Fibroids

If you are experiencing prolonged menstrual periods, heavy bleeding during periods, bloating in the belly/pelvis pain and pain during intercourse chances are that you are suffering from fibroids. In fact fibroids is the most common type of tumor. Around 10 million patients are diagnosed with fibroids every year in India itself, so don’t worry, you are not alone in the battle against pain!

Fibroids, also known as uterine myomas, are compact and firm tumors that are made of smooth muscle cells and fibrous connective tissue which develop in the uterus.  In 99% percent of the cases such tumors are benign in nature. The location, shape & size of the tumor can vary greatly .They can be present on the outside surface of the uterus, inside it or inside its walls. The growth and number of fibroids can also vary. It is possible to have more than one fibroid. Also, the speed of growth can vary. For instance, a fibroid may remain small for many years and then suddenly grow rapidly.

The exact cause of fibroids is not known, but research points out towards the following factors:

Hormones: Estrogen and progesterone are responsible for regenerating the uterine lining during each menstrual cycle and may stimulate the growth of fibroid.

Heredity: If your mother, sister, or grandmother has ever suffered from fibroids then you may suffer from fibroids too.

Following are the risk factors involved with fibroids:

Heredity: Historical cases of fibroids in your family increase your risk of developing it.

Race: Studies suggest women from African- American heritage are more likely to develop fibroids.

Personal health & lifestyle: Personal health factors such as onset of menstruation at an early age, use of birth control, obesity and vitamin D deficiency are known to increase the risk of developing fibroids. On the other hand lifestyle factors such as drinking alcohol and consuming a diet which consists of larger proportions of red meat compared to fruits, green vegetables & dairy result in an increase in the likelihood of developing fibroids.

Prolonged menstrual periods: Fibroids may lead to menstrual periods which may last 7 days or longer.

Heavy bleeding during periods: Excessive or heavy bleeding during periods is one of the most common symptoms of fibroids. A menstrual cycle is said to be heavy or excessive when more than 80ml blood is lost.

Bloating or fullness in the abdomen or pelvis: The uterus is normally pear size but fibroids can lead to enlargement of uterus, & thus fullness or bloating near the abdomen or pelvis area.

Pain in the lower belly or pelvis: The uterus is located below the pubic bone, surrounded by the intestines and is just under the bladder. Therefore enlargement of uterus due to fibroids can result in pain in these areas as well in the pelvic area.

Some other vital symptoms:

• Constipation
• Pressure on urinary bladder with urinary problems
• Irregular vaginal bleeding
• Pain during intercourse
• Infertility, repeated abortions or poor pregnancy outcomes

It is estimated that around 70 to 80% of women age experience fibroids by the age of 50, but not all cases are diagnosed. Hence the first step for freedom from fibroids is to ascertain it. The following are the methods for diagnosis of fibroids:

Ultrasound: Ultrasound is one of the main tests to diagnose fibroids. It’s a painless procedure which uses ultrasound waves to get an image of the fibroid.

Hysteroscopy: Hysterectomy is a procedure in which a hysteroscope – a small telescope with light source, is inserted through the vaginal opening of the patient. This procedure is generally used in the case of submucosal fibroid i.e. when the fibroid is present in the womb. The surgeon may use anesthesia (local or general), but most of the women don’t require it.

Laparoscopy: During laparoscopy the surgeon makes a small incision. These incisions are made near the patient’s abdomen. The laparoscope which is a small telescope with a light source and camera at one end is passed through the incisions so that the doctor can examine the tissues & organs inside the abdomen. During this procedure general anesthesia is used. Such type of procedure can be used to look for fibroids outside your womb or fibroids in the layer of muscle surrounding the womb. The former case is known as subserosal fibroids and the latter is known as intramural fibroids

Biopsy: In certain cases in order to further examine the tissues the surgeon may remove a small tissue sample to view under the microscope.

The treatment depends on

1. Extent of disease
2. Severity of symptoms like pain.
3. Desire for child bearing

Medication : Treatment is not always necessary especially if there are no symptoms or they do not affect your everyday activities. In such conditions medication can suffice. The medication can be aimed towards two results a) recess the effect of symptoms or b) shrink the fibroids.

Surgery : If medication is ineffective & the symptoms do not recede in severity thus surgery should be considered. Hysterectomy & Laparoscopy the two main procedures are discussed below.

 Hysterectomy(laparoscopic,open,vaginal) : A hysterectomy should be considered if you have large fibroids or severe bleeding and you don’t wish to have any more children since it involves removal of the womb. It’s an effective way of preventing fibroids coming back. The side effects of this procedure can include early menopause and a loss of libido (sexual drive). But the later only occurs when ovaries are removed.

Myomectomy : If you wish to have children then the suitable option would be myomectomy. It is surgery where the fibroids are removed from the wall of the womb. But it is important to note that a myomectomy may not be the answer to all types of fibroids. Your gynecologist can evaluate the suitability based on the size, position & number of fibroids. You will require to spend few days in the hospital to recover after the surgery.