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Uterine Fibroids

 - Hyderabad

Gynaecologist

Hyderabad   |   27 Sep 2023

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Uterine Fibroids

What are Uterine Fibroids?

Uterine fibroids, or uterine leiomyoma, are noncancerous tumors arising from the uterus' smooth muscle and connective tissue. They are more commonly seen in the reproductive age group and may present as a single or multiple tumour.

Alternate name

Fibroids

Is Uterine Fibroids condition a Medical emergency?

Uterine fibroids are not a medical emergency.

Types

Fibroids may be of the following types based on their location within the uterus:

  • Intramural Fibroids: These are located within the muscular wall of the uterus
  • Subserosal Fibroids: These are located on the surface of the uterus
  • Submucosal Fibroids: These are located in the muscle beneath the endometrium (the inner layer of the uterus)
  • Cervical Fibroids: These are located in the wall of the cervix

Sometimes fibroids can be found in other areas of the body, such as lungs, lymph nodes, and within the peritoneum; these are called metastatic fibroids or extra-uterine Fibroids of uterine origin.

Causes

The exact cause of uterine fibroid development is not fully understood, but the following may predispose to their development.

  • Genetic predisposition
  • Hormonal factors – due to the presence of a more significant number of estrogen and progesterone receptors in the fibroid tumor cells
  • Increased levels of extracellular matrix
  • Prenatal hormone exposure
  • Increased action of other growth factors
  • Presence of xenoestrogen – hormones that imitate estrogen

Risk factors

Factors that are known to increase the risk of uterine fibroid development include:

  • Obesity
  • Diabetes
  • Polycystic ovarian syndrome
  • Hypertension
  • Nulliparity – not having borne a child
  • Family history of fibroids

Symptoms & signs

In a majority of cases, fibroids may remain asymptomatic. The signs and symptoms if present, may include the following:

  • Abdominal pain
  • Heavy menstrual bleeding
  • Menstrual periods lasting for longer than 7 days
  • Increased frequency of urination, difficulty urinating
  • Low backache
  • Constipation
  • Pain during sexual intercourse

Investigations

Some investigations that are advised for the evaluation of uterine fibroids include:

  • Laboratory tests:
    • CBP & ESR
    • Thyroid Profile
    • Coagulation Profile
    • Iron profile
  • Imaging tests:
    • Ultrasound
    • Angiography – useful when embolization is considered as a treatment
    • Hysteroscopy
    • Hysterosalpingography
    • Hysterosonography – useful for submucosal fibroids

Diagnosis

Uterine Fibroids are diagnosed based on medical history, clinical evaluation, and investigations.

Treatment options

The treatment of uterine fibroids depends on the individual's type, severity, symptoms, and general health. In most asymptomatic cases, only watchful waiting is done without intervention. In symptomatic individuals, medical or surgical interventions may be done.

Medical management

Medical management of fibroids may include the following:

  • Analgesics – For the management of pain
  • Gonadotropin-releasing hormone Agonists – To help shrink the fibroids by reducing the production of estrogen and progesterone.
  • Mirena IUD– Delivered via intra-uterine devices to provide symptomatic relief
  • Tranexamic acid – For the management of heavy menstrual bleeding
  • Aromatase inhibitors – For shrinking fibroids

Interventional, including surgery and indications for surgery

Surgical interventions for the management of fibroids may include the following:

  • Minimally invasive procedures:
    • Laparoscopic Myomectomy: This is done via the minimally invasive laparoscopic procedure to remove the fibroids completely. Large fibroids are subjected to morcellation to break into smaller pieces that can be removed with the help of laparoscopic procedures.
    • Hysteroscopic Myomectomy: It is done for sub-mucosal fibroids; the fibroids are removed with the help of a hysteroscopy and other surgical tools passed through the uterine cavity
    • Uterine Artery Embolization: It is done by injecting embolic agents that cut off the blood supply to the fibroids, resulting in their death
    • Radiofrequency Ablation: It is done by directing radio frequencies to shrink the fibroids and the blood vessels that supply them
    • Endometrial Ablation
  • Open Surgery:
    • Abdominal Myomectomy: This is done when multiple or very large fibroids can be removed through the small incisions given during laparoscopic procedures.
    • Hysterectomy: The uterus is removed, although the ovaries may be left in place.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

There are no measures that can be taken to prevent fibroids formation. Eating a healthy diet and maintaining blood pressure, blood sugar levels, and body weight control can help reduce the risk of Uterine Fibroids.

Complications

Complications associated with fibroids may include:

  • Miscarriage during pregnancy
  • Preterm labor during pregnancy
  • Malposition of the fetus inside the uterus
  • Excessive bleeding during labor
  • Anemia and iron deficiency due to heavy menstrual bleeding

Prognosis

The prognosis for uterine fibroids is generally very good, with most of them asymptomatic. There is hardly any or minimal risk of uterine fibroids turning cancerous. Fibroids are also not known to impact fertility, though they may cause complications during pregnancy.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if the signs and symptoms of Uterine Fibroids are noticed.

Indications for hospitalization if required

Hospitalization is not required to manage uterine fibroids unless surgical interventions are advised.

Suggested clinical specialist/ Departments to consult for this condition

  • Gynaecology
  • Obstetrics

Here are some common myths and facts about uterine fibroids:

No Myths Facts
1 Only older women get uterine fibroids Uterine fibroids can develop at any age, although they are more common in women aged 30-40
2 All uterine fibroids cause symptoms Many women with fibroids do not experience any noticeable symptoms.
3 Uterine fibroids are always cancerous. Uterine fibroids are noncancerous growths of the uterus and are almost always benign.
4 Having uterine fibroids means you can't get pregnant While fibroids can sometimes interfere with fertility, many women with fibroids can still conceive and have successful pregnancies.
5 Surgery is the only treatment option for uterine fibroids There are various treatment options for fibroids, including medication, minimally invasive procedures, and, in some cases, surgery.
6 Uterine fibroids always need to be treated Not all fibroids require treatment. If they are small, asymptomatic, or near menopause, they may not require intervention
7 Uterine fibroids always grow and get bigger over time Fibroids can grow, shrink, or remain the same size over time. Growth patterns can vary from person to person
8 You can prevent uterine fibroids from developing. The exact cause of uterine fibroids is unclear, so there's no guaranteed way to prevent their development.

Remember, if you suspect you have uterine fibroids or have been diagnosed with them, it's important to consult with a healthcare professional for personalized advice and treatment options.

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