Uterine fibroids

Overview

Uterine fibroids (myomas or leiomyomas) are benign muscular tumors. They develop in the uterus. Uterine fibroids are rarely cancerous.

Fibroids are not always symptomatic. But some patients may experience symptoms like back pain, heavy menstrual bleeding, painful sex, frequent urination, etc.

Fibroids are more common in women in their thirties and older. Generally, they appear during childbearing age. Treatment for fibroids includes medications and surgeries.

What are uterine fibroids?

Uterine fibroids are muscle growths in the uterus. They do not increase the chances of uterine cancers.

Fibroids can be of different shapes and sizes. A uterine fibroid can be 1-mm in size or grow into a large bulky mass.

Fibroid can be a single growth or develop into clusters. They grow inside the uterine walls or develop outside. Sometimes, the growth spreads to the rib cage and increases the body weight.

Many women develop uterine fibroids in their lifetime but remain undetected due to the absence of symptoms. Sometimes, symptoms are detected during a prenatal ultrasound or pelvic exam.

Who gets fibroids?

Here are some risk factors for getting fibroids:

Age

Women over 30 and above are susceptible to fibroids. After menopause, the fibroids generally shrink.

Overweight

Obesity increases the risk for fibroids.

Ethnicity

Research shows fibroids are more common in African-American women.

Genetics

A family history of uterine fibroids increases the risk of getting the disease.

Unhealthy eating habits

Red meat increases the risks for fibroids.

Infertility

Fibroids are one of the prime reasons for infertility.

Early menstruation

Women who had early periods in adolescence can get uterine fibroids.

Types of uterine fibroids

The type of fibroids depends on their location and how the fibroids attach themselves.

Submucosal fibroids

They grow in the uterine cavity where the baby grows. They are not common. They grow in the space in the uterus and sometimes develop a stalk (peduncle).

Pedunculated fibroids

These fibroids develop a think stem or stalk (peduncle) and attach to the uterine wall. They sometimes look like a mushroom because of a wider top. The fibroids can grow outside the uterine wall.

A pedunculated fibroid attaches to the uterine wall using the peduncle.

Subserosal fibroids

These fibroids grow on the serosa or the outside wall of the uterus. Sometimes they grow large and the uterus appears bulky on one side.

Intramural fibroids

They are very common. Intramural fibroids are embedded in the uterine wall. The growth sometimes stretches to the womb.

Causes for uterine fibroids

It is unclear what causes fibroids. Here are a few reasons that may trigger the disease.

Hormones

The progesterone and estrogen hormones stimulate the menstrual cycle and pregnancy. These hormones promote fibroid growth. Typically, fibroids shrink after menopause.

Family history

If your grandmother or mother had the disease, you may likely develop the disease in the future.

Pregnancy

A pregnant woman has increased levels of estrogen and progesterone. Sometimes, it stimulates fibroid growth.

ECM (extracellular matrix)

Increased ECM production is associated with uterine fibroids. Increased ECM deposition stiffens the tumors and makes them fibrous.

Uterine fibroid symptoms

The symptoms depend on the location and number of fibroids. Menopausal women may not notice any symptoms because the estrogen and progesterone hormones drop and the fibroids start shrinking during menopause.

Common symptoms:

• Heavy menstrual bleeding.
• Bleeding between the periods.
• Blood clots in period blood.
• Pelvic and lower back pain.
• Constipation.
• Menstrual cramping.
• Painful intercourse.
• Increased urination.
• Periods last longer.
• Excessive vaginal discharge.
• Bloating or feeling pressure in the lower abdomen.
• Abdomen enlargement.

Diagnosis

Doctors may incidentally detect fibroids during a routine ultrasound or pelvic exam. The exam may show certain irregularities in the uterus.

Tests include:

Ultrasound

Sound waves projects images to confirm the presence and size of the fibroids. The doctor may perform a transabdominal exam where the ultrasound device (transducer) is placed on the abdomen. In a transvaginal exam, the doctor inserts the device through the vagina to examine the uterus.

Laboratory tests

In cases of abnormal bleeding, doctors may suggest other tests like CBC (complete blood count) and other blood tests and see if you have anemia, thyroid, or other bleeding disorders.

Other tests:

In case of inconclusive ultrasound study, doctors order other diagnostic tests like:

MRI (magnetic resonance imaging)

It identifies the type of fibroids and locates its location and size. It helps in deciding the treatment plan.

CT (computed tomography) scan

A CT scan reveals detailed images of the internal organs.

