Uterine Fibroids

What are uterine fibroids?

Uterine fibroids, also known as leiomyomas or myomas, are benign (non-cancerous) growths that develop from the smooth muscle tissue of the uterus (womb). They can vary in size, number, and location, and are classified according to where they grow:

• Subserosal fibroids form on the outer surface of the uterus.

• Intramural fibroids grow within the muscular wall.

• Submucosal fibroids protrude into the uterine cavity. 

• Pedunculated fibroids grow on a stalk-like structure attached to either the inner or outer wall of the uterus.

Most fibroids are harmless and may not cause noticeable symptoms. However, in some cases, they can lead to heavy menstrual bleeding, pelvic pain or pressure, frequent urination, or fertility problems depending on their size and location.

Fibroids are almost always non-cancerous. The chance of a fibroid being cancerous, known as a leiomyosarcoma, is very low, with studies suggesting this occurs in fewer than 1 in 1,000 cases (less than 0.1%). The risk does not necessarily increase just because a fibroid is large, although rapidly growing fibroids, especially after menopause, may require closer evaluation to rule out malignancy.

Who gets fibroids and why do they occur?

Uterine fibroids can develop at any stage during a woman’s reproductive years, but they are most frequently diagnosed in women between the ages of 30 and 50. Their prevalence tends to increase with age until menopause. After menopause, fibroids often shrink due to the decline in hormone levels.

Although the exact cause of fibroids remains unclear, their growth is strongly influenced by female hormones, particularly oestrogen and progesterone. These hormones stimulate the development of the uterine lining during the menstrual cycle and can similarly encourage fibroid growth. This helps explain why fibroids often enlarge during pregnancy, when hormone levels are higher, and why they typically reduce in size after menopause.

Several factors can increase a woman’s risk of developing fibroids, including:

• Family history — having a close relative with fibroids increases the likelihood.

• Higher body weight — obesity and excess body fat can affect hormone levels.

• Early onset of menstruation — beginning periods at a younger age is linked to a greater risk.

• Never having been pregnant — pregnancy appears to have a protective effect, possibly due to hormonal and uterine changes.

What are the symptoms of fibroids?

Not all women with fibroids experience symptoms. In many cases, fibroids are discovered incidentally during a routine pelvic examination or ultrasound scan performed for another reason. However, when symptoms do occur, they can vary widely depending on the size, number, and location of the fibroids.

Common symptoms include:

• Heavy or prolonged menstrual bleeding — this may include periods that last longer than usual, are painful, or cause bleeding between cycles.

• Pelvic pressure or bloating — a feeling of fullness or heaviness in the lower abdomen.

• Lower back pain — often related to the weight or pressure of larger fibroids.

• Anaemia — heavy bleeding can lead to iron-deficiency anaemia, causing fatigue and weakness.

• Urinary symptoms — such as frequent urination, a sudden urge to urinate, or difficulty emptying the bladder completely.

• Constipation — fibroids pressing on the bowel may make bowel movements difficult.

• Fertility challenges — fibroids can interfere with implantation, increase the risk of miscarriage, or contribute to difficulty conceiving.

Because symptoms can mimic those of other gynaecological or gastrointestinal conditions, it’s important to consult a doctor if any of these issues arise.

How are uterine fibroids diagnosed? 

Uterine fibroids are often discovered during a routine pelvic examination, where a doctor may feel an irregular or enlarged uterus. If fibroids are suspected, further imaging tests are used to confirm the diagnosis and assess their size, number, and location.

Common diagnostic methods include:

• Pelvic ultrasound — this is the most frequently used imaging test, involving sound waves to create a picture of the uterus and detect fibroids.

• Transvaginal ultrasound — an internal scan using a probe inserted into the vagina for clearer images of the uterus.

• MRI (Magnetic Resonance Imaging) — provides detailed images of the uterus and is particularly useful for mapping fibroids before surgery or in complex cases.

• Hysterosonography (saline infusion sonography) — involves injecting sterile fluid into the uterus during an ultrasound to better visualise submucosal fibroids.

• Hysteroscopy — during a hysteroscopy, a thin, lighted telescope is inserted through the cervix into the uterus to look directly at the uterine lining.

Accurate diagnosis is key to tailoring treatment options based on the woman’s symptoms, reproductive goals, and fibroid characteristics.

When is fibroid treatment necessary?

Not all fibroids require active treatment. If the fibroids are small and not causing any symptoms, they can often be managed with regular monitoring through pelvic examinations and imaging. However, treatment becomes necessary when fibroids begin to interfere with daily life or cause significant discomfort.

Common reasons for seeking treatment include:

• Heavy or prolonged menstrual bleeding
• Severe period pain
• Pelvic pressure or bloating
• Fertility concerns
• Anaemia caused by excessive blood loss

For women experiencing bothersome symptoms, gynaecologists may first suggest medical therapy to manage bleeding and discomfort.

