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Home|Fibroids

Fibroids

What are fibroids?

Fibroids are noncancerous growths that develop in or around the uterus. They are also known as uterine fibroids or leiomyomas. Fibroids are made up of muscle and fibrous tissue and can vary in size. They can be as small as a seed or as large as a grapefruit. Fibroids can be single or multiple and may grow inside the uterus, on the outer surface of the uterus, or within the uterine wall. They are quite common, with about 70-80% of women developing fibroids by the age of 50.

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Symptoms

The symptoms of fibroids can vary depending on their size, location, and number. Some women may experience no symptoms at all, while others may have more severe symptoms. Common symptoms of fibroids include:

  • Heavy or prolonged menstrual periods: This is the most common symptom. Women with fibroids often experience heavy and prolonged menstrual bleeding, which can lead to anemia.
  • Pelvic pain or pressure: Fibroids can cause discomfort or pain in the pelvic region. This may range from mild to severe.
  • Frequent urination: Large fibroids can press against the bladder, causing frequent urination or a constant urge to urinate.
  • Difficulty emptying the bladder: In some cases, fibroids can obstruct the bladder, making it difficult to fully empty the bladder.
  • Constipation: Fibroids can put pressure on the rectum, leading to constipation.
  • Lower back pain: Fibroids located in the back of the uterus can cause lower back pain.
  • Pain during sexual intercourse: Large fibroids can make sexual intercourse painful or uncomfortable.
  • Enlarged abdomen: In some cases, multiple or large fibroids can cause the abdomen to become enlarged or swollen.

It is important to note that these symptoms are not exclusive to fibroids and can be caused by other conditions as well.

Fibroids and Fertility

Uterine fibroids can sometimes affect fertility. While many women with fibroids are able to conceive and have successful pregnancies, some fibroids can interfere with the implantation of a fertilized egg or the development of the embryo. Fibroids that distort the shape of the uterus or block the fallopian tubes can make it more difficult for a woman to get pregnant. Additionally, large fibroids located in the uterine cavity can affect the blood supply to the uterine lining, making it less receptive to implantation.

Fibroids can also cause other fertility-related issues, such as recurrent miscarriages or preterm labor. However, the impact of fibroids on fertility varies from woman to woman, and not all fibroids will cause problems.

Causes and Risk factors

The exact cause of fibroids is unknown, but several factors may contribute to their development. These include:

  • Hormonal imbalances: Estrogen and progesterone are female hormones that regulate the menstrual cycle. An imbalance in these hormones, such as an excess of estrogen, can promote the growth of fibroids.
  • Genetic factors: There is evidence that certain genetic mutations may be associated with the development of fibroids. If a woman's mother or sister has fibroids, she is at a higher risk of developing them as well.
  • Age and race: Fibroids are most commonly diagnosed in women between the ages of 30 and 50. Additionally, African-American women tend to develop fibroids at a younger age and have more severe symptoms compared to other races.
  • Obesity: Being overweight or obese increases the risk of developing fibroids. Excess fat cells can produce and store estrogen, which can promote the growth of fibroids.
  • Lifestyle factors: Certain lifestyle choices, such as a poor diet high in red meat and low in fruits and vegetables, can increase the risk of fibroids. Additionally, lack of exercise and excessive alcohol consumption may also contribute to their development.
  • Reproductive factors: Women who have never been pregnant have a higher risk of developing fibroids. Pregnancy and childbirth are associated with hormonal changes that can help shrink fibroids. Use of birth control pills, especially at a young age, may also increase the risk.
  • Other medical conditions: Certain medical conditions, such as endometriosis or adenomyosis, may increase the risk of fibroids. These conditions involve the abnormal growth of tissue outside or within the uterus, respectively.

It is important to note that while these factors may increase the risk of fibroids, they do not guarantee their development. Many women with one or more of these risk factors may never develop fibroids, and vice versa.

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How is a diagnosis of fibroids made?

A diagnosis of fibroids is typically made through a combination of medical history, physical examination, and diagnostic tests. The process may include the following steps:

  1. Medical history: The healthcare provider will ask about your symptoms, such as heavy or prolonged menstrual bleeding, pelvic pain or pressure, frequent urination, or difficulty getting pregnant. They will also inquire about your personal and family medical history, including any previous diagnosis or treatment for fibroids.
  2. Physical examination: The healthcare provider will perform a pelvic examination to check for any abnormalities, such as an enlarged uterus or palpable masses. They will also check for signs of other conditions that may present similar symptoms.
  3. Imaging tests: Various imaging tests may be ordered to confirm the diagnosis of fibroids and determine their size, location, and number. These tests may include:
    • Ultrasound: This non-invasive test uses sound waves to create images of the uterus and any fibroids present. It can help visualize the size, location, and number of fibroids.
    • Magnetic Resonance Imaging (MRI): This imaging technique provides detailed images of the uterus and fibroids, helping to determine their characteristics and plan for treatment.
    • Hysterosonography: In this procedure, saline is injected into the uterus, and an ultrasound is performed to view the inside of the uterus more clearly.
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Keyhole Treatment for fibroids

Uterine fibroid embolisation (UFE) is a minimally invasive procedure used to treat uterine fibroids. During the procedure, a radiologist inserts a thin catheter into the blood vessels that supply the fibroids via the groin artery and releases small particles to block the blood flow, causing the fibroids to shrink and die.

The best candidates for uterine fibroid embolisation are women who have symptomatic fibroids, over the age of 35 and desire a non-surgical treatment option. UFE is particularly suitable for women who want to preserve their uterus and avoid surgery, such as a hysterectomy.

Some other benefits of UFE include:

Procedure usually only requires sedation and local anaesthetic (not full body) and does not cause scarring like most other surgery. The post-op pain after UFE is moderate in nature but will wane after a couple of days and is typically less than than open surgery pain.. 80-90% patients will experience significant symptomatic relief and there is usually a faster recovery time and reduced risk of infection compared to open surgery.

However, not all women with fibroids are suitable candidates for UFE. Women who are pregnant, planning to become pregnant, or have certain medical conditions that affect blood flow may not be eligible for the procedure.

Fibroids shrinkage after UFE

The amount of shrinkage of fibroids after uterine fibroid embolization (UFE) can vary from woman to woman. On average, studies have shown that UFE can result in a 40-60% reduction in fibroid volume within six months to one year after the procedure. However, it is important to note that the actual amount of shrinkage can depend on factors such as the size and location of the fibroids, as well as individual variations in response to the treatment.

Some women may experience significant shrinkage, while others may see more modest reductions. It is also possible for fibroids to continue shrinking for several years after UFE. The main goal of UFE is to alleviate symptoms associated with fibroids, such as heavy menstrual bleeding and pelvic pain, rather than focusing solely on fibroid size reduction.

Fibroids shrinkage after UFE

Varicose veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • $588 + GST

Spider veins screening package (single leg)

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  • Examination – to check distribution and anatomy plus to assess skin problem
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Varicose veins and spider veins package (single leg)

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  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • 1 session spider vein laser treatment (additional session 450 + GST)
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  • $388 + GST

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  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
  • Blood test – to check average sugar levels in 3 months
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  • X-ray one foot – to check bone infection
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Cardiovascular screening (normal)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • Echocardiogram – to identify heart muscle function
  • $1098 + GST

Cardiovascular screening (comprehensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • CT coronary Angiogram plus calcium score – gold standard to identify block heart arteries
  • $2098 + GST

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Senior Vascular & General Surgeon
Senior Vascular & General Surgeon