individual fibroids are removed from the uterus, but the uterus is not removed.
Hysterectomy. This is the surgical removal of the uterus. This should be the solution of last resort, especially in women who have no symptoms. Women who have fibroids and decide to have a hysterectomy should NOT have their ovaries removed unless there are other indications of cancer in the reproductive organs or of diseased ovaries.

Conclusion
Uterine fibroids are extremely common among women of African descent. Although many women with fibroids have no symptoms, some women do have severe symptoms and require treatment. Common symptoms are prolonged menstrual periods and pelvic pain or discomfort. Fortunately there are many treatment options available for the successful treatment of uterine fibroids.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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