Explaining fibroids, cysts to a patient

Both fibroids and cysts being mostly asymptomatic and usually only detected on routine abdominal or pelvic ultrasounds. As such, there are certain questions that are commonly posed to doctors. Dr Wong Yen Shi, Consultant Obstetrician and Gynaecologist, and Dr Farah Leong Rahman, Consultant Obstetrician, Gynaecologist and Fertility Specialist, tackle some frequently asked questions regarding these two conditions.

Q: How common are they and can they occur simultaneously?
A: Fibroids are non-cancerous growths that develop from the muscle of the uterus and are often found in women during their reproductive years. Ovarian cysts, however, are sacs containing mostly fluid, occasionally tissues or blood that grow within the ovaries or on its surface.

Cysts can be benign or malignant (cancerous). An ultrasound and CA125 tumour marker test are used to distinguish between benign and malignant cysts. Ovarian malignancy incidence peaks between the ages of 60 and 65. However, most cysts are benign, and doctors can allay patients’ fears by explaining most cysts regress on their own within a few months, and benign cysts such as follicular cysts or corpus luteal cysts grow and regress in tandem with a woman’s menstrual cycle. Fibroids are almost always benign.

Cysts and fibroids can occur concurrently; however, as the condition varies from patient to patient, management and monitoring are dependent on the size of each cyst and fibroid and the symptoms they cause.

Q: What are the causes of cysts and fibroids and what symptoms should women look out for?
A: It is believed that hormones, genetics, and growth factors play a role in these occurrences, but there is no definite cause. Pregnancy, pelvic infections, endometriosis, and a previous history of ovarian cysts can increase the risk of developing new ovarian cysts.

Fibroids and cysts may exhibit overlapping symptoms. These include painful or irregular period, compressive symptoms such as frequent urination or constipation, abdominal distension or bloating, back pain, unexplained weight gain, or even pain during sexual intercourse. In comparison to cysts, fibroids are more likely to present with heavy menstrual bleeding. In cases of ovarian malignancies, rapid satiety, weight loss, and loss of appetite are accompanying symptoms.
 

Q: Is fertility affected by the presence of fibroids and cysts?
A: Depending on the size and location of fibroids, one’s fertility may be affected. Even so, most women with fibroids and cysts are able to become pregnant without difficulty. Some of these conditions may result in blocked fallopian tubes leading to an environment less favourable for embryo implantation. This is especially true for fibroids located in the uterine lining. Again, treatment of this condition depends on the patient’s symptoms, and surgery is only recommended if it will increase the likelihood of conception.

Q: Do fibroids and cysts interfere with the development of the foetus or negatively impact the mother’s wellbeing?
A: The greatest concern associated with fibroids during pregnancy is the possibility of premature delivery. In certain instances, fibroids outgrow their blood supply, resulting in severe pain. Also, large fibroids can result in malposition of the foetus, in which the baby’s head may not turn down when it is time for delivery.

As for cysts during pregnancy, they are typically harmless unless they are large enough to cause torsion or rupture, in which case the patient should consult a physician before planning a pregnancy to ensure everything will progress smoothly.

Treatment options for fibroids and cysts
Larger cysts necessitate surgical removal, either laparoscopically or open surgery, whereas smaller cysts typically do not require treatment and are monitored for growth.

Surgery is the only permanent treatment for fibroids. Depending on the size and location of the fibroids, myomectomy (fibroid removal) can be performed via open surgery, laparoscopically, or hysteroscopically[JS1]  when fertility is a concern. The option of hysterectomy can be considered for postmenopausal women or those who no longer desire pregnancy.

Uterine artery embolization is another option for fibroid removal. A recent development is the high-intensity focused ultrasound (HIFU) surgery. These are additional options not yet widely accessible at many facilities. For patients who do not need surgical intervention, it is essential to provide medical relief for symptoms like heavy menstrual bleeding and painful periods.

Are there preventive steps one can take to avoid developing fibroids or cysts?
Fibroids and cysts can run in families. Therefore, regular gynaecological check-ups are necessary as these are sometimes asymptomatic. Regular check-ups will also enable monitoring of the fibroids and cysts, if any, and for timely intervention should they progress.

While there is no evidence that a healthy lifestyle and diet can prevent the formation of fibroids or cysts, there is no harm in living healthily.