Uterine Fibroids
uterine fibroids are the most common noncancerous tumors of women’s uterus. They are approached by the normal muscle of the uterus. They can develop within the uterine wall or remain attached to them. They can be single, multiple or in clusters. Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination.
Fibroids occur in almost 50% of women and are a leading cause of hysterectomy and a significant cause of infertility.
By bright start growing in the muscle tissue of the uterus. They can grow into the uterine cavity when they are called submucous, or into the thickness of the uterine wall called intramuscular. Then they grow on the surface of the press they are called subserosal and fibroids. Sometimes they grow as we don’t related or stalky fibroids.
What causes Uterine Fibroids?
The exact reason for fibroids is unknown. They have been seen to run in families. Some particular races have more chances of developing fibroids than the normal population. But the precise reason of having fibroids is grossly unknown.
The growth of fibroids is definitely influenced by the hormones especially estrogen which is normally produced by the Roman body. The fibroids have been seen to grow in young females as early as 20 years old. They tend to shrink after menopause when the body stops producing hormones.
Fibroids can be as small as in head size to as large as technically involved in the whole of the abdomen.
What are the symptoms of the Uterine fibroids?
Most of the fibroids even than their very large produce no symptoms. They are usually in the incidental findings for scans done for some other reasons. However, when the fibroids are symptomatic of the present is usually one of the following presentations.
An increase in menstrual bleeding called menorrhagia, prolonged menstrual bleeding called polymenorrhea, or painful menstrual bleeding called Metrorrhagia. The bleeding can be so excessive as to cause severe anemia. Pressure on the bladder which may cause frequent urination a sense of urgency to urinate or sometimes an inability to urinate. Pressure on direct either causing Constipation or asked for barstools frequently or sometimes painful defecation.
Pain in the lower abdomen or tummy, or fullness in the lower abdomen. When the fibroids are very large in size they can cause an increase in waist size or shape of the abdomen. I have seen parents coming with their unwed daughters suspecting of pregnancy and to the surprise being diagnosed as large fibroids.
Fibroids can be a cause of infertility which means the inability to become pregnant. Sometimes fibroids can be discovered as pelvic masses for some other reason.
When to consult a Doctor?
It’s irrelevant to say that if a lady comes to know that she has a fibroids in her ultrasound for some other reason definitely becomes anxious and consult a doctor. However medically speaking the reasons when. You should consult the doctor are as follows
- Irregular or heavy or painful or prolonged menstrual cycles
- Pelvic abdominal pain
- Prolonged or heavy periods leading to anaemia
- Increase in waist size or change in shape of abdomen
- Infertility
- Fibroids causing urinary or bowel problems
- If a woman with fibroids are following symptoms she should immediately contact the health care practitioner or hospital’s emergency department
- Menstrual bleeding soaking more than three pads and one hour. Severe or prolonged pain in pelvis or abdomen
- Chest pain, breathlessness, dizziness, lightheadedness and associated with vaginal bleeding
- Vaginal bleeding associated with pregnancy are possible pregnancy
The diagnosis of Uterine Fibroids.
- A detailed medical history followed by a physical examination, including our pelvic or Vaginal examination a rough idea of fibroids and uterus is made. Following a set of tests that are required to confirm that I was a fibroid
- An abdominal vaginal ultrasound gives a complete idea of the number and placement of fibroids and uterus
- For a large number of fibroids or ones with a big size with the intention of surgical removal of the same MRI scan is often ordered. It gives a piece of precise information about the size of all the fibroids are relative to the endometrial cavity and to each other and helps the surgeon make a plan to remove them
- Hysteroscopy is an investigation where a thin borescope is placed in the uterine cavity and the attached fiber-optic camera gives an internal view of the uterus. This investigation is done to see the submucous fibroids and the possible move them in the same sitting
- The laparoscope is a surgical procedure there is the scope that is placed in the abdomen. A fiber-optic camera is attached which gives a clear image of all the internal organs on the screen
What are the treatment options of Uterine Fibroids?
The deciding factors for treatment options of uterine fibroids are mainly the symptoms, their severity, the size and location of fibroids and the menstrual status of the female. Patients desire to have children and the coexisting medical problems of the patient have also a bearing on the treatment options available for the patient.
There are no home-made remedies or homeopathic treatments available for fibroids.
Medical treatment of Uterine Fibroids.
Most of the uterine fibroids are incidental findings and neither cause any problems nor need any treatment. Only in case of symptoms or the reasons cited above the patient needed treatment. If the patient is nearing menopause, hormonal manipulation often relieves the patient of the symptoms so that the patient can safely wait for menopause, when the symptoms themselves disappear as the fibroids start regressing. But this is not always the case. Usually, medical treatments are done for complications arising from the fibroids or waiting for the treatment which is usually surgical. Progesterone or GnRH analogs are required to decrease the size of fibroids.
Yet there is something very important that if the patient is to go in for surgical treatment of fibroids, they should not go in for medical treatment as the medical treatments decrease the blood supply of fibroids which damages the capsule of the fibroids making it difficult for the surgeon to remove them.
Surgical treatment of Fibroids.
Surgical treatment remains the main treatment option for fibroids. Earlier open surgery either through midline or transverse abdominal incision was usually done.
Myomectomy is the term used for the surgical removal of fibroids. This surgery can be done through hysteroscopy, laparoscopy or by opening the abdomen. The surgical approach depends on the size and location of fibroids. If the fibroids are submucous then the best option remains hysteroscopic myomectomy. However, in the case of large submucous fibroids, it is better to go in for laparoscopic or open myomectomy. The cut-off limit is different for different studies and surgeons, but usually, fibroids more than 3 cm in size or a surgery which is more than 25 minutes of operating hysteroscopic time warrants an abdominal laparoscopic approach to the fibroid. The laparoscopic approach is the best approach for small to medium fibroids and in case the number of fibroids is not very large. Many surgeons go in for open myomectomy for very large fibroids or if the number of fibroids is so huge that the chances of missing out a fibroid are high. Still, laparoscopic myomectomy remains the gold standard of treatment of for fibroids.
Hysterectomy is the surgical removal of the uterus. It has been the most commonly performed surgical procedure for the treatment of fibroids for a long time. But with the advent of laparoscopy, conservative approaches are becoming popular. Hysterectomy is usually done to remove the fibroids in case the families were completed the females are nearing menopause.
Uterine artery embolization is a procedure done to stop the arterial blood supply of the fibroid. The procedure is done by inserting a catheter into an artery of the leg under fluoroscopy. Once the catheter reaches the uterine artery, tiny plastic gelatin sponge or coils are released which block the blood supply to the fibroid. This method is a good option for women who do not want to undergo any operating procedure and don’t need babies. This procedure is performed by an interventional radiologist.
Magnetic resonance-guided focused ultrasound. This is a new procedure where MRA is used to guide an ultrasound beam that heats the fibroid which subsequently destroys the fibroid tissue. This is a technically very advanced procedure and is usually not widely available.
However, if you look at all the treatment options available, I would like to summarize that usually, fibroids don’t need any treatment. If at all treatment is required, laparoscopic or hysteroscopic myomectomy remains the gold standard of treatment. However, the surgeons trained to do these procedures are limited and homework should be done before finding a good surgeon.
We at Genesis Fertility and Surgical Centre, are regularly doing laparoscopic and hysteroscopic myomectomies on a routine basis. We have scores of satisfied patients. Since it a fertility-preserving center, our patients go in for assisted reproductive techniques after these surgeries.