What Are Uterine Fibroids and Who Gets Them

Dyspareunia from pelvic inflammatory disease usually comes with vaginismus, foul-smelling vaginal discharge and sometimes urinary tract symptoms. With a fibroid, the dyspareunia is not accompanied by these features. A vaginal swab sent for examination will show an infective organism in pelvic inflammatory disease, which is usually absent when a fibroid is the cause.

GnRH analogues are used to shrink a fibroid before a planned myomectomy, since a smaller fibroid means less bleeding during surgery; a monthly or three-monthly dose is given for this. The second use is in a perimenopausal woman, where these hormones hasten the natural shrinkage that would occur anyway as menopause approaches, since fibroids are otherwise known to delay menopause.

The two are not alternatives for diagnosis. MRI is a radiological procedure with no radiation that gives a detailed, thin-sliced view of a fibroid, and it is used when there is diagnostic doubt on ultrasound, for instance the rare possibility of a cancerous change. Hysteroscopy is a minimally invasive endoscopic procedure passed through the cervix, and it is never used as an investigative tool for diagnosing a fibroid. It is a treatment modality: it is used once a fibroid or polyp inside the cavity has already been identified, so it can be removed under direct vision.

Weight control through exercise and diet is important, since fibroids are more common in obese patients. An anti-inflammatory, broadly Mediterranean diet is recommended: plenty of green leafy vegetables, omega-3 sources like walnuts, flax seeds and olive oil, and less caffeine, alcohol and smoking. Red meat is considered inflammatory, so white meat such as fish, turkey and chicken is the better choice.

Myomectomy is a surgical procedure requiring hospitalization, done by a gynaecologist through open surgery, laparoscopy or robotically. Uterine artery embolization is an outpatient procedure done by an interventional radiologist together with a gynaecologist, who passes a catheter through the groin artery into the vessel feeding the fibroid and injects small particles to cut off its blood supply, so the fibroid shrinks over time. It is less invasive and generally preferable to myomectomy, but it has limitations: it is not suitable for very large fibroids, for fibroids with any suspicion of malignancy, or where there is an active uterine infection.

They affect nearly 70% of women by the age of 50 and are most often diagnosed between the ages of 30 and 50, though many cause no symptoms and are found incidentally.

Intramural fibroids grow within the uterine muscle, subserosal fibroids grow outward toward the abdomen, submucosal fibroids grow inward into the uterine cavity, and pedunculated fibroids develop a narrow stalk connecting them to the uterus.