Women’s bodies are complicated and at the same time, it’s important to be on top of our health. If you’re experiencing a change in the regularity or flow of your menstrual period, or feeling pain or pressure in your abdominal region, it’s important to consult your doctor.
In collaboration with obstetrician gynecologist Dr. Michelle Tsui 徐行悅醫生, we explain the difference between fibroids, cysts and polyps – their causes, symptoms, and treatments available in Hong Kong.
(1) UTERINE FIBROIDS
Uterine fibroids, also known as leiomyomas or myomas, are benign growths in the smooth muscle of the uterus. They usually appear during childbearing years and are very rarely cancerous. They range in size from undetectable to the eye to more than 10 centimeters in diameter.
Many women will have uterine fibroids without any symptoms – they will be discovered during a routine examination. Uterine fibroids are either submucosal (bulging towards the inside of the lining of the uterus), intramural (growing within the muscular uterine wall), or subserosal (bulging towards the outside of the uterus.
It’s important to note that most uterine fibroids will not require treatment.
Causes and risk factors
- Genetic changes: Researchers have found a genetic change in the cells of uterine fibroids as compared to surrounding cells. The cause is unknown.
- Hormones: Fibroid growth is stimulated by both estrogen and progesterone. Both hormones are involved in monthly cycles and pregnancy. Fibroids often shrink as women enter menopause when there is a decrease in hormones.
- Genetic: Uterine fibroids are more common in certain populations, including Afro-Caribbean women; and can sometimes run in families.
Symptoms of uterine fibroids vary based on the size, location and number of fibroids. The most common symptoms of fibroids include:
- Frequent urination
- Pelvic pressure
- Menstrual period lasting more than a week
- Heavy menstrual bleeding
Treatment of fibroids depends on their size, location and extent to which they are affecting the body’s ability to function normally. The following treatments are used to treat uterine fibroids:
Women planning to conceive in the future
- Simple, non-hormone medications such as tranexamic acid to reduce fibroid-associated bleeding.
- Hormonal oral contraception can reduce the pain and heavy bleeding associated with fibroids, however this is clearly not an option for women who are trying to conceive.
- Surgical fibroids removal, leaving the uterus intact. This is known as a myomectomy.
Women actively trying to conceive
- The best option is to do nothing but monitor the fibroid, especially if it is not pushing into the uterine cavity.
- If your physician determines that the fibroid’s size and location may affect your chances of getting pregnant (usually affecting implantation), a myomectomy may be suggested to remove the fibroid (if the fibroid is mainly inside the cavity and not too large, a hysteroscopic can be done).
Women who no longer wish to conceive
- MRI-focused high intensity ultrasounds waves to destroy fibroids.
- A uterine artery embolization is done by a radiologist and blocks blood supply to the fibroid.
- A myomectomy.
- As a last resort, a hysterectomy removes the uterus altogether, and removes the possibility of recurrence.
(2) ENDOMETRIAL OR UTERINE POLYPS
Endometrial polyps, also known as uterine polyps, are an overgrowth of cells in the endometrial lining of the uterus. Uterine polyps are usually benign, though they do occasionally develop into cancer. They are attached to the uterine wall by a large base or a thin stalk and range from several millimeters to a few centimeters.
Causes and risk factors
Risk factors include a history of cervical polyps. Scientists are not entirely sure what causes uterine polyps but it’s clear that they grow in response to estrogen. Individuals taking tamoxifen or hormone replacement therapy are at a higher risk of uterine polyps.
Like fibroids, often endometrial polyps will be asymptomatic and are picked up during routine screening. The most common symptoms include:
- Heavy menstrual bleeding
- Bleeding between menstrual periods
- Pre and/or post-menstrual spotting
- Infertility if they occur near fallopian tubes or are very large
- Bleeding after menopause
If a woman is symptom-free and not at-risk for cancer, she may wait and see if the polyp continues to grow larger. Asymptomatic polyps are usually found during routine examinations. Symptomatic (bleeding) polyps and polyps in older women are more at risk of abnormal cells and should be removed. If a woman is experiencing symptoms or advised so by her physician, a gynecologist will use a hysteroscopy to remove the polyps. A hysteroscopy is a tube and camera inserted through the vagina and cervix used to remove the polyps non-invasively. The removed polyps will be tested for cancerous or pre-cancerous cells.
(3) OVARIAN CYSTS
An ovarian cyst is a fluid-filled sac located within or on the surface of the ovary. Women have two ovaries – one on each side of her uterus. Cysts can appear on either or both ovaries. Many ovarian cysts are asymptomatic. There are multiple types of cysts depending on their relation to menstruation/ovulation. Cysts related to ovulation are known as follicular and corpus luteum cysts. These are normal physiological changes and do not require intervention as they come and go with the cycle.
Benign but non-physiological ovarian cysts will not disappear on their own. Benign ovarian cysts that are not related to normal menstruation include:
- Dermoid cysts or teratomas are formed from stem cells and contain tissues such as hair, skin or teeth.
- Cystademonas are fluid-filled sacs that occur in the ovary.
- Endometriomas occur when ectopic endometrial cells attached to ovaries and form a growth. They are also known as “chocolate cysts” and are a result of endometriosis.
Symptoms of an ovarian cyst can include:
- Either a dull or sharp ache in the lower abdomen on the side of the cyst
- Fullness, heaviness or pressure in the abdomen
- Unexplained bloating
- Pain during intercourse (usually with endometriomas)
- Painful period (usually with endometriomas)
It’s important to note that large ovarian cysts are at-risk of rupture or torsion (twisting). This can cause serious symptoms. Symptoms as a result of a complication from an ovarian cyst can include:
- Sudden and severe abdominal or pelvic pain
- Pain with or without fever or vomiting
- Symptoms of shock – cold and clammy skin, increased breathing rate, and lightheadedness/weakness
Causes and risk factors
- If you’ve had one ovarian cyst, you’re likely to have more. Dermoid and endometriomas are the most likely to recur.
- Sometimes during pregnancy, the cyst that forms when you ovulate stays on your ovary throughout pregnancy, but these usually resolve on their own.
- In women with endometriosis, endometrial tissue can attach to your ovary and form an endometriotic (chocolate) cyst.
Many ovarian cysts are actually functional or physiological and will resolve on their own. If an asymptomatic cyst is found during a routine examination, your physician may advise a waiting period with monitoring using periodic pelvic ultrasounds. If surgery is recommended, your cyst will be removed in a surgery known as cystectomy leaving the ovaries and other organs intact. Cystectomy is almost always done by laparoscopic or ‘keyhole’ surgery and is associated with minimal pain and short hospital stays. In rare severe cases if the cyst is cancerous or the woman is menopausal, removal of one or both ovaries will be required (oophorectomy).