Uterine Fibroids

Fibroids are benign (non-cancerous) tumours or growths affecting the uterus.  The uterus is composed almost entirely of muscle fibres which are not capable of voluntary contraction, but nonetheless contract strongly during childbirth, expelling the baby through the birth canal.

Fibroids are not composed of fibrous tissue at all, but each fibroid appears to grow by clonal replication of a single muscle cell.  In other words, a single muscle cell starts to grow and replicate itself many thousands of times over, creating a firm muscular tumour with some associated new blood vessels and supporting tissues within it.  

The normal controlling mechanisms restricting growth and replication of individual cells appear to be lost when a fibroid starts to grow.  It is not clear why this happens, nor why some fibroids grow more rapidly than others and why some women have a greater tendency to develop fibroids than others.  

Diagnosis
This is usually made by ultrasound scan or MRI.  The latter is better for distinguishing adenomyosis.  

Fibroid copy

Treatment
Usually surgery is the best option, where possible Mr Lower will offer laparoscopic myomectomy or keyhole surgery.  For very large fibroids open myomectomy is better, and for complex situations uterine artery embolisation has a part to play.


Medical Treatment
Ullipristal acetate is a new drug which has been shown to reduce the size of fibroids by up to 40% in European trials.  It is due to launched in the UK in Q1 2012 and will have a licence alllowing its use for up to 3 months to shrink fibroids prior to surgery.  In addition to shrinking fibroids most women wil have complete absence of periods whilst taking ullipristal acetate, and there is good evidence that the effects of shrinkage last much longer than 3 months and in some cases it may be possible to avoid surgery in women who are close to the menopause.  Smaller fibroids are easier to remove than large fibroids and fibroids that may be considered too large for laparoscopic surgery may be suitable after a period of treatment.  
Ullipristal acetate is also useful in stopping periods in women with severe anaemia, allowing the haemoglobin to recover prior to surgery.  
We are currently awaiting supplies of this new drug in order to assess its use in our patients.  Ullipristal acetate is a class of drug known as a selective progesterone receptor modulator and the side effects seem to be much less troublesome than the side effects of GnRH analogues which have been used in the past to shrink fibroids.


© Adrian Lower 2014