Uterine Fibroids

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What are Uterine Fibroids?

Uterine Fibroids, also known as uterine leiomyoma, are noncancerous tumors that arise from the smooth muscle and connective tissue of the uterus. They are more commonly seen in the reproductive age group and may be present as a single tumor or multiple ones.

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: Theses 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 extraUterine Fibroids of uterine origin.

Causes

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

  • Genetic predisposition
  • Hormonal factors – due to the presence of a greater 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 Fibroids 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, Uterine Fibroids may remain asymptomatic. The signs and symptoms of Uterine Fibroids 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

A diagnosis of Uterine Fibroids is established based on medical history, clinical evaluation, and investigations.

Treatment options

The treatment of Uterine Fibroids depends on the type, severity, symptoms, and general health of the individual. In a majority of asymptomatic cases, only watchful waiting is done with no other 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 with shrinking of the fibroids by reducing the production of estrogen and progesterone.
  • Progestin – 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:
    • 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 shrink the blood vessels that supply them
    • Laparoscopic Myomectomy: It is done via the minimally invasive laparoscopic procedure to completely remove the fibroids. Large fibroids are subjected to morcellation to break them into smaller pieces that can be removed with the help of laparoscopic procedures.
    • Hysteroscopic Myomectomy: It is done for submucosal fibroids; the fibroids are removed with the help of a hysteroscope and other surgical tools passed through it
    • Endometrial Ablation
  • Open Surgery:
    • Abdominal Myomectomy: It is done when there are either multiple or very large fibroids that can be removed through the small incisions given during laparoscopic procedures.
    • Hysterectomy: The entire 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, maintaining blood pressure, blood sugar levels, and body weight under control can help to 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 a majority of them being asymptomatic. There is hardly any or very little 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 for the management of Uterine Fibroids unless surgical interventions are advised.

Suggested clinical specialist/ Departments to consult for this condition

  • Gynecology
  • Obstetrics
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