Rashmi Hospital

Centre for Minimally Invasive Surgery & Maternity

190, Double Road, Indiranagar Bangalore 38

Tel: 25253311, 25251573, 25251139, 25200447

For Maternity, Gynaecology & ENT: 9880108844/9980015424

Keyhole surgeries performed

E-Mail: info@rashmihospital.com

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What are fibroids?

Uterine fibroids are non-cancerous [usually] tumors that develop within or attach to the wall of the uterus, a female reproductive organ also called the "womb" which is designed to hold a pregnancy.

What causes a fibroid?

Uterine fibroids are the most common pelvic tumor.

The cause of uterine fibroid tumors is unknown. Oral contraceptives and pregnancy lower the risk of developing new fibroid tumors.

Fibroids may be present in 15 - 20% of women in their reproductive years -- the time after starting menstruation for the first time and before menopause. Fibroids may affect 30 - 40% of women over age 30. The growth of a fibroid seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, the fibroids will probably continue to grow, usually slowly.

Fibroids rarely affect females younger than 20 or who are postmenopausal [those who have reached an age where their periods have stopped]

Fibroids begin as small seedlings that spread throughout the muscular walls of the uterus. They can be so tiny that you need a microscope to see them. However, they can also grow very big. They may fill the entire uterus, and may weigh several kilograms. Although it is possible for just one fibroid to develop, usually there is more than one.

Locations of fibroids:

Sometimes, a fibroid hangs from a long stalk, which is attached to the outside of the uterus. Such a fibroid is called a pedunculated fibroid.

What complaints could you have because of fibroids?

* Sensation of fullness or pressure in lower abdomen
* Pelvic cramping or pain with periods
* Abdominal fullness, gas
* Increase in urinary frequency
* Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots
* Sudden, severe pain due to a pedunculated fibroid which may have got twisted

Sometimes a patient may have large fibroids without any symptoms or complaints and this may only be picked up during a routine gynaecological check up.

How are fibroids diagnosed?

A pelvic examination may reveal an irregularly shaped, lumpy, or enlarged uterus. Frequently, this diagnosis is reliable. In some cases, diagnosis of fibroids is difficult, especially in obese women. Fibroid tumors have been mistaken for ovarian tumors, inflammation of the fallopian tubes, and pregnancy.

A transvaginal ultrasound or pelvic ultrasound may be performed to confirm the findings.

A D and C or a pelvic laparoscopy may be necessary to rule out potentially cancerous conditions.

How are fibroids treated?

Treatment depends on the severity of symptoms, the patient's age, whether or not she is pregnant, the desire for future pregnancies, her general health, and characteristics of the fibroids. Some women may just require monitoring of the fibroid. This requires pelvic exams or ultrasounds every once in a while.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn may be recommended for women who have cramps or pain with menstruation. Birth control pills (oral contraceptives) may be used to help control heavy periods and to stop the fibroid from growing. Iron supplements may be given to prevent anemia in women with heavy periods.

In some cases, hormonal therapy involving drugs such as injectable Depo Leuprolide is prescribed to shrink the fibroids. This medicine reduces the production of the hormones estrogen and progesterone. The hormones create a situation in the body that is very similar to menopause. Side effects can be severe and may include hot flashes, vaginal dryness, and loss of bone density.

Hormone treatment may last several months. Fibroids will begin to grown as soon as treatment stops. In some cases, hormone therapy is used for a short period of time before surgery or when the woman is expected to reach menopause soon.

Some sort of surgery is the only definitive treatment for fibroids.

Hysteroscopic resection of fibroids  may be needed for women with fibroids growing inside the uterine cavity. In this procedure, a small camera and instruments are inserted through the cervix into the uterus to remove the fibroid tumors.

A myomectomy is a surgical procedure to remove just the fibroids. It is frequently the chosen treatment for premenopausal women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids have. The disadvantage of a myomectomy is that there are often "seedling" fibroids which are so small that they cannot be seen and removed, and these may grow again after 5-10 years and the patient may require another surgery at that time. Still it could give the patient her time to have a baby and that is the reason myomectomies are carried out even at the risk that the patient may need a another surgery after some time. If you have had a myomectomy and later get pregnant you will usually be advised to undergo a caesarian section for your delivery as the contractions of a normal delivery may cause the stitches in your uterus to come apart.

A myomectomy may be carried out via an open surgical technique, laparoscopic technique or a hysteroscopic technique depending on the number, size and location of the fibroids.

If a patient has finished her child bearing and is of an age where she does not want any more children then a hysterectomy is usually the best option as then there is absolutely no chance of recurrence of the problem.

Complications of fibroids

  • possible infertility

  • anaemia which may be quite severe

  • emergency situations such as a twisted pedunculated fibroid

  • very rarely cancerous changes [usually after menopause]