CNA – At 31, Chen Liling’s life was upended by persistent fatigue, breathlessness, and heart palpitations. Initially, she attributed these symptoms to a need for more rest.
However, a comprehensive check-up in 2015 revealed a different reality: severe anaemia, likely due to her heavy menstrual bleeding, and the presence of significant uterine fibroids.
Fibroids, in Chen’s case, were the culprits.
A gynaecologist identified a large fibroid causing excessive bleeding and several smaller ones. Chen underwent a myomectomy, a procedure to remove the fibroids. However, her battle with fibroids wasn’t over.
By the time she turned 40, the fibroids had returned, significantly multiplying in number and size.
This time, the symptoms were different. Although her periods were normal, Chen noticed an enlarging, hardening abdomen and experienced gastric pain and frequent urination. The fibroids were pressing against her bladder and stomach, causing discomfort.
What Are Uterine Fibroids?
Uterine fibroids are benign growths of smooth muscle and fibrous connective tissue that originate in the uterus, according to Dr Harvard Lin, an obstetrician and gynaecologist at Asia Obstetrics & Gynaecology Centre.
The fibroids may appear in various parts of the uterus, including the wall, outside the uterus, or in rare cases, the cervix. They can range from the size of a grain of rice to that of a melon.
Dr Jessie Phoon of Mount Elizabeth Fertility Centre notes that fibroids affect about one in three women.
Often, they go unnoticed because they do not always present symptoms. Many women discover fibroids during routine pelvic exams or ultrasounds.
Symptoms and Impact
Symptoms can vary widely depending on the size, number, and location of the fibroids. Common signs include:
- Heavy or frequent menstruation
- Anaemia from excessive bleeding
- Pelvic pain and pressure leading to frequent urination or constipation
- Abdominal swelling from enlarged fibroids
- Pain during sex
- Lower back discomfort
Hormones and Risk Factors
Fibroids are most common in women aged 30 to 50, and their development is influenced by hormonal factors. Dr Phoon explains that fibroids grow in response to hormonal environments, particularly oestrogen and progesterone. Fluctuations in these hormones can affect fibroid size.
Dr Lin adds that fibroids typically shrink after menopause due to decreased hormone levels, though they can still cause issues. Risk factors include:
- Age: Women over 35 and those who have never given birth are at higher risk.
- Genetics: A family history of fibroids increases susceptibility.
- Ethnicity: Studies suggest that African-American and East Asian women have a higher risk.
- Obesity: Higher oestrogen levels associated with obesity may promote fibroid growth.
Impact on Fertility
Uterine fibroids can affect fertility. Large fibroids near the fallopian tubes or cervix may obstruct sperm passage, impair uterine contractions, or hinder embryo implantation.
They can also reduce blood flow to the uterine lining, affecting its ability to support pregnancy.
While some women with fibroids may experience infertility, many do not.
Fibroids located on the uterus’s outer surface often do not significantly impact pregnancy chances.
However, large fibroids can lead to complications such as increased risk of caesarean sections, labour complications, placental abruption, and pre-term delivery.
Treatment Options
Treatment varies based on fibroid size, location, symptoms, and the patient’s age and fertility goals. Options include:
- Monitoring: Small, asymptomatic fibroids may just be observed.
- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can relieve pain. Hormonal treatments, including progestin-releasing IUDs, can regulate bleeding and reduce fibroid size.
- Non-Invasive Procedures: MRI-guided high-intensity focused ultrasound and uterine artery embolisation (UAE) can treat fibroids without surgery.
- Surgery: Myomectomy removes fibroids while preserving the uterus, suitable for women wanting to maintain fertility. Hysterectomy, the complete removal of the uterus, is considered for severe cases or when other treatments fail.
Recurrence and Prevention
Uterine fibroids cannot be entirely prevented or guaranteed to not recur. Regular pelvic exams are crucial for monitoring. Maintaining a healthy diet rich in fruits, vegetables, and fibre, along with managing body weight, can help.
Ultimately, managing fibroids requires a tailored approach with a healthcare provider to assess the need for treatment and adjust the plan as necessary.
For those struggling with symptoms or complications, seeking timely medical advice is essential to manage and alleviate the impact of fibroids on quality of life. – Vanessa Chia
