About 30-50% females are detected to have fibroids in their uterus. This detection maybe incidental on an ultrasound exam without the patient having problems due to it; or this detection could be very much related to your medical problems. Here are some answers which might help you.
1. What are fibroids?
These are benign tumors which develop from the involuntary muscle of the uterus. These maybe within the wall (intramural) or arise from the wall but as they grow they project into the uterine cavity (submucosal), distorting it and often causing excessive menstrual bleeding. They may also project outside the wall (serosal); some may have a stalk (peduncle) which makes the fibroid vulnerable to twisting (torsion) as a complication. If a fibroid lies near the mouth of the uterus, it might cause difficult birth due to obstruction. One may have a variable number of fibroids which usually grow slowly. Transformation to cancer is very rare (1:1000)
2. Who is more likely to have fibroids?
There is a mild increase in predisposition in Asian and African American women as compared to western women. But these can occur in any woman.
3. What are the symptoms of fibroids?
These maybe totally without any symptoms or may cause any of the following problems besides those listed above.
- Longer, more frequent, or heavy menstrual periods.
- Menstrual pain (cramps)
- Vaginal bleeding at times other than menstruation.
- Anemia (from blood loss)
- Pain —In the abdomen or lower back (often dull, heavy and aching, but may be sharp); pain during sex
- Pressure —Difficulty urinating or frequent urination; Constipation, rectal pain, or difficult bowel movements
- Abdominal cramps
- Infertility (need to rule out other causes of infertility first).
- What complications can occur with fibroids?
4. What causes fibroids?
The causes are to some extent genetic but most often these tumors have been found to be hormone dependent (estrogen/ progesterone). Therefore fibroids may regress after menopause.
5. How are fibroids detected?
These can be detected by ultrasonography, hysteroscopy (a slender device, the hysteroscope is used to see the inside of the uterus. It is inserted through the vagina and cervix, hysterosalpingography which is a special X-ray test which may be able to detect abnormal changes in the size and shape of the uterus and fallopian tubes. Sometimes a laparoscope (a slender device inserted through a small cut in abdomen might help the doctor see the inside of the abdomen. The doctor can see fibroids on the outside of the uterus with the laparoscope. Imaging tests, such as magnetic resonance imaging and computed tomography scans, may be used but are rarely needed. Some of these tests may be used to track the growth of fibroids over time.
6. When to see a doctor if detected with fibroid?
Small fibroids may cause no problem, its only when you have symptoms listed above that you need to get them treated.
7. Is there medical treatment for fibroids?
The decision on type of treatment, medical/surgical should be taken by you after you get an appropriate advice about the best option for you. The same will depend on your clinical condition, fertility status, types , number and location of fibroids. Medical treatment is available in the form of hormones (gonadotropin-releasing hormone; GnRH agonists). These are used best upto 6 months max. They help to shrink fibroids; however these may get back to their size after stopping. Hormonal intrauterine devices may also be inserted too into the uterus.
8. What are the surgery options?
These are individualised to each case depending upon whether you have completed your family and the types of fibroid. If pregnancy is desired then a myomectomy is the best choice; wherein only selective removal of the fibroid is done. This procedure is usually done laparoscopically (through a small cut in the abdomen) and it preserves the uterus. Hysteroscopic removal with a resectoscope is another method used to remove fibroids that protrude into the cavity of the uterus. A resectoscope is inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. Hysteroscopy often can be performed as an outpatient procedure (you do not have to stay overnight in the hospital). Another procedure that your doctor may recommend depending on your case is `endometrial ablation` wherein inner lining of endometrium is destroyed. Thsi maybe a choice in v small fibroids (less than 3 cm). Blocking the blood supply selectively to the fibroid which helps to shrink it is another choice and is known as ùterine artery embolisation. Magnetic resonance imaging-guided ultrasound surgery is another non invasive procedure where ultrasound waves are used to destroy fibroids; its long term cure is still under research.
If the patient has completed her family the removal of uterus along with the fibroid in it maybe the best choice.
9. How would I know if my fibroid is predisposed to cancer?
Most fibroids are benign. Certain features on imaging also reveal the same. It is important that after removal, the tissue removed is examined by a pathologist to ensure the same. There maybe certain miscroscopic features which suggest that you need a follow up. All human tissue removed at any surgery must be confirmed for its identity under a microscope by a histopathologist as per international health care standards.
10. After a myomectomy removal , how soon could a pregnancy be planned?
The best time is after 6 months although healing is complete by 3 months.