Uterine fibroids are very common and are simple (non-cancerous) tumors that are formed inside or on uterus. One may have a single fibroid or many and their size can also vary from being very small to very large. In medical language they are known as leiomyoma. They may be growing into muscle of uterus or may grow towards inner or outer side of uterine wall. They may or may not cause any symptoms and do not always need treatment.
Not all fibroids cause symptoms, but when they do, symptoms can include heavy menstrual bleeding, back pain, frequent urination and pain during sex. Small fibroids often don’t need treatment, but larger fibroids can be treated with medications or surgery.
Risk factors for getting fibroids-
Obesity
Positive family history of fibroids
Early age at menstruation
Not bearing child
Getting early onset of menstruation
Attaining late menopause
Types of fibroids-
Submucosal fibroids: These fibroids are growing inside the uterine space (cavity) where a baby grows during pregnancy.
Intramural fibroids: These fibroids remain inside the wall of the uterus.
Subserosal fibroids: These grow on outer surface of uterus.
Pedunculated fibroids: These fibroids are also located on the outside of the uterus but they are connected to the uterus with a thin stem.
Is there a risk for cancer with fibroids?
It is quite rare for a fibroid get transformed into cancer but still it is possible. It can not be said from available tests today which fibroid is going to turn into cancer. Risk factors-
Rapid growth of size of uterine fibroid
Fibroids that grow during menopause
Causes-
Most fibroids happen in women of reproductive age but their exact cause is not yet known.
Symptoms-
Most fibroids do not cause any symptoms and so may not require treatment other than observation under a doctor. But fibroids can cause a variety of symptoms as well like-
Excessive bleeding during menses.
Painful menses.
Pain or fulness in lower abdomen.
Low back pain.
Infertility.
Vaginal discharge.
Frequent urination.
Constipation.
Abdominal distention like in pregnancy if fibroid is very big.
The growth of fibroids is likely to stop after menopause due to hormonal changes.
Tests to Diagnose Fibroids
Ultrasound: This is the most common test where fibroids are diagnosed. In many cases no other test is required to manage fibroids.
Magnetic resonance imaging (MRI): in some cases of doubt or when a cancer is suspected, MRI may be recommended.
Computed tomography (CT): Again in cases of doubt a CT scan may be ordered to get more detailed view of uterus and surrounding organs.
MANAGEMENT AND TREATMENT
Observation-
If fibroids are small and are not causing any symptoms, one may not need any treatment and wait till menopause when they are expected to shrink or at least stop growing.
Medication– No drug is uniformly effective against fibroids so that they can dissolve fibroids. At best they can control heavy menstrual bleeding or temporarily shrink the size of a large fibroid. You can discuss these options with your doctor if you are not willing for surgery at present.
Myomectomy – This means removal of fibroid from uterus. This can be done by open method or by laparoscopic (Key Hole) or by hysteroscopic method.
Open Surgery – Incision is given in lower abdomen and fibroids are removed through this large cut. Not recommended these days by expert doctors unless same surgery can not be done by laparoscopic method.
Laparoscopic Surgery – Same surgery is done via very small holes – typically one hole that is 1cm and three holes which are just 0.5cm. Camera is inserted inside abdomen, uterus and fibroids are visualised on monitor and surgery is performed with the help of very thin and long instruments. Even large fibroids can be removed and later crushed with the help of a machine to be removed from a very small hole. This method has many advantages of open surgery-
Much smaller cuts
Much less pain
Much better recovery
May lead to less blood loss
Early return to work
Less pelvic adhesions – so much better for patients who wish to conceive after surgery.
Hysteroscopic Surgery: Fibroid that is projecting into the cavity of uterus can be removed by this method where a thin scope is inserted through vagina into the uterus. No incisions are made on skin. Advantages-
No cuts
Less pan
Early recovery
But not all fibroids can be removed by this procedure and it is applicable to minority of patients who have suitable fibroid for this surgery.
Hysterectomy: This procedure means removal of uterus. This may be a choice for patients who-
Have completed their family and want a one time procedure as after hysterectomy uterine fibroids can not come back.
Can be done laparoscopically (Key Hole Method or Laser Surgery in lay man terms) in advanced centres.
There are some new and still not in common use procedures like-
Uterine fibroid embolization
Radiofrequency ablation (RFA)
Magnetic Resonance Imaging (MRI)-guided focused ultrasound
Risks involved in fibroid surgery-
In general these are quite safe surgeries but as with any other surgery, there are certain risks involved like-
Infection
Bleeding
Anaesthesia risk
Injury to surrounding structures
As said before, these are in general quite safe surgeries, so these risks should not deter you from getting suitable treatment at the right time.
At what size fibroids need surgery?
This is a common question that many people ask but unfortunately there is no clear cut answer to this. Sometimes a small fibroid causes symptoms like excessive bleeding or infertility and needs removal. Sometimes a large fibroid causes symptoms due to its size by putting pressure on surrounding structures like urinary bladder, ureters, rectum etc and hence need removal. Any fast growth in size of fibroid is another indication for surgery.
PREVENTION
Quite frankly, nothing can be done to prevent fibroids for sure. One can reduce risk by maintaining a healthy body weight and getting regular health examinations
Can I get pregnant with fibroid?
In many cases fibroid is not pushing into the uterine cavity and one may become pregnant but in some cases fibroid can cause infertility and your doctor will guide you accordingly.
Can fibroids go away on their own?
Fibroids can shrink in some women after menopause. This happens because of a decrease in hormones. When the fibroids shrink, your symptoms may go away. Please see your doctor before making your mind about management of fibroids.
Our Achievements :
Our remarkable achievements challenge the misconception that multiple fibroids require open surgery. With laparoscopy, we successfully removed over 35 fibroids, setting a new standard in minimally invasive gynecological procedures.
