Dr Neha Gupta
Uterine fibroids are growths that arise from the muscle layer of the uterus. These growths are non cancerous in 99 percent of the cases but they can give rise to various problems due to their size or location. Fibroids can be single or multiple, located in the wall, projecting towards the cavity or growing outwards towards the cavity of the belly. When located within the cavity of the uterus, they usually cause heavy, painful or irregular periods. Such fibroids can also interfere with fertility leading to repeated miscarriages or difficulty in getting pregnant. Fibroids that are large can cause pressure symptoms like heaviness or pain in lower belly, sometimes pressing on the urinary bladder, they can lead to difficulty in passing urine or even urinary retention. Fibroids in pregnancy need a special mention. They tend to increase in size in pregnancy. In the second trimester of pregnancy, they can undergo some changes known as the ‘red degeneration’, which can give rise to significant pain and fever. If they are located in lower part of the uterus, they can render vaginal delivery difficult and doing a cesarean section becomes mandatory in such cases. The growth of fibroids depends upon the female hormones (oestrogen) and hence after menopause, fibroids usually don’t grow any further. If however, rarely, there is increase in the size of the fibroid in a postmenopausal lady, it’s a red alert and demands immediate attention.
Fibroids are usually easy to diagnose. A clinical examination by a gynecologist and an ultrasound scan will usually clinch the diagnosis. Sometimes an MRI may also be advised for more detailed evaluation and as an aid to the surgical planning.
It’s very important to know that not all fibroids need treatment. Only the ones which are large (usually more than 5cms) or causing symptoms (period/ pressure) need attention. Treating fibroids with medicine is not a very successful option. Medicines at best can only cause marginal (40 percent) reduction in the size and it usually regrows after stopping the medicine. Medicines used to treat fibroids can only be given upto a maximum of three months as giving for a longer time can have an impact on the liver of the patient. So that means that when they do need treatment, it is mostly surgical. What surgery is to be performed depends upon fibroid size, number, location, the symptoms that it is causing, patient’s age and fertility desires. If it is desirable to preserve the uterus, then only the fibroid can be removed. Removal of fibroid is called myomectomy. Myomectomy can be performed by the conventional open method where a large cut is given on the belly. Now a days, most cases are being performed by key hole surgery method (laparoscopically/ robotic). Key hole surgery has been a revolutionary change as no large cut is given and the entire procedure is performed through small 5-10mm cuts. There is less pain and faster recovery after surgery and it is cosmetically much better as well. For women who have completed their family, are more than 42 years of age or have previously undergone fibroid removal surgery, sometimes decision may be taken to remove the uterus (hysterectomy) in place of the fibroid. What surgery is decided and by which method is the combined decision taken by the patient and the doctor after detailed counselling and understanding of all the risks and benefits.
While we have talked about myomectomy, some other novel approaches are also there to treat the fibroid and retain the uterus. These include Uterine artery embolization (a technique which stops the blood supply to the fibroid by blocking the feeding blood vessel, so that the fibroid shrinks) and MR guided focused ablation (highly focused energy beam is administered to the fibroid causing breakdown of the fibroid cells). There are very selective indications to use these techniques and one should opt for them only after detailed understanding of their pros and cons.
There is a old saying, “if the uterus doesn’t make babies, it will make fibroids”!! So fibroids are common and we don’t really know why they happen. It’s important not to ignore your symptoms and see the doctor for a timely diagnosis. Treatment in expert hands yields good outcomes.
(The autor is Senior Consultant, Obstetrics & Gynecology Medanta, The Medicity, Gurugram)
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