Fibroids are tumors of the uterine musculature 99% these tumors are benign i.e. they are not cancerous. These are commonly seen in women 30- 45yrs of Age and those who don’t have children.
Fibroids usually present with heavy periods, pain during periods and heaviness in lower abdomen about 50% of fibroids are without any symptoms & they are accidentally picked up during a health check up or check up for infertility.
Those fibroids which are less than 3cm in size and are not causing any symptoms should not be treated.
Fibroids are easily diagnosed on ultrasound. A good USG is needed to localize the fibroids as treatment is based on location of the fibroids. A fibroid which is inside the cavity is known as sub mucosal fibroid & these are the fibroids which cause infertility, abortions, heavy & painful periods and intermenstrual bleeding (i.e. bleeding in between periods.) These fibroids can be treated hysteroscopically. A telescope is put inside the uterine cavity and the fibroid is either shaved, burnt or cut off. This is a very simple treatment & patient goes off home the same day.
When the fibroid is located in the wall of the fibroid it is known as intramural fibroid. These fibroids sometimes cause abortions, pain during pregnancy & abnormal position of baby obstructed labour & bleeding after delivery. These fibroids if they are bigger than 3 cm & the woman is infertile I would recommend removal. But this is very controversial & some people recommend 5cm size as cut off. This surgery is now a days done laproscopically i.e. keyhole surgery & patient goes home after 2 days. The same surgery can be done by open surgery also.
Removal of the uterus or hysterectomy is advised if the woman is b/w 40-45yrs of age or if the patient has multiple fibroids & has finished with child bearing. Some women prefer hysterectomy because of the recurrence rate of fibroids. In patients with multiple fibroids these can come back again.
In 0.2% of patients these fibroids can have cancer. Usually these patient show very rapid growth in size, have a lot of pain & complain of intermenstrual building or spotting. These need to be managed aggresively.
Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. As many as three out of four women have uterine fibroids, but most are unaware of them because they often cause no symptoms. Your doctor may discover them incidentally during a pelvic exam or pelvic ultrasound.
Fibroids contain more estrogen and estrogen receptors than do normal uterine muscle cells. If your mother or sister had fibroids, you're at increased risk of also developing them.
The most common uterine fibroids symptoms include:
Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus through an internal examination, suggesting the presence of fibroids.
Ultrasound:
If confirmation is needed, your doctor may obtain an ultrasound – a painless technique that uses sound waves to obtain a picture of your uterus. Transvaginal ultrasound provides more detail because the probe is closer to the uterus than the transabdominal scan.
Hysteroscopy:
Your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. The tube releases a gas or liquid to expand your uterus. The fibroid can be removed using electrical energy, but not in all cases. Thi procedure requires anaesthesia.
Laparoscopy:
A small cut is taken on the umbilicus, to look inside the abdomen using a telescope. This provides direct visualisation of the fibroid. Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. Fibroids can require emergency treatment if they cause sudden, sharp pelvic pain.
Treatment:
Watchful waiting without treatment can be done if fibroid are very small or without symptoms.
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.
Hysterectomy
This operation involves removing the uterus. It is done in older patients, those who have completed their family, or those with very large fibroids.
Hysteroscopic or Laparoscopic myomectomy.: it is a method by which the only the fibroids are removed with the help of telescope thus conserving the uterus.