Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage.
What are the Symptoms?
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.
What could be the possible symptoms?
In women who have symptoms, the most common symptoms of uterine fibroids include:
Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Difficulty emptying the bladder
Backache or leg pains
What are the types of fibroid?
1) Intramural fibroids grow within the muscular uterine wall.
2) Submucosal fibroids bulge into the uterine cavity.
3) Subserosal fibroids project to the outside of the uterus.
4) Cervical fibroid are located in the lower part of uterus.
5) Broad ligament fibroid -near the lateral border of uterus.
When to see a doctor?
See your doctor if you have:
Pelvic pain that doesn't go away
Overly heavy, prolonged or painful periods
Spotting or bleeding between periods
Difficulty emptying your bladder
Severe vaginal bleeding or sharp pelvic pain that comes on suddenly.
What are the Causes?
Other growth factors
The growth patterns of uterine fibroids vary - they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to a normal size.
What are the Risk factors?
There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include:
Heredity-If your mother or sister had fibroids, you're at increased risk of developing them.
Race-Black women are more likely to have fibroids than women of other racial groups.
Environmental factors- Onset of menstruation at an early age; use of birth control; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.
What happens with fibroids in pregnancy?
it's possible that fibroids - especially submucosal fibroids - could cause infertility or pregnancy loss. Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction and preterm delivery.
How is it diagnosed ?
Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids. If you have symptoms of uterine fibroids, you doctor may . advise -
Ultrasound-It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids.
Magnetic resonance imaging (MRI)-This imaging test can show the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options.
Hysterosonography - also called a saline infusion sonogram, uses sterile saline to expand the uterine cavity, making it easier to get images of submucosal fibroids and the endometrium.
Hysteroscopy - In submucous fibroid, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. Your doctor then injects saline into your uterus, expanding the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.
What are the Medications?
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:
Other medications. For example, oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size.
Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids.
what are the surgical treatment available?
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
Uterine artery LIGATION - can usually be planned after completing family.
Myolysis - In this laparoscopic procedure, radiofrequency energy, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them.
Laparoscopic - In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place.
Hysteroscopic myomectomy - This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.
Endometrial ablation - This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow.
Typically, endometrial ablation is effective in stopping abnormal bleeding.
HOW DOES IT HELP?
The endometrium heals by scarring, which usually reduces or prevents uterine bleeding.
Endometrial ablation may be done in an outpatient facility . The procedure can take up to about 45 minutes. The procedure may be done using .general anesthesia.
Submucosal fibroids can be removed at the time of hysteroscopy .by endometrial ablation, but this doesn't affect fibroids outside the interior lining of the uterus
What is laparoscopic procedure?
Its minimal invasive which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. The fibroids are removed by breaking them into smaller pieces, a process called morcellation.
Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments.
What is the normal recovery time following laparoscopic surgery?
Recovery depends on the type of procedure you had undergone.. Most patients feel well within days of surgery. But if major surgery has been performed rest is still required. Most patients will require some form of pain medicine in the immediate postoperative period. A prescription for a narcotic as well as an anti-inflammatory, will be provided prior to discharge.
Routine activity can be.resumed by 2-3 days .Avoidance of heavy lifting (greater then 10-15kgs), jumping and jogging is recommended until 4 weeks postoperatively. Sexual intercourse should also be postponed for 4 weeks. It is preferable not to put anything into the vagina for at least 4 weeks including tampons. The timing for returning to work depends on the procedure performed -usually 2 days.
What are the advantages of having laparoscopic surgery?
Laparoscopic surgeries have become very popular in short span of time, infact they have replaced all traditional abdominal surgeries. Their popularity is due to the immense advantages they have got over traditional surgeries. The advantages and benefits to the patients are.
Patient recovers faster (24-48 hrs.) and can resume to work within few days.
No post operative rest required.
No/ small scars on the abdomen.
No chances of wound infection.
No chances of post operative hernias and adhesions.
Apart from these benefits, patients also will have immense long term benefits.
How is specimen retrieved?
By morcellation -a process of breaking fibroids into smaller pieces using a instrument called morcellator.
What is inbag morcellation?
Open morcellation of uterine fibroids may result in the dispersion of bits of tissue around the abdominal cavity and surgical ports which might increase the chance of formation of new fibroids called parasitic and iatrogenic fibroids
What Is a Hysteroscopic Myomectomy?
Hysteroscopic myomectomy is a technique that can be performed only if fibroids are within or bulging into the uterine cavity .
How effective is the procedure?
When fibroids are the cause of infertility, pregnancy rates following hysreroscopic myomectomy have been about 60-70%. And when performed for heavy bleeding, nearly 90% of women have a return of normal menstrual flow.
Is pregnancy possible after this?
-You can become pregnant after myomectomy.chances are more than 80%.
What is the recovery period for hysteroscopic myomectomy?
Patients usually are sent home after the procedure and have minimal need for recovery. The hospital stay can last from 30 minutes to 2 hours and recovery time is generally 1-2 days. Generally only fibroids that are small and accessible through the cavity can be treated this way.
What were the Traditional surgical procedures earlier?
Options for traditional surgical procedures include:
Hysterectomy. This surgery - the removal of the uterus - remains the only proven permanent solution for uterine fibroids.
It ends your ability to bear children. .. Most women with uterine fibroids may be able to choose to keep their ovaries.
What If you still might want to have children?
if so myomectomy is generally the treatment of choice. However, all treatments have risks and benefits. Discuss these with your doctor. way.
Hysterectomy and endometrial ablation are the only two treatment options that can't be used by women who want to preserve the ability to become pregnant. Before deciding on a treatment plan for fibroids, a complete fertility evaluation is recommended.
Is there a Risk of developing new fibroids?
For all procedures except hysterectomy, seedlings .could eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence.New fibroids, which may or may not require treatment, also can develop.
Are they cancerous?
Almost never. Far fewer than one percent of uterine fibroids are cancerous.
What is Mirena?
is a hormonal intrauterine device (IUD) that's inserted into the uterus for long-term birth control (contraception). A T-shaped plastic frame that releases a type of progestin, Mirena thickens the cervical mucus to prevent sperm from reaching or fertilizing an egg. Mirena also thins the lining of the uterus and partially suppresses ovulation.
What are the noncontraceptive benefits of mirena ?
Decreases menstrual bleeding after at least several months of use.
Decreases severe menstrual pain and pain related to endometriosis
Decreases the risk of endometrial cancer and possibly cervical cancer
The progesterone in the IUD thins the uterine lining cells, so the cells bleed less. After 3 months, 85% of women returned to normal bleeding, and heavy bleeding and anemia were cured in virtually all women at the end of one year.