What are Fibroids & Adenomyosis?
Uterine fibroids are noncancerous uterine growths that commonly appear during childbearing. Uterine fibroids, also known as leiomyomas (lie-o-my-O-muhs) or myomas, aren’t correlated to an elevated risk of uterine cancer and almost never turn cancerous.
Fibroids range in size from small seedlings that are undetectable to large masses that distort and enlarge the uterus. A single fibroid or a group of them can be present. Multiple fibroids can cause the uterus to enlarge to the point where it reaches the rib cage, causing weight gain.
Uterine fibroids affect many women at one point or another in their lives. However, because uterine fibroids often have no symptoms, you may be unaware that you have them. During a pelvic exam or prenatal ultrasound, your doctor may discover fibroids by chance.
Why should women know about fibroids?
By the age of 50, about 20% to 80% of women have fibroids. Women in their 40s and early 50s are most likely to get fibroids. Symptoms aren’t always present in women with fibroids. Fibroids can be difficult to live with for those who do have symptoms. Some people experience pain and heavy menstrual bleeding. Fibroids can also put pressure on the bladder, causing frequent urination, or on the rectum, resulting in rectal pressure. Fibroids can cause the abdomen (stomach area) to expand, making a woman appear pregnant.
Fibroids can cause such heavy bleeding that you may be at risk for developing anemia. When a fibroid blocks a fallopian tube or interferes with your reproductive cycle in any way, it might make it difficult to get pregnant.
Who Gets Fibroids?
Where Can Fibroids Grow?
The majority of fibroids develop in the uterine wall. Doctors divide them into three groups depending on their growth patterns:
- Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.
- Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.
- Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.
It’s possible to have more than one type of fibroid.
Symptoms of Fibroids?
Heavy bleeding, painful periods or prolonged menstrual bleeding
Feeling of fullness in the pelvic area (lower stomach area)
Enlargement of the lower abdomen
Severe cramping or sharp, knife-like pelvic pain during menstruation
Pain during intercourse
Lower back pain
Complications during pregnancy and labour
When a fibroid outgrows its blood supply and begins to die, it can occasionally produce intense pain. It’s possible that your uterus will enlarge. You may feel soreness or pressure in your lower abdomen, even if you don’t know if your uterus is bigger.
The location of a fibroid is used to classify it. Fibroids that grow within the muscular uterine wall are referred to as intramural fibroids. The uterine cavity is engulfed by submucosal fibroids. Subserosal fibroids grow beyond the uterus’s walls.
What Causes Fibroids?
Fibroids are caused by a variety of factors that no one understands. More than one element, according to the researchers, could be at play. These factors could include:
- Genetic changes: Many fibroids contain changes in genes that differ from those in typical uterine muscle cells.
- Hormones: Genetic changes. Many fibroids contain changes in genes that differ from those in typical uterine muscle cells. Fibroids have a higher number of oestrogen and progesterone receptors than uterine muscle cells. Due to a reduction in hormone production, fibroids tend to shrink after menopause.
- Other growth factors: Insulin-like growth factors and other substances that contribute in tissue preservation may have an impact on fibroid growth.
We don’t know what causes fibroids to develop or shrink because no one knows for sure what causes them. Uterine fibroids are thought to arise from a stem cell in the uterus’ smooth muscle tissue (myometrium). A single cell divides several times, eventually forming a solid, rubbery mass that is separate from surrounding tissue.
Uterine fibroids have a variety of growth patterns: they might grow slowly or quickly, or they can stay the same size. Some fibroids experience growth spurts, while others decrease on their own.
As the uterus returns to its normal size after pregnancy, many fibroids that were present during pregnancy shrink or eliminate.
How Do I Know for Sure That I Have Fibroids?
When you visit your doctor for a routine pelvic exam to check your uterus, ovaries, and vagina, your doctor may discover that you have fibroids. During a routine pelvic exam, the doctor can feel the fibroid as a (usually painless) lump or mass on the uterus with her or his finger. A doctor will often compare the size of your fibroids to the size of your uterus if you were pregnant to determine how tiny or large, they are. For example, you might be told that your fibroids have increased the size of your uterus to that of a 16-week pregnant woman. Alternatively, the fibroid could be compared to a grape, an orange, an acorn, a walnut, a golf ball, or a volleyball.
Imaging tests might be used by your doctor to confirm that you have fibroids. These are non-invasive examinations that provide an “image” of the inside of your body. These testing could include the following:
Uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
Uses magnets and radio waves to produce the picture
Uses a form of radiation to see into the body and produce the picture
Takes many X-ray pictures of the body from different angles for a more complete image
An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.
What questions should I ask my doctor if I have fibroids?
- How many fibroids do I have?
- How big are my fibroid(s)?
- Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?
- Is it possible that the fibroid(s) will become bigger?
- How rapidly have they grown (if they were known about already)?
- How will I know if the fibroid(s) is/are increasing in size?
- What kinds of issues might fibroid(s) cause?
- What diagnostics or imaging studies should I use to monitor my fibroids’ growth?
- What are my treatment options if my fibroid(s) becomes a problem?
* If your doctor hasn’t answered all of your questions or doesn’t appear to be fulfilling your needs, getting a second opinion is usually a smart choice.
How are fibroids treated?
The majority of women with fibroids experience no symptoms. There are treatments available for women who are experiencing symptoms. Consult your doctor for the best treatment options for your fibroids. Before assisting you in selecting a treatment, she or he will analyse a number of factors. Among these are the following:
- Whether or not the fibroids are causing you any symptoms
- The size of the fibroids
- If you plan to get pregnant in the future
- Fibroids’ exact location
- Your age and whether or not you’re approaching menopause
If you have fibroids but no symptoms, you might not need treatment. During your routine checkups, your doctor will check to see if they have grown.
