Q: I am 21 weeks pregnant. I went for a scan and the result shows a calcified fibroid mass is evident in the posterior (intramural) segment measuring 42mm * 39mm. Please Dr, explain to me because I don’t understand. Can it be cured without surgery?

A: Fibroids develop from the muscle tissue of the uterus (womb). These growths can range in size from seedlings to big masses. They are differentiated by the sites where they are found: inside the cavity of the womb (sub-mucosal), within the muscle of the uterus (intramural), on the surface of the womb (sub-serosal). Fibroids do not cause infertility per se, but sub-mucosal ones in the cavity of the womb, can take up the place where a baby would have implanted causing infertility. Fibroids can also distort the shape of the ovaries and fallopian tubes causing problems with conception.

Hormones are implicated in the development of fibroids as when women get to menopause with resultant decrease in the level of circulating hormones, estrogen and progesterone, the fibroids shrink. Fibroids are more likely to occur in black women, people who take alcohol, people with a family history, obese people and those who eat a lot of red meat and little vegetables.

Symptoms of fibroids include heavy menstrual bleeding, prolonged menstrual bleeding, frequent urination as the mass presses on the bladder, feeling of incomplete emptying of the bladder, pelvic pressure etc. Pain can also result in fibroids when a fibroid has a stalk and gets twisted or when the fibroid grows so fast that it outgrows its blood supply lead to its ‘death’. When this happens, deposition of calcium crystals is encouraged leading to calcification. If this occurs during menopause, the fibroid regresses/reduces in size (due to the deficiency of estrogen at this time) and the potential for calcification increases. When the fibroid outgrows its blood supply in pregnancy, it leads to a condition known as red degeneration. The fibroid usually turns red and dies. This leads to intense abdominal pains and contractions. Will the pain last forever? Usually it occurs around 12 to 22 weeks of pregnancy and bed rest for a couple of days coupled with pain killers should do the trick. Judicious fluid intake is also advised. The attending obstetrician may give another analgesic (NSAID).

There are a couple of different methods for the treatment of fibroids but only your doctor can confirm which one is suitable to you.

If the fibroids are small and causing no problem (probably discovered incidentally), then your doctor will most likely not institute any treatment other than watchful waiting.

If one is around menopausal age and probably has finished having children, some drugs that mimic the effect of menopause are giving. These deprive the fibroids of nutrient supply and thus they shrink. Other treatment modalities may involve using IUCDs which release hormones that reduce the severity if bleeding and pain medications. With technology advances, there are also non-invasive and minimally invasive procedures that can take care of fibroids. Speak with your gynaecologist for these options. The final options are the tried and tested surgical procedures. One of the surgical procedures, myomectomy, involves removing the fibroids while preserving the healthy tissue of the uterus (womb). You can still get pregnant after this surgical procedure. So, you may want to have a long chat with your doctor to determine what options are available in your location and what applies to you.

Fibroids can co-exist with pregnancy in which case pregnancy may be normal or associated with breech pregnancy, pre-term delivery (delivery of pre-mature babies) etc. However, once a woman registers in a good antenatal center under a good obstetrician, these issues will be anticipated and addressed promptly. Having fibroids does not necessarily mean one cannot have children.

So, have a long chat with your doctor and ensure you are getting the best care available.

All the very best and….hugs!