Hysterosonography

Hysterosonography is also known as “saline infusion sonogram”. It infuses saline into the uterine cavity and enlarges it. This process helps to get clear images of the uterine lining. It helps detect submucosal fibroids in patients attempting pregnancy or to detect heavy periods.

Hysteroscopy

In this exam, the doctors inject saline into the uterine cavity through the cervix. This expands the uterus. The doctor inserts a hysteroscope (lighted telescope) and examines the uterine lining and the fallopian tubes.

Hysterosalpingography

The doctor injects a dye into the uterine cavity and the fallopian tubes to project x-ray images. Doctors recommend this test in cases of infertility. The test shows if the fallopian tubes are blocked or the presence of submucosal fibroids.

Laparoscopy

A laparoscope with a camera is inserted through a small abdominal incision to examine the internal organs.

Treatment options

The treatment for uterine fibroids depends on:

• The number of fibroids.
• Fibroid’s location.
• Size of the fibroids.
• Symptoms.
• Infertility issues.
• Uterine preservation.

Fibroids are non-cancerous and do not usually interfere with pregnancy. Sometimes there is hardly any symptom. Fibroids develop slowly and start shrinking after menopause.

Natural treatments

Acupuncture, yoga, and abdominal massage help relieve the symptoms. Traditional Chinese herbal medicine Guizhi Fuling is a widely used formula for treating uterine fibroids.

A heating pad gives relief to abdominal cramps. But avoid it if you are experiencing heavy bleeding.

Food rich in flavonoids, green vegetables, green tea, fish like salmon and tuna is good for health. Avoid high-calorie foods and meat.

Manage your stress levels. Try losing weight.

Medications

Medicines treat hormonal imbalance, reduce menstrual bleeding, regulate the menstrual cycle, and alleviate pelvic pain. Medications can’t eliminate fibroids but shrink them.

GnRH (Gonadotropin-releasing hormone) agonists

They reduce estrogen and progesterone production. There is temporary menopause that stops the menstruation cycle and the fibroids shrink. Sometimes, doctors use GnRH agonists to shrink fibroids before surgery. These medications are not used for more than 3-6 months. Long-term use can result in bone loss and other complications.

Progestin-releasing IUD (intrauterine device)

It reduces heavy menstrual bleeding. It is also used to prevent pregnancy. It does not shrink uterine fibroids.

Tranexamic acid oral

This medication treats heavy bleeding during the menstrual cycle.

Iron supplements

Some doctors prescribe iron supplements for patients suffering from anemia due to abnormal bleeding.

Birth control

Doctors use birth control to treat fibroid symptoms. It can prevent menstrual cramps and regulate heavy period bleeding. Patients can use contraceptive pills, IUD devices, injections, intravaginal contraception.

Other medications

NSAIDs (nonsteroidal anti-inflammatory drugs) are used for pain relief. Elagolix is a GnRH antagonist that manages heavy menstrual bleeding.

Minimally-invasive procedures

Doctors use certain procedures to destroy the fibroids instead of removing them through surgery. There are other procedures to treat the symptoms.

Surgeries

Traditional open surgeries like hysterectomy and abdominal myomectomy remove the uterus or large fibroids. They are permanent solutions for treating fibroids.

Preparation

A few weeks before the surgery:

• Stop drinking alcohol or smoking. It slows down the recovery process.
• Eat foods that promote healing.
• Avoid blood thinners. Talk to your healthcare provider about medications to continue before surgery.
• Do light exercises to strengthen your body.
• Prepare and make arrangements at home for postoperative care.
• Arrange a help at home for aftercare.
• Be prepared with routine laboratory tests and imaging studies.
• If you are diabetic, ask the doctor about your insulin medication.
• Ask the doctor about queries regarding the surgery.

Procedures

Minimally-invasive procedures

Uterine artery embolization

This treatment injects embolic agents into the arteries of the uterus. It cuts off the blood supply and shrinks the fibroids.

Radiofrequency ablation

This procedure uses radiofrequency energy to destroy blood vessels supplying the uterine fibroids. The procedure shrinks the fibroids. This procedure is done laparoscopically or through a transcervical procedure.

Laparoscopic radiofrequency ablation (Lap-RFA)

The surgeon makes two incisions in the abdomen. He/she then inserts a laparoscopic camera and ultrasound tool through the incisions. The laparoscopic device uses small needles to destroy the fibroid. The fibroid changes its constituency and becomes soft. It gradually shrinks within the next few months.