If you have fibroids and are experiencing mild symptoms, your doctor may recommend you to take medication. Mild pain can be treated with over-the-counter medications. Medicines work by targeting the hormones that regulate your menstrual cycle, treating the symptoms such as heavy menstrual bleeding and pelvic pressure.
Gonadotropin-releasing hormone agonists (GnRHa) is one of the medications that will be used to treat fibroids by blocking the production of hormones (estrogen and progesterone), leading you into a temporary postmenopausal state. In this state, there will not be any menstruation, in other words, there will not be any blood-feeding to the fibroids. As a result, fibroids will shrink and the anemia symptoms often improve. However, this medicine cannot be used for more than 6 months.
The symptoms of fibroids such as heavy bleeding, period cramps, swollen belly and etc will appear once you have stopped the medicines. Doctor may prescribe this medicine for you to shrink the size of your fibroids before a planned surgery.
Medicines don’t eliminate fibroids but may shrink them.
When do I need surgical treatment?
If you have fibroids that are causing persisting moderate or severe symptoms, surgery may be the best option. Here are your choices:
Asymptomatic (no symptoms) or mild fibroids do not usually need surgery. If you have fibroids that are causing moderate or severe symptoms persistently, surgery may be the best option. Type of surgery will depend on the patients’ age, symptoms, preference, position, size and number of fibroids, and patient’s desire to retain reproduction potential. Surgical treatment is needed when:
- No response to medical treatment
- Worsening vaginal bleeding or anemia from abnormal uterine bleeding
- Chronic pain (severe dysmenorrhea or lower abdominal pain)
- Compression symptoms or discomfort from the enlarged uterus
- Infertility with fibroids as the only abnormal finding
- Urinary symptoms
- Rapidly enlarging fibroids in the premenopausal patient or after menopause
If you have fibroids that are causing moderate or severe symptoms, surgery may be the best option. Here are your choices:
It is a major surgery which involve removal of the whole. When a woman’s fibroids are large, having severe bleeding, is near or past menopause, or does not desire children, she may need this procedure. In this procedure, a big cut will be made on the lower abdomen to take out (remove) the whole uterus. It takes several weeks to recover from a hysterectomy.
Once uterus is removed, it will end the ability to bear children as well as brings on menopause. In most cases, women with uterine fibroids would choose to keep their ovaries.
This surgery involves the removal of the fibroids only, leaving the uterus in place. Myomectomy can be done in a variety of methods. It can be major surgery (including incisions in the belly) or a laparoscopy (keyholes) procedure.
It is recommended for women who want to have children following fibroids treatment or who want to keep their uterus for other reasons. However, there is a possibility of new fibroids can develop after a myomectomy.
Minimally Invasive Procedures:
Is a minimally invasive treatment whereby only a catheter is introduced into the arteries supplying the uterus. Tiny particles (embolic agents) are then released into the blood vessels that feed the fibroid, cutting off the blood flow to the fibroids, causing them to shrink over time.
This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised. This treatment generally is not an option for women wanting to get pregnant at some point after treatment.
Minimally Invasive Microwave Ablation for Fibroids & Adenomyosis Treatment
The Latest Treatment for Uterus Preservation
Is a minimally invasive thermal ablation treatment available for treating fibroids and adenomyosis without cutting open and removing any of your uterus body part.
Did you know?
The same Microwave Ablation (MWA) Technology has been available in Malaysia since year 2012, widely used by Interventional Radiologists to treat solid cancerous tumours in liver, lung, kidney, adrenal, spleen, bone and others as a Minimally Invasive Cancer Therapy.
Why Microwave Ablation?
This procedure is precise and safe. Ultrasound is utilized during the procedure to clearly locate the lesion and monitor the needle placement and ablation. During the procedure, the doctor will insert a microwave antenna (needle) as small as 1.6mm in diameter through the skin under a real-time image guided by ultrasound into the lesion, once it is in position, microwave energy will be activated to kill the lesion cells. A fine needle prick is left which heals quickly after the procedure.
MWA procedure is a quick Day-Care Procedure that generally takes about 30 minutes, depending on the size of the lesion. A lesion size of 5.6cm in diameter can be ablated in 15 minutes. Thanks to the advancement in Microwave Technology as it is not limited by the types of tissue for conductivity, MWA is able to achieve larger homogenous ablation zone in a shorter time.
How does Microwave Ablation work?
MWA uses electromagnetic waves to produce a tissue heating effect. The oscillation of polar molecules produces frictional heating, ultimately generating tissue coagulation necrosis within the tumour. It destroys and eradicates non-cancerous lesions / adenomyosis by ablating them with thermal ablation.
Mechanism of Microwave Thermal Ablation generates a series of biochemical changes, such as tumour cell dehydration, intracellular protein denaturation, and coagulation that brings the synthesis of tumour cell’s deoxyribonucleic acid (DNA) and protein to a halt. It also destroys the blood supply of the lesion, which results in the necrosis of tumour cells. The treated tumour will be absorbed by body over time, no tissue removal is required.
What are the advantages of Microwave Ablation?
MWA is a minimally-invasive treatment, with benefits as follows:
Almost painless, without cutting or stitching, keeping the uterus intact
Nearly scarless or tiny wound size of 1.6mm
Precise treatment, under real-time ultrasound guidance
Go home on the same day or next day
Fast procedure time
Recovery is quick
Local anaesthesia (LA) is possible