Symptoms Medication And Treatment Of Uterine Fibroids

“Mostly fibroids are asymptomatic and are incidentally diagnosed on ultrasound”

Fibroids very rarely cause cancer, so it you have tibrolds don’t get scared. Uterine fibroids or myoma or leiomyoma are the tumours of the womb and is a very common benign gynaecological disorder. These tumours may grow outside the uterus (subserous tibroid), inside the uterus (submucous fibroid) or on the wall of the uterus (intramural tibroid).

Fibroids usually occurs in the 30-40 age group but may happen before and after this age group. Also, many women don’t even know they have fibroids, until they get their first scan done. Mostly fibroids are asymptomatic and are incidentally diagnosed on ultrasound. However, around 10 per cent of women present its symptoms and are diagnosed with fibroids.

Symptoms

As mentioned earlier they are usually asymptomatic but when they have symptoms, the most common ones are as follows:

Lower abdominal pain
Heavy and prolonged bleeding
A lump in the lower abdomen
Back pain
Difficulty in conceiving
Recurrent miscarriage in case of submucous fibroid
Feeling of heaviness or fullness
Urge to urinate often, or bowel symptoms
Pain during sex

Diagnosis

Your doctor will ask you about your symptoms and examine you to check the size of the uterus and advise an ultrasound. Usually ultrasound is diagnostic in these cases and your doctor can tell you exactly how big your fibroids are and where they are located. In some cases of multiple tibroids, where it is required to know the exact location and size of the fibroids, especially in infertility cases, uterine mapping can be done using 3D ultrasound or a pelvis MRI scan can help. Also, in some cases you may be advised to do hysterography, hysterosalpingography or hysteroscopy.

Medications

If you have prolonged, heavy and painful periods, your doctor may prescribe pain killers and hemostatic agents for the control of bleeding as first line management. Medical management perse, does not cure fibroids, but it does help in shrinking the size in some cases. The commonly used medical treatments are:

GnRH analogues usually produces a state of pseudo menopause and helps in shrinking the size of the fibroids. It also helps in improving anaemia in patients suffering from heavy blood loss. Sometimes, this s used before the surgery to reduce the size of the fibroid.
IUDhnirena helps in reducing the amount of bleeding, but it doesn’t reduce the size of the fibroid and another advantage is, it acts as a contraceptive as well.
Tranexamic acid, mefenamic acid, oral contraceptives, progesterone are some of the other medications for control of pain and bleeding due to fibroids.

Treatment

There are various treatment options available and no single method qualifies as best. All treatment options should be discussed with your doctor as there is no blanket treatment for fibroids – it is case specific and symptom based. Nevertheless, the method of watchful expectancy is sought, as in many cases fibroids are asymptomatic, so if the size of tibroids is small and there are no symptoms, we can just keep a watch for an increase in size or for any other changes.

HIFU/ High Intensity Focused Ultrasound

This is a non-invasive treatment for fibroids, in which there is no incision and it is done as an OPD procedure. In this procedure, exact mapping of the fibroid is done and focused ultrasound waves or sonic waves destroy portions of the fibroid. Thus, it may need multiple sittings for completion of the procedure. However, your doctor is the best judge to decide this treatment option.

Surgical Treatment Options

Uterine Artery Embolisation

In this procedure. special particles are used to block the vessels supplying blood to the tibroids. It thus helps in shrinking the size of fibroids and associated symptoms. However, it is not advisable for women trying to conceive.

Laparoscopic Or Robotic Myomectomy

In myomectomy, the fibroids are removed, while leaving the uterus. This is the most common minimally invasive way of doing the tibroid surgery in which small keyhole incisions are made on the abdomen and with the help of a telescope and screen or monitor and long slender instruments surgery is performed.

Fibroids are detached from the uterus and the uterus is repaired after the removal of the fibroid.

Now to retrieve the fibroid from the abdomen, it is broken down into small pieces by a process called morcellation Laparoscopic surgery has a lot of advantages over traditional open myomectomy as there is less blood loss, less adhesions, early recovery and for infertility patients, it provides the best results, but surgical expertise should be available, as it requires technical expertise with endosuturing as well,

Hysteroscopic Myomectomy

This is also a minimally invasive method of removing fibroids and suitable for submucoal fibroids, which are formed inside the uterine cavity. With the help of a telescope and special instruments, the fibroid is resected.

Laparoscopic Hysterectomy

It is the removal of the uterus, but should be exercised judiciously, depending on the age of the patient and her symptoms. It a patient is near menopause and the fibroids are not very big in size, after menopause, they will shrink or become asymptomatic.

Endometrial Ablation

This method uses special instruments to remove the lining of the uterus, so as to stop or reduce menstrual flow, but it does not affect the fibroid in the wall of the uterus and outside the uterus. This can be used for women who have finished with childbearing, but want to retain their uterus, but suffering from heavy bleeding due to fibroids.