Fibroids

What is Fibroids

Fibroids(also called leiomyomas) are benign lumps in the uterus.

They are made of smooth muscle and are either;

  1. Intramural-completely in the uterine muscle wall
  2. Subserosal-protruding outside the uterine surface
  3. Submucosal-protruding in the uterine cavity.

Fibroids are present in about 1 in 4 women and can be of different sizes and in different locations.

They can cause:

  1. Heavy menstrual bleeding – This can affect a woman’s quality of life and also make her anaemic and weak
  2. Infertility – Difficulty to conceive – especially fibroids in the uterine cavity
  3. Pressure – Frequency in passing urine/interference with opening bowels- this is predominantly due to the size of the fibroids and the congestion
  4. Pain – Occasionally the fibroids can necrose inside when they grow too big for their blood supply, and this can lead to recurrent pelvic pain.
  5. Effect on pregnancy – Miscarriages especially if they are obstructing the cavity, bleeding in pregnancy and interference in the growth and position of the baby resulting in operative delivery.

Diagnosis

It is important to know the size and location of fibroids to determine the treatment options available.

Pelvic ultrasound – This can either be performed at Lotus Medics or elsewhere to exactly determine the location and size of fibroids

MRI – Sometimes this is essential to map the fibroids before surgery and also to monitor progress of medical management.

It is also an important tool to rule out malignancy in fibroids – thankfully a rare occurrence.

Treatment

Not everyone with fibroids needs surgery.

The decision whether to treat is made depending on the following factors:- 

  • Age
  • Fertility desire
  • Type(location) and size of fibroids
  • Medical comorbidities
  • MOST importantly-a Woman’s wishes

A comprehensive consultation and assessment covers all these aspects to reach the final decision that you are happy with.

Wait and watch
If you don’t want any treatment- An option is to wait and watch-This is especially true if fibroids are asymptomatic / if women don’t want treatment. Fibroids grown under the influence of hormones and can stop growing/shrink after menopause.

Medical therapy
This is effective in selective women and is often a sensible option before surgery.

The options for medical treatment are:-

Esmya(Ulipristal) – This is a new medication for treatment of fibroids – It is a selective progesterone receptor modulator and can be used to treat fibroids on a short to medium term basis-especially whilst the patient is considering surgery or is nearing menopause.

Mirena/Combined oral contraceptive pill

Implant/Depo/Progesterone only pills

GnRh analogues

Surgical treatments
Surgery is undertaken if:

  • Medical treatment fails
  • That is the line of treatment the woman wishes
  • Increase in size of fibroids
  • Definitive treatment desired quickly, especially in infertility/miscarriage

Myomectomy-Fibroid removal whilst conserving the uterus:-
This is done in women who wish to preserve fertility.

Fibroids are removed laparoscopically using the latest technique of

In-Bag Morcellation.
This ensures that the fibroids are reduced to small pieces in side a bag in the abdomen to safely remove them and reuse the spread of either fibroid tissue inside the cavity and reduce the rare but devastating effects of a malignancy inside a fibroid.

This is the latest technique that Dr Kotasthane has introduced to facilitate safe and minimally invasive removal of fibroids

Animated video of Contained In bag Morcellation 

Removal of fibroid can also be performed via a hysteroscope if the fibroid is encroaching inside the uterine cavity

Hysterectomy –
This is indicated in women with fibroids:

  • Who have completed their childbirth
  • In whom medical/conservative therapy has failed
  • Have recurrent fibroid growths despite earlier removal
  • Have other conditions requiring hysterectomy like-endometriosis/adenomyosis

Other treatments for Fibroids

Uterine artery embolization
This is a treatment modality reserved for women who are not suitable candidates for surgery-whilst it does not eliminate fibroids like a surgical treatment, the reduction in size of the fibroids is around 40-60%.

If you have fibroids – we at Lotus Medics will discuss all these treatments with you and help you choose the correct treatment option customised to your condition and needs.