Fibroids



What are fibroids?

Fibroid tumors are usually benign (non-cancerous) tumors found, most often, in the uterus of women in their 30's and 40's. Most often fibroids occur as multiple tumor masses which are slow-growing.

The size of fibroids varies immensely from so small that a microscope is required to see them, up to the size of a watermelon or more Such large tumors can weigh as much as 25 kg; the largest, reported, fibroid ever recorded weighed in at 140 pounds(63kgs).


Why fibroids develop?

No one is sure why fibroid tumors develop, but some facts are quite clear. They do not develop before the body begins producing estrogen during the onset of menstruation.
Estrogen, such as in birth control pills and taken for menopausal symptoms, does cause fibroid tumors to grow and fibroid tumors will grow very quickly during pregnancy when the body is producing extra estrogen.
They often shrink and disappear after menopause when the body stops producing estrogen. A woman will almost never develop fibroid tumors after menopause.


Types of Fibroid Tumors

1. Sub mucous Fibroids occur just below the lining of the uterus and can cause menstrual problems, including pain as they grow and move around the pelvic area.

2. Intramural Fibroids are the fibroids growing within the uterine wall which can cause enlargement of the uterus as they grow.

3. Subserous Fibroids are the fibroid which are sitting on the outer wall of the uterus and usually causes no symptoms until it grows large.

4. Pedunculated Fibroids having stalk, as they grow larger they may become twisted and cause severe pain.

5. Interligamentous Fibroid, Parasitic Fibroid are few others to complete the list.


What are the problems fibroids can cause?

Most fibroids cause no symptoms.
Patients may have abnormal bleeding, pain during menstruation, larger fibroids may be seen/feel as a swollen abdomen/ mass in the abdomen.
They may cause frequent urination or an inability to control your bladder, either the ability to control the urge or in severe cases, a women may find that she is unable to urinate at all.

If a fibroid extends towards a woman's back it may push on the bowels, causing constipation and a backache.


Diagnosis of Fibroid Tumors

Physical examination: Diagnosis of fibroids is generally made by gynecological exam when your physician feels a mass.

Ultrasonography: An ultrasound scan to know exact size/number/ position of fibroids, so also to rule out any other disease.

MRI pelvis: This is the most accurate method to diagnose fibroids. Usually we don’t do MRI for fibroids unless we want exact information regarding size/position/number of fibroid or else we want to rule out other conditions, before planning treatment.


Treatment of Fibroids

Surgery for fibroid tumors includes myomectomy and hysterectomy.

Myomectomy is the surgical removal of each individual tumor without damage to the uterus, preserving a woman's ability to conceive. However, fibroids will often grow back and although it is possible to have a myomectomy repeated.

Surgical removal of fibroid is called as myomectomy and removal of entire uterus and cervix is called as hysterectomy.

Traditionally myomectomies and hysterectomies were done by open abdominal methods. In open method one need to take a larger incision/cut on the abdomen either vertical or horizontal. Pain after the surgery these surgeries is more and post operative rest is for longer duration. Now a day’s Laparoscopic removal of fibroids/ uterus is preferred. Laparoscopic surgery is done under general anesthesia through 3-4 small incisions/cuts measuring 1 cm and half centimeter. During Laparoscopic myomectomy the fibroid is separated from the uterus. The defect in the uterus left behind after removal of fibroid is closed by sutures and the fibroid is taken out of the body by the process of morcellation. Morcellation cuts large fibroid in to small strips of one or one and ah half centimeter diameter. After fibroid is completely morcellated and removed it is sent for histopathological testing. Recently the morcellation is done in bag. That means the removed fibroid is placed in special bag and morcellation is carried out in that bag. By doing this, the spillage of the tissue is avoided and chances of spread of undiagnosed cancer are eliminated.

At Yashadaa hospital we routinely do laparoscopic myomectomies and in bag morcellation. Hysterectomy is, most often, the procedure of choice for fibroid tumors when a women with severe symptoms, has completed her family and her uterus has grown to the size of a uterus at twelve weeks of pregnancy; a women has excessively large fibroid tumors; severe abnormal bleeding occurs; or when the fibroids are causing problems with other organs such as the bladder and bowels. Like laparoscopic myomectomies Laparoscopic hysterectomies are routinely done at our centre.

Uterine Artery Embalization: Uterine artery embalizotion leaves the uterus intact in a non-surgical procedure. Polyvinyl particles are placed into the uterine artery. The particles flow into the vessels and clog them. This prevents the fibroids from receiving the constant blood supply they require and causes the fibroids shrink overtime, almost immediately the symptoms of heavy bleeding and pelvic pain are significantly reduced.

Medical management is also tried to reduce the size of the fibroid before surgery or in patients who want to wait before surgery. These medicines are hormonal medicines which will interfere with normal hormones produced in the body.

Though medical management is tried for fibroid it is very clear that there is no permanent medical solution for the fibroid so that these tumours will get dissolved. All the available medicines will cause shrinkage of the fibroid not complete disappearance. The shrinkage will be temporary phenomenon and fibroids will regrow when the effects of the medicines are gone.

The sad fact is that because fibroids do grow back, most women will eventually have to face a hysterectomy. Removing the uterus is the only permanent way to effectively relieve most women of fibroids.