Knowledge of uterine fibroids

Uterine fibroids or leiomyomas or fibroids are benign growths of the uterine muscles.

They are most common in women of childbearing age. The uterus is a lemon-sized inverted pear-shaped organ in the pelvic area. During pregnancy, a baby grows and develops in the uterus.

Uterine fibroid can be a single isolated growth or can occur in a cluster. The diameter of the nodules can range from 1 mm to more than 8 inches. Sometimes the lesion can be the size of a watermelon.

Are fibroids in the uterine wall common?

Myoma growth in the pelvis is common. According to various studies, more than 50 percent of women can have fibroids. However, these fibroids do not cause symptoms in most women.

What are risk factors for developing uterine fibroids?

Fibroids are most common in women of childbearing age. Typically, young women who missed their first period do not have fibroids.

Although doctors cannot pinpoint the cause of fibroids developing, some risk factors can increase the likelihood of fibroids developing:

• Family history of fibroids
• Higher body weight or obesity
• No children.
• Menstruation began at a young age.
• Late age for menopause.

Where do fibroids usually grow in the uterus?

Fibroids can appear anywhere inside or outside the uterus.

The location and size of the fibroid can determine the modality of treatment.

We can categorize the fibroids according to their location

1. Submucosal fibroids: fibroids that grow in the uterine cavity.
2. Intramural fibroids: fibroids embedded in the wall of the uterus.
3. Subserosa fibroids: fibroids that are attached to the outer wall of the uterus.
4. Pedunculated fibroids: fibroids that are located outside the uterus. A thin stalk connects pedunculated fibroids to the uterus.

Can all uterine fibroids develop into cancer?

A uterine fibroid rarely undergoes a malignant (cancerous) transformation. No one can predict whether or not a uterine fibroid will develop into cancer. However, if gynecologists observe rapid growth in the size of fibroids, they further evaluate it to rule out malignancy.

What are the most common uterine fibroid signs and symptoms?

Signs and symptoms of uterine fibroids depend on their size and location. Small, isolated fibroids can avoid diagnosis because they do not cause symptoms.

Larger fibroids can cause a variety of symptoms, including but not limited to:

• Excessive bleeding during menstruation
• Pain during the menstrual cycle
• Bleeding outside of the menstrual cycle
• Abdominal fullness or gas.
• Frequent urination or the inability to empty your bladder as a fibroid may put pressure on the bladder
• Painful intercourse
• Lower back pain
• constipation
• Vaginal discharge.
• Abdominal distension (enlargement)

Symptoms usually subside after menopause due to a decrease in hormone levels in the body.

How to test for uterine fibroids

Asymptomatic fibroids can often avoid diagnosis.

A gynecologist may discover some fibroids during a regular or antenatal exam. Sometimes a history of pain and heavy menstrual bleeding may prompt your doctor to conduct further tests.

Tests that can diagnose the size and location of fibroids include:

• Ultrasonic:
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)
• Hysteroscopy: Your doctor inserts a thin, flexible tube with a camera on the end through the vagina and cervix and moves further into the uterus.
• Hysterosalpingography (HSG): After the injection of contrast medium, an X-ray of the uterus is made.
• Sono-hysterography: The doctor inserts a small catheter transvaginally to deliver saline into the uterine cavity. The saline solution creates a clearer picture of your uterus on USG.
• Laparoscopy: Through a small incision in the lower abdomen, the doctor inserts a flexible tube with a camera at the end to make your internal organs more visible.

What is the therapy of choice for uterine fibroids?

Treatment for fibroids depends on the following:

• Number of fibroids
• Size of the fibroids
• Location of the fibroids
• The severity of the symptoms related to the fibroids
• Desire for pregnancy
• The desire to preserve the uterus

Medicines to relieve symptoms:

• Pain relievers, used to treat the discomfort and pain caused by the fibroids
• Iron supplements for anemia due to excessive bleeding,
• Gonadotropin-releasing hormone (GnRH) agonists used to shrink fibroids, making it easier for a surgeon to remove them.

surgery

Some surgical options can preserve the uterus while others can either damage or remove the uterus. Therefore, the desire to preserve the uterus, or the chance of a future pregnancy, is also an important factor in determining the type of surgical option to treat fibroids.

Myomectomy: It removes the fibroids without damaging the uterus. There are three types of myomectomy procedures.

1. Hysteroscopy:

The surgeon uses a telescopic sight to insert a thin, flexible, tube-like tool through the vagina and cervix into the uterine cavity and remove the fibroids without making an incision.

2. Laparoscopy:

The surgeon makes some small incisions in the abdomen and inserts a telescopic sight to remove the fibroids.

3. laparotomy

A larger incision is made in the abdomen to remove the fibroids.

There are some surgical options for patients who do not want to have future pregnancies or who do not want to protect the uterus.

• Hysterectomy: Surgical removal of the uterus.
• Uterine fibroid embolization: Small particles inserted into the uterine artery or radial artery through a small catheter block the flow of blood to the fibroids. Loss of blood causes the fibroids to shrink
• Radio frequency ablation (RFA)

Magnetic resonance imaging (MRI) -guided focused ultrasound

Dr. Sapna Raina, Senior Consultant – Obstetrics and Gynecology, Narayana Multispeciality Clinic, Electronic City – Niladri Road, Bangalore