They are medically termed as leiomyomas and myomas. Fibroids are usually tumours of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that 70-80% of women will develop fibroids in their lifetime.The cause of uterine fibroids is not known. Some studies have demonstrated that there may be a genetic component contributing towards chances of developing fibroids. Higher levels of female hormones Oestrogen and progesterone during reproductive years of a woman may tend to swell fibroids. Consumption of red meat, alcohol and caffeine in excess are linked to risk of fibroids. Women who are overweight or obese are also to be alert on chances of fibroids. Childbearing and giving birth is known to lower the risk of developing fibroids. In menopausal women, fibroids often shrink and symptoms often become less severe or may even resolve completely.
Fibroids do not show evident symptoms. It is common for women without symptoms to be unaware of the presence of fibroids. Fibroids are more commonly diagnosed on pelvic examination secondary to another medical concern.
The most common type of fibroid. These appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch the uterus.
They form on the outside of the uterus, which is called the serosa. They may grow large enough to make the womb appear bigger on one side.
Subserosal tumours can develop a stem, a slender base called the peduncle that supports the tumour. When they do, they’re known as pedunculated fibroids.
These types of tumours develop in the middle muscle layeror myometrium of the uterus. Submucosal tumours are rare of all types of fibroids.
Cervical fibroids take root in the neck of the womb, known as the cervix.
Diagnostic tests such as ultrasound, MRI or hysteroscopy can detect fibroids and rule out other conditions. Diagnostic procedures also form the baseline for locating and quantifying fibroids for appropriate choice of treatment.
A notable characteristic of fibroids is that they are not cancer and they do not have the potential to become cancer. This could be the reason for women diagnosed with fibroids to opt for observation rather than immediate treatment. Studies have shown that fibroids grow at different rates, even in the same woman, and can range from the size of a bean to the size of a watermelon.
Treatment is mostly recommended for those women experiencing disturbing symptoms as a result of fibroids. If the fibroids are not affecting quality of life, treatment may not be necessary. Though fibroids may lead to heavy periods, without major problems, one may choose not to have treatment.The location of the fibroids, the severity of symptoms, and any future childbearing plans can all affect the decision. When treatment is necessary, it may be in the form of medication or surgery.The first line of treatment for fibroids is medication.
Gonadotropin-releasing hormone(GnRh) agonist/antagonist, Non-steroidal anti-inflammatory drugs (NSAID), birth control pills andLevonorgestrel intrauterine system (LNG-IUS) are theprimary choice of drugs in the treatment of fibroids. However, these drugs have the risk of causing menopause like symptoms, headaches, breast tenderness and acne and hence are for short term use only. Moreover, these medications are less effective in the treatment of larger fibroids.
Severe fibroids may not respond to conservative treatment optionsand surgery may be much needed. Surgical procedures to be considered may differ based on the size, location, severity and number of fibroids.
A hysterectomy is the partial or total removal of the womb. This is considered for treating extremely large fibroids or excessive bleeding.A total hysterectomy can prevent the return of fibroids but also causes side effects like reduced libido and early menopause. Total hysterectomy also means no child bearing.
This is the removal of fibroids from the muscular wall of the womb. Myomectomy (Myoma = fibroids, ectomy = removal) literally means surgical removal of fibroids, the procedure of choice for women who have symptomatic fibroids and do not wish to have a hysterectomy. It can help women who still want to have children. Myomectomy may be best suitable for women with fibroids causing symptoms that are troublesome or interfere with day to day normal activities and yet need their uterus.The surgeon’s goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike a hysterectomy, which removes the entire uterus, a myomectomy removes only the fibroids and spares the uterus.
Women who undergo myomectomy report improvement in fibroid symptoms, including decreased heavy menstrual bleeding and pelvic pressure. If there is a need for surgery, reasons to choose a myomectomy instead of a hysterectomy for uterine fibroids include:
Lasers have occupied a speciality spot among the public, surgeons and clinicians alike. This technologyis being applied to many laparoscopic proceduresincluding fibroid removal.Myomectomy is best performed by key hole approach (laparoscopically). Larger and more numerous fibroids can be removed by this route depending on individual circumstances. Generally, if estimated duration of surgery is expected to be less than three hours, a laparoscopic approach is used. Sometimes, it can also be used as a two or three stage procedure. The surgeon may decide on key hole Laser surgery through a highly advanced single port procedure for small fibroids whereas bigger fibroids will need regular key hole surgery. Compared to open abdominal surgery laparoscopic (key hole) myomectomy offers many advantages such as
The overall treatment cost for fibroid removal may vary depending mainly on the appropriate surgical procedures which in turn is decided upon the size, type, intensity and quantity of fibroids. Varying on these factors, an approximate range would be between Rs.75,000 and Rs.1 lakh towards myomectomy by key hole Laser surgery.
Endometrial ablation, Uterine artery embolization (UAE), uterine fibroid embolization (UFE) and ultrasound surgery are other options of treatment forwomen to shrink/remove fibroids but they have their disadvantages of recurrence or infertility. Women at risk of labour problems, pregnancy trouble, fertility issues and repeated miscarriages associated with the presence of fibroids need specialist advice and opinion on available treatment options suitable to their respective concerns.
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