• Non-hormonal medications — such as tranexamic acid or anti-inflammatory drugs can help reduce heavy bleeding during periods.

• Hormonal treatments — like oral contraceptives or progestin-releasing intrauterine devices (IUDs) can help regulate the menstrual cycle and ease pain.

It’s important to note that while these medications can alleviate symptoms, they do not eliminate the fibroids themselves.

In certain cases, gonadotropin-releasing hormone (GnRH) agonists may be prescribed to temporarily shrink fibroids by inducing a menopausal-like state. This approach is typically used for a few months before planned surgery, as it can make fibroid removal easier and reduce surgical risks.

What are the treatment options for fibroids in Singapore?

Treatment for uterine fibroids depends on several factors, including the severity of symptoms, size and location of the fibroids, a woman’s age, and whether she wishes to have children in the future. Options range from medication and lifestyle adjustments to surgical and minimally invasive procedures.

Surgical treatment for fibroids

Surgery is often considered when fibroids cause heavy bleeding, pain, pressure symptoms, or affect fertility. The most appropriate surgical approach depends on whether future pregnancy is desired.

• Myomectomy — this is recommended for women who wish to preserve fertility. A myomectomy removes fibroids while leaving the uterus intact. It can be performed in different ways depending on the fibroid’s size and location:

• Laparoscopic (keyhole) myomectomy — for fibroids on the outer surface or within the uterine wall.

• Hysteroscopic myomectomy — for fibroids within the uterine cavity, using a telescope inserted through the vagina.

• Open myomectomy — for larger or multiple fibroids that cannot be accessed minimally invasively.

• Hysterectomy — this method is suitable for women who do not plan future pregnancies. A hysterectomy involves the complete removal of the uterus and is the only permanent solution for fibroids. The ovaries can usually be preserved if they are healthy, which means the woman will not enter menopause after surgery. However, she will no longer have menstrual periods or the ability to conceive. Depending on the uterus size, this may be done via a laparoscopic surgery or an open abdominal surgery

Minimally invasive alternatives

For women who are not suitable candidates for surgery or prefer a less invasive approach, there are emerging procedures that can reduce fibroid size without removing the uterus.

• Uterine Artery Embolisation (UAE) — a radiological procedure that blocks the blood supply to fibroids, causing them to shrink. It is done through a small incision in the groin or wrist and does not require general anaesthesia.

• High-Intensity Focused Ultrasound (HIFU) and microwave ablation — these techniques use focused energy to destroy fibroid tissue. They are non-invasive or minimally invasive options and are suitable only for certain fibroid types.

While pregnancy may be possible after UAE or HIFU, there is limited long-term data on safety and outcomes. These options are generally not primary treatment options for women who plan to conceive and are more often used in women who are not ideal surgical candidates.

Impact of diet on fibroids

Although diet cannot cure fibroids, it may play a role in their development and progression. Certain foods influence hormone levels — particularly oestrogen — which can stimulate fibroid growth.

Foods to limit or avoid

• Meat and dairy with added hormones — opt for organic and low-fat versions
• Processed red meat — such as ham and sausages, which may increase inflammation and body fat
• Soy products — including soy milk, tofu, edamame, and beancurd
• Flax seeds — which contain phytoestrogens that mimic oestrogen in the body

Recommended foods

• Fruits — apples, strawberries (aim for at least two servings daily)
• Cruciferous vegetables — broccoli, cabbage, Chinese cabbage
• High-fibre vegetables — tomatoes, cucumbers
• Vitamin E-rich foods — almonds, hazelnuts

These foods support liver detoxification and help regulate oestrogen levels, which may reduce fibroid growth. A diet high in fruits and vegetables has also been linked to a lower risk of fibroids.

Other considerations

• Vitamin D deficiency has been associated with a higher risk of fibroid development.

• Food pollutants, such as polychlorinated biphenyls (PCBs), bisphenol A (BPA), and phthalates found in disposable plastics, have been linked to fibroid growth. Avoid reheating or storing food in plastic containers, and minimise takeaways that come in disposable packaging. 

• Green tea extract has shown potential in reducing fibroid size and symptoms in some studies. 

Summary 

Uterine fibroids are non-cancerous growths that commonly affect women in their 30s to 50s, often influenced by hormonal and lifestyle factors. While some women remain symptom-free, others may experience heavy periods, pelvic pain, bloating, urinary symptoms, or fertility challenges. 

Diagnosis typically involves ultrasound or MRI scans, and treatment is tailored based on symptoms, fibroid size, and reproductive goals. Options range from medication and lifestyle adjustments to surgery, such as myomectomy or hysterectomy, as well as less invasive procedures like uterine artery embolisation and focused ultrasound. Diet and environmental exposures may also influence fibroid development and progression. 

If you are experiencing symptoms or have concerns about fibroids, schedule a consultation with Holistic Gynaecology & Fertility to explore the most suitable care options for your needs.

Frequently Asked Questions (FAQs) 

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