In a transcervical Lap-RFA, the laparoscopic devices are inserted through the cervix to destroy the fibroid. Patients recover within a week.

Laparoscopic (robotic) myomectomy

Here, the surgeon inserts a laparoscopic instrument through the incision to break the fibroids into pieces (morcellation). The broken fibroids are removed. Robotic myomectomy produces 3D images of the uterus that gives precision and dexterity to the procedure.

Hysteroscopic myomectomy

The surgeon use instruments to remove fibroids from the uterus through the vagina and the cervix.

Endometrial ablation

This procedure helps stop abnormal menstrual bleeding. The procedure destroys the inner uterine lining. It reduces or ends the menstrual flow.

Invasive procedures

Abdominal myomectomy

Abdominal myomectomy removes multiple or very large fibroids. It is open abdominal surgery. Many patients opt to go for an abdominal myomectomy instead of a hysterectomy. This surgery can cause scarring and affect a future pregnancy.

Hysterectomy

Hysterectomy removes the uterus and is a permanent cure for uterine fibroids. Women undergoing hysterectomy can’t have children.

Uterine fibroids and pregnancy

Can fibroids affect pregnancy? Research shows that many women with fibroids have uneventful pregnancies and deliveries. Complications depend on the size, number, and location of the fibroids.

If patients have large multiple fibroids, there may be fetal risks like:

• Fetal growth restriction.
• Abnormal placenta.
• Breech births.
• Preterm delivery.

Risks for pregnant women:

• Placental abruption.
• Abdominal pain.
• Miscarriage.
• Bleeding.
• Block the cervical dilation. Patients may need a c-section.
• Weak contractions during delivery.
• Postpartum hemorrhage.

In certain cases, large fibroids can cause infertility. Work out a treatment plan with your OB/GYN doctor. Certain procedures like hysterectomy, endometrial ablation, or radiofrequency ablation can affect future pregnancies.

When should you go for surgery?

Doctors usually choose surgery when they have exhausted all possible treatments for fibroids.

Surgery is recommended if:

• The symptoms are affecting the patient’s wellbeing.
• Symptoms can’t be treated with medications and lifestyle changes.
• For treating infertility and improving chances of getting pregnant.
• As a permanent solution for fibroids.

Surgery options

Generally, Uterine fibroid procedures are inpatient surgeries and need hospital stays. Laparoscopic or robotic surgery is less invasive but requires an overnight stay in the hospital.

Small clinics

Pros

• Affordable cost.
• Personalized care.
• Short waiting time.

Cons

• Lack of proper amenities.
• Inadequacy to handle complications.

Big hospitals

Pros

• Large facilities.
• An extensive list of doctors and medical staff.
• Properly equipped to handle critical patients.

Cons

• High cost.
• Lack of individual care.

Cost of surgery

The cost of uterine fibroid surgery depends on:

• Pre-surgery evaluation.
• Diagnostic tests.
• Type of fibroids.
• Patient’s overall health.
• Type of procedure.
• Surgeon’s fees.
• Fees for the surgical team.
• Hospital charges.

Post-op care and things to keep in mind

Going home after surgery you may feel:

• Abdominal cramps and pain.
• Slight bleeding.
• Mild fever.
• Slight vaginal discharges.

These are normal symptoms and usually go away after some time.

Postoperative instructions:

• Follow dietary instructions. Eat healthy food. Patients with diabetes, renal problems, or cardiovascular diseases, continue dietary restrictions as instructed earlier.
• Take prescription drugs regularly.
• For constipation, use stool softeners.
• Avoid bathing or soaking for at least 5 days after the procedure.
• Take showers.
• Avoid tampons.
• Refrain from intercourse for some time.
• Avoid strenuous activities or exercises.
• Visit your doctor for follow-ups.

Complications

Risks include:

• Infection.
• Bleeding.
• Damage to internal organs.
• Abdominal scar tissues.
• Fertility problems.
• Urinary problems.
• Pregnancy complications.
• Need for another surgery or hysterectomy in rare cases.

Best option

Once you decide to have fibroid surgery, the next step is to choose the hospital or facility where you can have the surgery. Goficure provides all sorts of services in elective surgeries. Based in Bangalore, they have a team of expert medical providers who will assist you in consultations, surgery, postoperative care, insurance charges, and aftercare.

Why go for goficure?

• Reliable services.
• Affordability.
• Safety and transparency.
• High success rates.
• Top doctors and hospitals.
• Assured insurance coverage.

References