Symptoms associated with Uterine Fibroids
The first thing to say is that many women do not have any symptoms from uterine fibroids during their lives. This is because they are lucky in that the fibroids are small and usually within the wall of the uterus or extending from the surface. Equally, many women do get significant symptoms from uterine fibroids and this probably relates to the site and size of the fibroids which again relates to underlying genetic factors and the sensitivity of the fibroid to oestrogen which affects the oestrogen receptors within fibroids. If the fibroid involves the cavity of the uterus and therefore the lining of the womb, then this will result in heavy periods. These fibroids are called submucous or intracavity fibroids: they extend into the wall of the uterus to a varying degree (less than 50% they are called type 1 and more than 50% type 2). As they get bigger, which they invariably do under the influence of oestrogen, the periods get worse and worse. This can result in anaemia and debilitation requiring a blood transfusion. Fibroids which are near the womb lining, interstitial or intramural fibroids, may also cause heavy periods by increasing the surface area of the cavity of the womb and particularly if their edge is adjacent to the womb lining.
Another group of symptoms comes under the heading of compression syndrome. In this condition the fibroids grow large and cause the uterus to press on adjacent structures. Quite often, the uterus will impress the dome of the bladder causing increased frequency of urination. The fibroids may press on the bowel giving rise to constipation or can impinge on the vagina making intercourse uncomfortable or painful. If the fibroids press on posterior pelvic nerves this can result in sciatica and back pain.
Fibroids often grow large enough to cause the uterus to press on adjacent structures leading to a number of problems including bloating and severe pain.
Many women with fibroids complain of bloating, whether this relates to the prostaglandins that fibroids secrete or simply the size of the fibroid is not clearly understood, but bloating is a very common problem in patients with enlarged fibroids.
Another problem is distension of the abdomen due to fibroid enlargement which produces a cosmetically unsightly lump simulating a pregnancy. Fibroids may grow to the size of a term pregnancy.
Another factor with fibroids which affects the symptoms is their rate of growth. This is extremely variable and fibroids may grow very rapidly or very slowly and are unpredictable in their behaviour.
During pregnancy the growth of fibroids due to oestrogen stimulation may cause them to outstrip their blood supply and they may die. This produces severe pain lasting weeks in the abdomen and can be a difficult diagnostic problem. Rarely fibroids may spontaneously die, not in the pregnancy situation, and again this is a cause of pelvic pain which can be severe. In the case of fibroids which spontaneously die, eventually the symptoms will regress spontaneously.
Patients should have fibroid embolisation at an earlier stage
Patients should be having fibroid embolization much earlier. Unfortunately, patients are being treated for their fibroids at an unnecessarily late stage. When fibroids are requiring treatment, in other words, symptomatic but relatively ‘small’, fibroid embolization frankly is a piece of cake. The patient’s post procedural symptoms e.g. pain are much less, the fibroids are all killed at one hit and the cure is permanent.
In the past the only treatments available were major surgery and therefore gynaecologists understandably were reluctant to advocate the surgery until the situation became really pretty desperate. Unfortunately, this is still the case.
It is increasingly the view that embolization is a simple procedure which should be undertaken early in the course of the disease once the patient becomes symptomatic or the fibroids are demonstrated to be growing and it is wrong that this method of treatment is being withheld from patients or that patients are simply not being told that fibroid embolization exists, despite the recommendations of both the Colleges of Radiology and Obstetrics and Gynaecology in this country and in the United States and also the fact that it has been passed as a routine procedure by NICE in 2007 and given an A rating treatment under the National Health Service.
The Delayed Treatment of Uterine Fibroids
We see many patients who have had failed myomectomy followed by recurrence or continual growth of remaining fibroids, who are either advised conservative treatment by their doctor or who do not wish to face the prospect of further treatment, especially surgery.
Patients need to realise that fibroids often continue to grow. The bigger they become the more difficult they are to treat and the more a patient's quality of life is impaired.
It is especially important that If fibroids grow following myomectomy, prompt treatment should be strongly considered before the fibroids become too large and therefore very difficult to treat except by radical surgery.