In awareness of women’s month, Dr Victor Hulme, spoke to Marie Hudson from ‘Gesondheid op RSG’ (‘Woensdag 8 Augustus 2018’), on the topic of fibroids. More specifically options for the conservative/non-surgical treatment of fibroids.
Dr Hulme answered a couple of questions on the topic:
What are fibroids?
A fibroid is a tumor of the muscle of the uterus.
Fibroids are very common in women and are benign (non-cancerous) in most cases. Less than 1% are malign/cancerous. Fibroids are made up of smooth muscle tissue, which grows at a rapid pace. Approximately 30% of women in their reproductive years present with fibroids and up to 70% of women older than 50, present with fibroids.
What causes fibroids to form?
We don’t know what the cause of fibroids are. If we knew the cause, it would be a lot easier to prevent fibroids from developing. We however do know that fibroids are more common under women who fall pregnant at a later age or women who have never experienced a pregnancy.
What are the signs and symptoms of fibroids?
- Menstruation becomes heavier
- anaemia (iron deficiency)
- Pelvic pain
- Pressure on the bladder, which leads to the sensation that one needs to urinate more frequently.
- Struggling to fall pregnant
How are fibroids diagnosed?
The gynaecologist will do an internal evaluation of the patient to feel if fibroids are present. Often the physician can feel that the uterus is enlarged due to fibroids, without patients having realised it themselves. If fibroids are suspected through the physician’s evaluation, an internal ultra-sound will be performed to confirm the diagnosis, as well as to establish the position and size of fibroid/fibroids.
Why do fibroids need to be treated?
Surgery for fibroids would be indicated if fibroids impact the quality of life. Symptoms that could impact the quality of life includes, heavy menstruation and high levels of pain. Furthermore, as the position and size of a fibroid could impact fertility, surgery would be indicated if the fibroid would hinder the implantation of an embryo within the uterus.
How many fibroids can occur?
There can be more than one fibroid. Previously, we have removed more than 30 fibroids from a patient.
How big can fibroids become?
I have previously seen a patient presenting with fibroids, whose uterus was a similar size to that of a 20 week pregnant woman.
How does the surgeon decide whether to remove the fibroid or the entire uterus?
The decision of the surgeon would strongly rest on the woman’s future desire to have more children. If the decision is made to only remove the fibroid, it’s done in attempt to preserve the uterus as far as possible for normal pregnancy to still take place. However, if the woman’s family is complete and she does not desire to have more children in future, a hysterectomy is indicated.
Does conservative/non-surgical treatment of fibroids exist?
As fibroids are common and some women prefer to avoid surgery, there is a need/desire for conservative management/non-surgical treatment of fibroids. One technique used, uterine artery embolization, works by eliminating the oxygen supply to the fibroid and the fibroid therefore decreases in size. This technique can however have long term effects, as it can lead to anovulation (no ovulation) and therefore infertility.
Furthermore, there is medication for the treatment of fibroids:
- One type of medication works by causing early menopause, which means ovulation and menstruation will stop. This is also used as a short-term solution to shrink the fibroid for future surgery.
- A second type of medication exists which works on the progesterone receptors, with the aim of preventing the fibroid to grow any further.
Is there any current research on the treatment of fibroids with medication?
Yes, Aevitas Fertility Clinic, under the leadership of myself and Sister Tersia Fourie, is currently participating in two big studies through international pharmaceutical companies. These studies aim to look into the effect of medication as treatment for fibroids, for women who are seeking non-surgical solutions.
- Study #1: Suppresses the female’s own hormone, to inhibit fibroid growth. Additionally, a low dose of hormone replacement is given, to counter the effect of hormone suppression, by controlling the symptoms of hot flushes.
- Study #2: Works against progesterone (as progesterone can stimulate fibroid growth). It is an oral medication to control the growth and symptoms of fibroids.
Who can participate in this research study on fibroids?
We are looking for voluntary participants who meet the requirements (as indicated below). Conservative/non-surgical treatment of fibroids, during the research study, will be given at no cost.
Requirements for participants:
- Diagnosed with fibroids
- Do not plan to have surgery to remove the fibroids
- Does not want to fall pregnant within the next 2 years
- Heavy menstrual bleeding
- Age: 18 – 50
- From Cape Town or surrounding area (able to visit the clinic monthly for 2 years)
How can one find out more?
- Contact Sister Fourie at: 071 236 6565
- Alternatively, phone Aevitas Fertility Clinic’s land line and request to speak to Sister Fourie: 021 531 6999