DELAYED conception and fewer births have contributed to an increase in the number of women with fibroids.

However, the higher number can also be attributed to early detection due to annual health screenings, which more women go for these days.
 
Fibroids - overgrown muscle fibres of the womb that are mostly non-cancerous - affect as many as one in four women, says Adjunct Associate Professor Bernard Chern, head and senior consultant at KK Women's and Children's Hospital's Minimally Invasive Surgery unit. 'Many don't have symptoms and aren't aware of fibroid growth until they go for a screening,' he says.

Some women do experience problems, such as heavy bleeding during their periods.

And some fibroids may affect fertility.

However, only about 10 per cent of fibroid cases contribute to the inability to conceive.

'It depends on where the fibroids are,' says Dr Chern. 'They can be located inside the womb cavity, which is called a sub-mucous fibroid, or in the muscle wall (intra-mural), or on the surface of the womb (sub-serous).'

The sub-mucous fibroid within the womb is the main one that can present a problem for women trying to be pregnant, he says.

If it grows too big, then it will 'compete' for space.' So that's the main one for which doctors recommend removal.'

But ultimately, removal boils down to size, number and location.

'The intramural fibroid is generally harmless but if it gets too big then it will distort the uterus or obstruct the fallopian tubes,' says Dr Chern. 'That's when it requires removal. Otherwise, if it's small, then sometimes the patient doesn't have to have it removed.'

The good news is that minimally invasive surgery (MIS) techniques are increasingly being used to remove fibroids.

Laparascopy is used to remove sub-serous and intramural fibroids, whereas sub-mucous fibroids are removed via hysteroscopy.

This procedure is very similar to the resection (part removal) of the male prostate gland through the urethra.

In general, the keyhole approach is suitable for fibroids that are fewer in number and smaller in size.

However, fibroids up to 15cm have also been removed via laparoscopy. 'Despite that, only half of our fibroid removal surgery is done by MIS, due to the number and size factor,' says Dr Chern, adding that the other half are removed by open surgery.

Still, handling 50 per cent of fibroid cases with MIS is a huge leap - from a mere 7 per cent in 1993. In 2004, 28 per cent of fibroid removals were done by MIS, and the percentage almost doubled to 46 per cent by 2007.

'There are two reasons for this. Women are detecting fibroids earlier, thanks to health screening,' says the doctor. 'Also, patients are more discerning these days. They are requesting MIS because they're aware there is such a procedure that will result in less pain and faster healing.'

Ultimately, fibroids are more troublesome than they are dangerous - the risk of malignancy is low.
Even for fibroids affecting fertility, it's mainly those in the womb. 'Women can opt not to do anything with their fibroids if they're asymptomatic or if they're not fast-growing,' Dr Chern advises.