All about Uterine fibroids

All about Uterine fibroids

Fibroids of the uterus, or myomas, as they are often called, are one of the commonest benign tumors of the reproductive tract found in women.

About 40-77% of women may develop uterine fibroids at some point in their life, but not all of these will cause any symptoms or complications.

The development of symptoms depends to a large extent on the size, location & number of fibroids present in the uterus.

Based on the location, the fibroids can be of various types

• Intramural- Fibroid is present within the muscular wall of the uterus.
• Submucosal- Fibroid is bulging into the cavity of the uterus.
• Subserosal- Fibroid is located on the outer surface of the uterus. 
• Pedunculated- Fibroid is attached only with a thin stalk to the surface of the uterus.

What are the symptoms of fibroids?

Many women who have fibroids may not experience any symptoms at all, however, about 25-50% of women may experience problems like

• Heavy &/or prolonged periods.
• Bleeding in between two periods (Inter-menstrual bleeding).
• Painful periods.
• Pelvic pressure or pain.
• Difficulty in passing urine.
• Frequent urination.
• Constipation.
• Lump in abdomen.
• Difficulty in conceiving.
• Pain during intercourse.

Who is at risk of uterine fibroids?

Fibroids can develop in any woman and at any age. However, these are hormone-dependent tumors and are found more commonly in women who have certain risk factors like

• A family history of uterine fibroids.
• Obesity.
• Pregnancy.
• African-American origin.
• Age 30 years or older.

Why do fibroids develop?

Inspite of major developments in the field of Medical science & technology, we have still not been able to pinpoint the exact reason why fibroids develop in some women but not in others. The risk factors have been identified but the exact cause is still unclear.

We do know, however, that fibroids are hormone-dependent tumors that develop in response to the female hormones- Estrogen & progesterone.

 In some women, the effect of these hormones leads to overgrowth of the uterine muscle tissue & thus causes the formation of fibroids.

This is supported by the observation that fibroids are rarely diagnosed before puberty & are known to shrink in size after menopause. Similarly, they are known to increase in size during pregnancy when the estrogen & progesterone content in the body is higher.

How are fibroids diagnosed?

Your doctor may do a physical abdominal and pelvic examination & the presence of fibroids. You may be advised to undergo certain tests based on your symptoms & clinical examination. These include

• Ultrasound of the pelvis and abdomen to detect the number & size of the fibroids.
• Magnetic Resonance Imaging ( MRI) – This is required in certain cases to differentiate the fibroids from other benign or cancerous conditions like adenomyosis or sarcomas.
• CT scan may be required to study the organs of the pelvis & abdomen in detail.
• Hysteroscopy is a minimally invasive procedure where a thin & long camera is introduced into the uterus through the vagina to study the cervix, uterine cavity & endometrial lining. This may help diagnose submucosal fibroids or fibroid polyps.
• Laparoscopy is also a minimally invasive technique where a thin telescopic camera is introduced into the abdomen under anaesthesia to study the internal organs, uterus, tubes & ovaries.

What is the treatment for uterine fibroids?

Small, asymptomatic fibroids which are diagnosed only by chance and are not causing any symptoms do not require any specific treatment & are usually just kept under observation by an annual ultrasound and clinical examination.

Larger fibroids or the fibroids that are causing symptoms require treatment and there are various options available

1. Over-the-counter medications- Painkillers and medications for controlling the bleeding may be prescribed by your doctor to help control the excessive bleeding and pain. Your doctor may also prescribe supplements like Iron, B-complex, protein supplements, etc to help build a better hemoglobin value.
2. NSAID’s- These are medications that help control the pain & bleeding.
3. Hormonal medications- The doctor may prescribe oral hormonal tablets to control the growth of the fibroids & also to help regulate the periods. These medications need to be taken exactly as prescribed by your doctor as any non-compliance may further cause irregular bleeding.
4. Injectable hormones- Sometimes, your doctor may prescribe monthly or quarterly injections of hormones to control the growth & symptoms of fibroids.
5. Intrauterine device containing the hormone levonorgestrol has been found very effective in controlling the bleeding and works well for 5 years.
6. Surgical procedures- Sometimes, when conservative medical methods fail or are unsuitable for some women, the doctor may recommend a surgical procedure to remove only the fibroids ( Myomectomy), or occasionally, the entire uterus may need to be removed ( Hysterectomy).
7. Other methods- Some newer methods are being used to control the symptoms & growth of the fibroids. These include High-Intensity Focussed Ultrasound ( HIFU) or Uterine Artery  Embolisation (UAE).

In HIFU, the fibroid is destroyed by Highly focussed ultrasound waves while in UAE, the blood supply to the uterus & fibroid is blocked which leads to degeneration of the fibroids.

To summarize, Fibroids are a common condition among women of reproductive age group. They may or may not cause significant symptoms and in most cases, these symptoms can be managed by simple medications. Occasionally a surgical intervention may be needed and your doctor would be the best person to decide about the best course of action for you.

For any further information & queries, you can consult our medical specialists at Maitri & get personalized expert advice.