Ask the health expert: What can a woman with intramural fibroids do if she wants to bear children?

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Q: What can a woman with intramural fibroids do if she wants to bear children?

A: Fibroids are non-cancerous tumours that grow in the uterus and are commonly found in women of reproductive age. The size and location of fibroids vary with each individual.

Intramural fibroids grow within the uterus walls, while submucosal fibroids grow underneath the uterus' lining and can also grow inside the uterus. Subserosal fibroids grow outside the uterus.

While some patients may experience no symptoms, others may suffer symptoms such as heavy and painful periods, or even impaired fertility.

Graphic: The Straits Times

Intramural and subserosal fibroids are less likely to cause problems with conceiving, as compared to submucosal fibroids which may be large enough to affect implantation of a fertilised embryo.

These are the three methods to treat and manage fibroids:

Expectant management

This involves close monitoring of the fibroid instead of immediate treatment and may be the course of management for patients who have no symptoms, or if the fibroids are small.

Medical management

For women who do not wish to undergo surgery, the size of fibroids can be managed using medication such as the new drug ulipristal acetate.

It is usually given to patients for three months before a repeat assessment to gauge their response to the treatment.

This drug may also help to reduce the size of fibroids in patients before surgery.

Surgical management

Women with large fibroids can consider surgery, especially if they have trouble conceiving.

There are different procedures to treat fibroids, such as hysteroscopic resection of myoma, laparoscopic myomectomy, and open myomectomy. The route and type of surgery will greatly depend on the size and location of the fibroids.

After surgical removal of fibroids, the chance of recurrent growths is between 15 and 30 per cent.

Patients should also avoid pregnancy for at least three to six months to allow the myometrium (the muscle tissue of the uterus) to heal.

If a large part of the myometrium was removed during surgery, the patient may be advised to undergo a caesarean section to deliver her baby if she becomes pregnant.

Associate Professor Bernard Chern, Head of Obstetrics and Gynaecology, KK Women's and Children's Hospital