Part 2: Symptoms of uterine fibroids

Thulasi is in tears. She is 46 years old and has been diagnosed to have a fibroid on an ultrasound scan. Her periods are regular and she had no inkling that she had a fibroid. The gynaecologist that she has consulted told her that she needed a hysterectomy. “You are not going to have another child. What do you need a uterus for?” asked her gynaecologist. Thulasi should seek a second opinion. Just the presence of a fibroid is not a reason to undergo major surgery.

Are fibroids common?

Fibroids are extremely common. If 100 women undergo an ultrasound scan, 40-50 of them will be found to have fibroids! By age 50, fibroids can be found in 70 per cent of Indian women. Fibroids can vary in size and number. Most women will not even know they have fibroids unless they undergo an examination or a scan. Unfortunately, the knowledge that they have a fibroid causes needless anxiety among women.

Do fibroids always cause symptoms?

Most women with uterine fibroids have no symptoms or just mild symptoms. The majority of fibroids do not need treatment. Almost 80% of women who choose no treatment for their fibroids have no major changes in their periods, pain, bothersome symptoms, general health or routine activity. After menopause, fibroids will shrink. Women who are close to their menopause should try to wait till menopause so that they can avoid surgery if possible.

What are the troublesome symptoms of fibroids?

Heavy and prolonged menstrual flow

Sometimes fibroids may lead to heavy bleeding. This usually happens when the fibroid is pressing on the uterine cavity, thereby enlarging the area from which bleeding occurs. In such a case, the ultrasound report will usually say that the fibroid is ‘impinging on the cavity’ or ‘distorting the cavity’. A submucous fibroid is a fibroid that grows into the cavity of the uterus. This can cause heavy and prolonged bleeding even if it is small.

Before blaming a fibroid for heavy bleeding, other treatment may be tried to control the bleeding. Many women who are in the perimenopausal age group (3-4 years before menopause), may experience abnormal bleeding. This can usually be treated with medications. Only when that fails should surgery be considered. Surgery should also be considered when the bleeding leads to severe anaemia.