9.JUN.2020 4 MIN READ | 4 MIN READ

Fibroids and cysts are very common structural abnormalities of the female reproductive system and commonly affect women in their child-bearing years.

Fibroids and cysts affect different structures within a women’s reproductive system. However, they can both present with similar symptoms, such as pelvic pain and abnormal uterine bleeding. There’s also a possibility that both condition can affect fertility.

Fibroids affect the uterus while cysts occur in the ovaries. Treatment depends on the symptoms, plans for a family, and can take the form of non-surgical as well as surgical intervention. Both fibroids and cysts are diagnosed by an ultrasound scan.

What are uterine fibroids?

Uterine fibroids
Uterine fibroids are non-cancerous muscular growths within the walls of the uterus. They can grow up to several centimetres in diameter, but are often undetected because they don’t cause any obvious symptoms. Fibroids are very common and around 50% of all women will have fibroids by the time they reach 50. These are usually detected during their routine gynaecological examinations. Fortunately, most of these women that have small fibroids have no symptoms. On average, only 25% of women will ever experience symptoms.

How do I tell that I have fibroids?

Heavy and painful periods, abnormal uterine bleeding, abdominal and pelvic cramping, lower back pain and pain, or pressure during intercourse may point to the possibility of fibroids in your uterus. Frequent, or difficulty passing urine may be another telltale sign of the condition. When in doubt, consult your gynaecologist as fibroids can complicate a pregnancy and can lead to miscarriage and/or infertility.

A family history of uterine fibroids could indicate a risk for the condition, but maintaining a healthy lifestyle and weight can reduce a woman’s risk of developing fibroids.

How are fibroids treated?

The treatment plan will depend on how the symptoms are affecting your daily life, and your body’s ability to function normally. A key consideration is also whether or not you intend to get pregnant in the near future.

Your gynaecologist may adopt a watch-and-wait approach to see if medication can relieve your symptoms. Hormonal medication may be prescribed to regulate your menstrual cycle, reduce the pain and heavy bleeding. They can also arrest the growth of the fibroids.

Alternatively, the gynaecologist may recommend a surgical procedure called a myomectomy to remove the fibroids.

Other treatment options, more suited for patients with no intention to have children, include uterine artery embolization (UAE), which destroys the fibroids by cutting off their blood supply or MRI-focused ultrasound therapy, a non-surgical technique that destroys the fibroids with high-intensity ultrasound waves.

As a definitive end to symptoms, you could elect to have a hysterectomy, where the uterus is removed but the ovaries, which are responsible for producing female reproductive hormones, are kept in place so that you do not enter early menopause.

What are ovarian cysts?

Ovarian cysts
Responsible for producing the hormones that regulate your reproductive system, a woman’s ovaries also release the all-important egg that’s central to her ovulation cycle. It’s also during this monthly ovulation cycle that a cyst, a fluid-filled sac, on one or both ovaries, may form. They usually occur without symptoms, when one of the follicles responsible for releasing the egg fails to open. They would usually resolve on their own within a few months without you ever knowing they happened. Because most ovarian cysts occur during the ovulation cycle, they are less common in women who have gone through menopause.

Symptoms and complications arise if a cyst grows abnormally large or ruptures. Sufferers of what’s known as polycystic ovary syndrome often see numerous small cysts developing on their ovaries – which is a common cause of infertility.

Cysts are fluid-filled sacs and can be benign or malignant. Benign examples include endometriotic chocolate cysts and dermoid cysts. Malignant tumours include epithelial ovarian cancers, or germ cell tumours.

How can I tell if I may have a cyst rather than fibroids?

The key difference, is that cysts can sometimes go away on their own without ever causing symptoms.

Should you experience bloating, abdominal pressure, pelvic pain, pain during intercourse, consult your gynaecologist for an accurate diagnosis. If the pain is sudden and sharp, especially if accompanied by vomiting and fever, seek urgent medical attention at the A&E department.

How are ovarian cysts treated?

If you have been diagnosed with an ovarian cyst, your gynaecologist may take a wait-and-watch approach to see if it resolves on its own. In this case, your condition will be monitored using periodic pelvic ultrasounds. Sometimes a tumour marker blood test, like CA125 may be performed to assess the risk of malignancy.

You may be prescribed birth control pills to prevent the formulation of future cysts during ovulation. If the cyst is a cause for concern, your gynaecologist may make use of a minimally invasive procedure called laparoscopic surgery, to investigate the condition. The procedure makes use of a tiny camera that is introduced through tiny key-hole sized incisions in the abdomen. Your gynaecologist may remove the cyst in the same procedure. This operation, known as a cystectomy, removes the cyst while leaving the ovary intact. An oophorectomy (removal of the ovary) may be necessary if the ovary cannot be saved.

Early diagnosis and treatment is key to successful treatment of both cysts and fibroids. Make an appointment to see your gynaecologist should you notice any worrying symptoms.

 

Article reviewed by Dr Quek Swee Chong, obstetrician and gynaecologist at Gleneagles Hospital

References

Fibroids and Cysts. Retrieved 12/5/2020 from https://mtalvernia.sg/education/fibroids-and-cysts/

Uterine Fibroids, Endometrial Polyps and Ovarian Cysts. Retrieved 12/5/2020 from https://rmob.coloradowomenshealth.com/health/fibroids-polyps-cysts

Ovarian Cysts and Uterine Fibroids - Symptoms and Treatment. Retrieved 12/5/2020 from https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/cysts-and-fibroids

9.JUN.2020
img
Quek Swee Chong
Obstetrician & Gynaecologist
Gleneagles Hospital

Dr. Quek is a specialist in Obstetrics & Gynaecology at the Parkway Gynaecology Screening & Treatment Centre in Gleneagles Hospital, Singapore.