Uterine Fibroids in Singapore

What are uterine fibroids?

Uterine fibroids are non-cancerous growths that come from the muscle layer of the uterus. Also known as myomas or leiomyomas, fibroids can occur at any age although they are commonly found in women from 30 – 50 years old. Fibroids can be single or multiple, have varying shapes and can be located inside the uterine cavity (submucous), within the muscle wall of the uterus (intramural), or on the outer surface of the uterus (subserous). They continue to grow at varying sizes throughout the reproductive years and will typically start to shrink only once a woman reaches menopause. 

What causes uterine fibroids?

Uterine fibroids commonly affect women of childbearing age. However, the exact cause remains unknown. The most common factors involved in uterine fibroids include: 

Hormones

Estrogen and progesterone encourage the growth of fibroids, which is why they shrink upon menopause, when these hormone levels start to decline.

Extracellular Matrix (ECM)

Extracellular Matrix is the material that sticks cells together. Fibroids have more ECM, and studies associate this with the fibrous nature of the fibroids. 

Genetic Changes

A significant proportion of fibroids have gene modifications different from those in your normal uterine muscle cells.

Growth Factors

Some growth factors that your body relies on for tissue maintenance may also cause uterine fibroid growth.

Picture of a female genital

What are the symptoms of uterine fibroids?

It is estimated that between 30-40% of women have uterine fibroids, but many do not have any symptoms. In fact, some discover they have uterine fibroids by accident during a pelvic exam or pelvic ultrasound. 

Depending on their size and location, fibroids can cause symptoms such as:

  • Menstrual changes: heavy periods, long periods, painful periods, bleeding in between periods 
  • Anemia (low blood count)
  • Pressure symptoms: lower backache, bloatedness, difficulty passing urine, incomplete emptying of the bladder or constipation
  • Abdominal bloatedness
  • Miscarriages 
  • Infertility

These symptoms may disappear or reduce in intensity at menopause, as your hormonal levels decline. 

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What are the Risk Factors of Uterine Fibroids?

  • Obesity
  • Onset of menstruation at an early age 
  • Family history of uterine fibroids

How are fibroids diagnosed?

A pelvic exam can pick up large fibroids. Tests commonly performed to detect fibroids include:

  • Ultrasound scan: repeat scans can be done over time to monitor growth
  • Hysteroscopy: where a camera is inserted through the cervix to visualize fibroids inside the uterine cavity (submucous)

What is the Best Treatment for Uterine Fibroids?

Not all uterine fibroids require treatment. Fibroids that are small and do not cause symptoms can usually be monitored. However, if you get symptoms that interfere with your quality of life, seeking uterine fibroids treatment would help. Your gynaecologist may recommend the following treatment options:

Medical Treatment

Non-hormonal medications

To reduce the pain and blood loss associated with periods (painkillers). These do not shrink or make the fibroids disappear.

Hormonal Medications

Hormonal medications may be recommended for you if you’re struggling with heavy menstrual bleeding due to fibroids. The purpose of these medications is to regulate your menstrual cycle and reduce this bleeding.

Surgical treatment

Myomectomy

This is a surgical procedure aimed at removing the fibroids but preserving your uterus. It may be a good treatment option for you if you wish to conceive in the future. Depending on the size of fibroids, this can be done laparoscopically or open. There is a risk of fibroid recurrence in the future.

Hysterectomy

Surgical removal of uterus – this is suitable for women who are not keen on conserving their uterus. Depending on the size of womb, this can be done laparoscopically or open. You will not have any more periods and will not be able to have children after this. The ovaries may or may not be removed.

Hysteroscopy

Hysteroscopic resection is suitable only for fibroids inside the womb cavity (submucous)

Uterine Artery Embolization (UAE)/High intensity focused ultrasound (HIFU)

This is a relatively new procedures that are suitable only for women with specific size/location of fibroids, who are keen to conserve their uterus and wish for a less invasive treatment compared to surgery. Data on long-term effectiveness and future pregnancies is limited.