Fibroids: what every woman should know 

 Part 4: Do all fibroids need a hysterectomy?

Tasleem is 42 years old. She has regular periods. The flow is not heavy and she uses 2-3 pads per day. She has mild, bearable pain during her periods. She occasionally takes a painkiller tablet for this. When she went to see her family physician for diarrhoea and lower abdominal pain, an ultrasound was ordered. The uterus was incidentally found to contain a fibroid measuring 5 x 4 centimetres. Tasleem was then asked to see a gynaecologist who advised a hysterectomy. Does Tasleem really need surgery?

Thamarai is 56 years old. She reached her menopause 6 years ago. She went for a regular checkup and was told she had a lump in the lower abdomen. An ultrasound confirmed the presence of two large fibroids, the larger one measuring 6 x 6 centimetres. She was asked to have a hysterectomy. Is surgery essential for Thamarai?

When is surgery needed for fibroids?

The mere presence of fibroids is not reason enough to have a hysterectomy. Even large fibroids need no surgery unless they are causing problems. Fibroids cannot ‘burst’ as they become larger. At the same time, there are no medicines that can make fibroids shrink permanently. Just remember, fibroids will shrink after menopause.

Uncontrolled bleeding

It is common for women between 35 and 45 years of age to have some irregularity in their periods. This may be in the form of missed periods or frequent periods, scanty or heavy flow. This is usually due to not forming an egg, leading to a hormonal imbalance. This becomes more frequent as a woman gets closer to her menopause. In the 3-4 years leading up to menopause, this irregularity can become worse. If at this time, an ultrasound scan reveals a fibroid, there is no need to immediately blame the fibroid.

All efforts must be made to control the heavy bleeding with hormonal tablets, if indicated, or with medications like tranexamic acid or mefenamic acid which, taken at the right dose, can reduce bleeding by as much as 60-80 per cent.

Surgery is only indicated if you have heavy bleeding that is persistent and causes severe anemia. Fibroids may be the cause of bleeding if:

• They are lying in close contact to the lining of the uterus
• They are lying inside the cavity (fibroid polyp)
• They are so large and numerous that they distort the uterine cavity