- Fibroids are classified by numbers based on their location in the womb.
- Heavy Periods is the most common symptom. It is usually due to large fibroids or fibroids that are near the menstruation area like Type 0,1,2 fibroids.
- Fibroids can cause Infertility and Miscarriage, especially those close to the center of the womb like Type 0,1,2 fibroids.
- Large fibroids can press on the bladder to cause Pressure and Frequent Urination. They can also cause a Bloatedness feeling. In severe cases, fibroid can block urination or cause severe constipation.
- Some fibroids may cause Pain when they undergo a process called degeneration.
Small Fibroids (<4cm) May Not Need Treatment
When fibroids are small and not causing symptoms, they can be monitored with yearly scans.
The natural history of fibroids is that they can grow with time. They will stop growing after menopause and begin to shrink.
Most fibroids grow at a rate of 10% of its volume every 6 months. Naturally some fibroids grow faster and some may even shrink with time. (Peddada et al)
FIBROID TREATMENT
Fibroids without symptoms and <4cm may not need treatment
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Oral Medication to treat the symptoms of fibroid
Tranexemic Acid – to reduce heavy menstruation related to fibroids.
Pain killers – to relieve painful pressure symptoms caused by large fibroids.
Selective Progesterone Receptor Modulators (SPRM) that was previously used to shrink fibroids and stop its associated bleeding issues, is now not recommended. This decision was taken by the European Medicines Agency in Sept 2020 because of the possible risk of unpredictable liver injury associated with SPRM.
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Injection GnRH can shrink fibroids over 3 months for surgery.
GnRH injection causes a temporary state of menopause by blocking all female hormones. During this induced-menopause state, fibroids start to shrink by up to 50% in 3 months. When the GnRH injection wears off, the fibroids will grow back to its original size.
GnRH does not shrink fibroids permanently. So before it re-grows, very large fibroids can then be surgically removed by keyhole surgery rather than traditional open surgery.
GnRH can cause severe menopause side effects like hot flushes, mood swings and sleep disturbances. It can cause osteoporosis if used for more than 6 months. Hence GnRH is only used as a short term treatment
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Uterine Artery Embolisation (UAE) blocks blood supply to fibroids to shrink them.
UAE is a procedure done by specially-trained Radiologist. Under X-ray guidance, a catheter is placed into the groin blood vessel to reach the blood vessels of the fibroid. Particles are then injected to block the blood supply of the fibroid.
Once deprived of blood supply, the fibroid will shrink permanently over 6 months. UAE is good for women wishing to avoid surgery. UAE is not advised for women wanting pregnancy.
The immediate side effects are moderate to severe pain, possible infection and bleeding. The long term side effects are loss of menstruation, early menopause and failed fibroid treatment.
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High Intensity Focus Ultrasound (HIFU) uses strong ultrasound beam to burn fibroids to shrink them.
This treatment uses high intensity ultrasound beams to target the fibroids, heating up the fibroids to 55-90 degC, causing cell death.
It is effective in reducing heavy menstruation caused by fibroids. It can also shrink fibroids by 30-50% of its initial volume, some 6-12 months after treatment.
HIFU has been shown to be safe for women wishing to get pregnant. However, it may not be suitable for women with abdomen or pelvic surgical scars.
In Jan 2021, the Ministry of Health Singapore reviewed HIFU treatment for uterine fibroid and decided that HIFU should be done in a research or clinical trial setting.
