Fibroids

Uterine fibroids are non-cancerous growths from the muscle layers of the uterus which can be varied in size from a bean to that of a melon. They usually develop at the reproductive age group in which the level of estrogen is very high. It is unclear exactly how they form, but it is clear that it has a relation with a high level of estrogen. Most people experience no symptoms. But some may have low backache, constipation, and painful uterine bleeding leads to anemia. Complications of uterine fibroids are rare, but they can be serious.

Types of fibroids:

  • Intramural fibroids
  • Subserosal fibroids
  • Submucosal fibroids
  • Cervical fibroids

Causes of fibroids:

  • The exact cause is unclear, but it may be related to estrogen level. When estrogen level is high, especially during pregnancy, the fibroid There is more chance to develop when a woman takes birth control pills which contain estrogen. The estrogen level reduced by menopause, and the fibroid usually shrinks.
  • Genetic factors are thought to have a role in the development of fibroids.
  • Red meat, caffeine and alcohol could increase the risk of fibroids.
  • Obesity may increase the chance of development of fibroids.
  • Childbearing lowers the risk. The risk reduces each time when the woman gives birth.

Symptoms of Fibroids:

-Heavy painful bleeding/ Menorrhagia

-Anemia from heavy bleeding

-Low backache or leg pain

-Constipation

-Discomfort in the lower abdomen, especially in the case of large fibroids.

-Frequent micturition

-Dyspareunia

-Pregnancy problems and labor problems

-Infertility

-Repeated miscarriages

-If the fibroid is very large, then there may be weight gain and swelling of the lower abdomen.

Treatment of Fibroids:

Treatment is only recommended for women who are experiencing severe symptoms due to fibroids. If the routine of the woman is not affected, then treatment is not suggested. During menopause, the fibroid often shrinks, and symptoms become less apparent and may resolve completely. The location of the fibroid, the severity of symptoms and any childbearing plans in the future are the tools to select the treatment method.

1.  Medications

  • Gonadotropin-releasing hormone agonist helps the body in less production of estrogen and progesterone. It shrinks fibroids, and it stops the menstrual cycle without affecting fertility. It can cause menopausal symptoms like hot flush, increased sweating, etc.
  • GnRH antagonist is drugs that affect pituitary glands and stops production of FSH and LH, which in turn causes less production of estrogen and progesterone.
  • Non-steroidal anti-inflammatory drugs

It reduces the production of hormone-like lipid compounds called prostaglandins. It reduces fibroid pain and doesn’t affect fertility.

  • Birth control pills

It regulates the ovulation cycle.

2.  Surgery

  • Hysterectomy

It is the partial or total removal of the uterus. This is considered for treating very large fibroids and for heavy bleeding.

  • Myomectomy

It is the removal of fibroid from the wall of the womb. It may help women who have a childbearing plan in the future.

  • Endometrial ablation

If fibroids are near the inner surface of the uterus, then can remove the lining of the uterus by this procedure. It is an effective alternative to hysterectomy.

  • Uterine fibroid embolization (UFE)

It is the procedure of cutting off blood supply to the area of fibroid. This is suitable for women who are pregnant and typically not for those who have future plans for pregnancy.

  • MRI-guided percutaneous laser ablation

MRI scan is used to locate the fibroid. A fine needle is inserted into the skin to reach the fibroid. Then a laser fiber device is inserted through the needle, and laser light is sent, which helps in shrinking the fibroid.

FAQ

Frequently Asked Questions

Fibroids are almost always benign. Cancerous fibroids will occur rarely. Studies show that cancer does not arise from already existing fibroids.

Some are growing steadily during the reproductive years, while others stay the same size for many years.  If left untreated it can continue to grow both in size and number. Fibroid symptoms will become worse and pain will increase. Heavy bleeding will be there with severe cramping. After menopause, all fibroids stop growing.

By embolization, fibroid begins to shrink immediately. Improvement in bleeding is immediate and shrinkage is reached a maximum by 6 months after the procedure. Heavy bleeding from fibroid stops right away.

Even if uterine fibroids are very common, they infrequently cause acute complications. Significant bleeding from ruptured fibroid is very rare. If there is a rupture of a degenerated fibroid and causing acute hemorrhage, then it requires a massive blood transfusion.

Vaginal discharge and abdominal pain are usual following procedure but usually resolve in a few days. The vaginal discharge can become chronic and foul smelling due to fibroid expulsion and surgical evacuation of the uterus is required.