Fibroids of the uterus - how can it be managed?

Uterine fibroids are benign (non-cancerous) tumors arising from the smooth muscle of the uterus.

The cause being unknown, can occur with hormonal imbalance, family history, obesity, nulliparity. Early menarche, late menopause, hyper estrogenic states DM and HT, inadvertent use of oral contraceptives being a few risk factors for fibroids. 

Genetic factors too play a role.

TYPES OF FIBROIDS:

            ◦           Intramural

            ◦           Subserous

            ◦           Submucous 

            ◦           Cervical fibroids

SYMPTOMS

• Around 75% of women with fibroids may not have any symptoms at all.
• About 25% experience menstrual problems, most commonly menorrhagia (heavy menstrual bleeding).
• Some women may have polymenorrhea, where periods occur more frequently and with heavy bleeding.
• Dysmenorrhea (painful periods) is also common.
• Large fibroids, especially those larger than 6 cm, can cause pressure-related symptoms depending on their location:
  • Pressure on the bladder may lead to frequent urination, pain while passing urine, or difficulty urinating.
  • Pressure on the rectum can cause chronic constipation.
• Infertility may occur in about 15% of patients.
• In cases of very large fibroids, a noticeable abdominal mass or swelling may be present.
• Excessive menstrual bleeding can also lead to symptoms of anaemia, such as fatigue, weakness, and dizziness. 

DIAGNOSIS

Diagnosis is confirmed by a TRANSVAGINAL ULTRASOUND (TVS)

The number of fibroids and the size of fibroids with the exact location helps us in planning the management.

Fibroids grow very gradually, at 10 % growth rate over a 12-month period.

Beyond menopause growth reduces.

A drastic growth of fibroids in short interval needs to be evaluated at the earliest.

MANAGEMENT METHODS

Medical management includes medications given to reduce the symptoms for the patient.

Medication to reduce the fibroids

            ◦           Gonadotropins

            ◦           Progesterone releasing Intrauterine Device 

Both these are not permanent treatments, patients need to be followed up on a regular basis and treated accordingly.

SURGICAL MANAGEMENT OF FIBROIDS

Myomectomy

A myomectomy is a surgical procedure in which only the fibroids are removed while preserving the uterus. It is usually recommended for:

• Women with infertility related to fibroids
• Women with large fibroids who wish to retain their uterus 

Myomectomy can be performed in two ways:

Abdominal Myomectomy (Open Surgery)

• Performed through an abdominal incision
• Requires hospital admission, usually for at least one day
• Recovery time is comparatively longer 

Laparoscopic Myomectomy

• Minimally invasive “keyhole” surgery
• Usually done as a day-care procedure
• Offers faster recovery, less pain, and earlier discharge from the hospital 

Hysterectomy

A hysterectomy is the surgical removal of the uterus and is generally advised for:

• Women who have completed their family
• Patients who do not respond to medical treatment 

Types of hysterectomy include:

Total Abdominal Hysterectomy (TAH)

• Open surgical procedure performed through an abdominal incision 

Total Laparoscopic Hysterectomy (TLH)

• Minimally invasive laparoscopic procedure  
• Suitability depends on the patient’s medical history and examination findings 

Secondary Changes Seen in Fibroids

Over time, fibroids may undergo certain degenerative changes, including:

• Hyaline degeneration – the most common type, where fibroid tissue becomes firm and glassy
• Cystic degeneration – formation of fluid-filled spaces within the fibroid
• Fatty degeneration – fatty changes within the fibroid tissue
• Calcification – calcium deposits causing hardening of the fibroid
• Red degeneration – painful degeneration often seen during pregnancy
• Sarcomatous changes – rare cancerous transformation of the fibroid tissue

INFERTILITY AND FIBROID

Infertility with fibroids occurs in 12 to 15 percent of cases

They can cause recurrent miscarriages 

Submucous fibroids have to be removed hysteroscopically or laparoscopically depending on the extension of fibroids into the cavity of uterus, prior to planning pregnancy

PREGNANCY WITH FIBROIDS

They can undergo a mild increase in the size and undergo red degeneration, which can cause abdomen abdomen during pregnancy

Advise:

            ◦           Bed rest

            ◦           Prescription of Analgesic

            ◦           Adequate hydration

Through the pregnancy, the patient can have miscarriages, preterm deliveries, small babies, abnormal placental positions, breech presentation etc. and post-delivery can have heavy bleeding too. (Postpartum Haemorrhage).

Featuring insights from Dr. Senthamil Selvi, Obstetrician & Gynaecologist, Apollo Women's Hospitals, Chennai

For Queries or Appointments: 080629 72808.