Authored By: Dr. K. Shilpi Reddy

HOD & Sr. Consultant Obstetrician & Gynaecologist,

High-Risk Pregnancy Care, Minimal Invasive Surgeon (Mini Lap, Laparoscopy, Robotic Team)


Uterine fibroids are benign tumors of the uterus. They are made up of the same smooth muscle fibers as the myometrium, but are much denser than normal myometrium. Uterine fibroids usually appear in women of childbearing age(30-40years of age), but they can show up at any age.

SYMPTOMS

Many women who have fibroids without any symptoms. In those who have symptoms can be influenced by the location, size and number of fibroids.

The most common signs and symptoms are:

  • Heavy menstrual bleeding
  • Menstrual periods for more than a week
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die. They rarely can turn into cancer.

CAUSES

There are no exact known causes. 

Hormones– Estrogen and progesterone are the hormones that make the lining of your uterus thicken every month for your period. They also seem to affect fibroid growth. When hormone production slows down leading to menopause, fibroids usually shrink.

Genetics– Research have found genetic differences between fibroids and normal cells in the uterus.

Other growth factors. Substances in your body that help with tissue upkeep, such as insulin-like growth factor, plays an important part in fibroid growth. 

Extracellular matrix (ECM). ECM makes your cells stick together. Fibroids have more ECM than normal cells, due to which it becomes fibrous. ECM also keeps growth factors in it and leads to changes in cells.

RISK FACTORS

EFFECTS ON PREGNANCY

Fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids especially submucosal fibroids can cause infertility or pregnancy loss.

Fibroids also raises the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction and preterm delivery.

DIAGNOSIS

  • Pelvic Examination-shape of your uterus feels irregular or unusually large
  • Ultrasound. Ultrasounds use sound waves to take a picture of your uterus to see location, numbers of fibroids and type.
  • Lab tests. Your complete blood count (CBC) can detect anemia (low levels of red blood cells) or other bleeding disorders.
  • Magnetic resonance imaging (MRI). MRIs show more detailed images of fibroids and can help decide the best treatment. 
  • Hysterosonography. This helps to see fibroids that are growing inside uterus (submucosal fibroids) and the lining of uterus. This is helpful if you’re trying to get pregnant or have heavy periods.
  • Hysterosalpingography. Helps to confirm if fibroids are blocking the fallopian tubes, when you are trying to get pregnant. 
  • Hysteroscopy. A small camera is inserted into the ureine cavity to look at the walls of your uterus and fallopian tube opening.

TREATMENT

Observation- if no signs or symptoms, or only mildly annoying signs and symptoms then observation is best espiecally if women is approaching menopause.

Medications

Medications don’t eliminate fibroids, but may shrink them and reduce the severity of symptoms. Medications include:

  • Gonadotropin-releasing hormone (GnRH) agonists- GnRH agonists treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. Results causes menstruation to stops, fibroids shrink and anemia often improves.

GnRH agonists include leuprolide, goserelin and triptorelin.

GnRH agonists cannot be used for more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

GnRH agonist can be used to shrink the size of your fibroids before a planned surgery.

  • Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD only relieve heavy bleeding caused by fibroids.
  • Tranexamic acid . This non-hormonal medication is useful to relieve heavy menstrual periods. It’s taken only on heavy bleeding days.
  • Other medications. Oral contraceptives can help control menstrual bleeding.Nonsteroidal anti-inflammatory drugs (NSAIDs),may be effective in relieving pain related to fibroids.

Minimally invasive procedures

Uterine artery embolization- Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die.Thus, reliving the symptoms.

Laparoscopic radiofrequency ablation-destroys uterine fibroids and shrinks the blood vessels that feed them.

Cryomyolysis– freezes the fibroids.

  • Laparoscopic or robotic myomectomy. Fibroid is removed, leaving the uterus in place.If the fibroids are few in number, you may opt for a laparoscopic or robotic procedure, which uses slender instruments to remove the fibroids from your uterus.
  • Hysteroscopic myomectomy. This procedure is an option if the fibroids are contained inside the uterus (submucosal). 
  • 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.

Submucosal fibroids can be removed at the time of hysteroscopy for endometrial ablation, but this doesn’t affect fibroids outside the interior lining of the uterus.

Traditional surgical procedures

Options for traditional surgical procedures include:

  • Abdominal myomectomy. This is the option mainly for multiple fibroids, very large fibroids or very deep fibroids.
  • Hysterectomy. This is surgical removal of the uterus which remains the only proven permanent solution for uterine fibroids.

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