Uterine Fibroids

Uterine fibroids are benign growths in the uterus or on the uterine wall, which may vary in shape and size. These growths are non-cancerous however depending on their size and location, they may cause mild to severe discomfort. In many cases however uterine fibroids go unnoticed and show no symptoms.

 

Also called leiomyomas or myomas, uterine fibroids commonly occur in women between 30-40 years of age. The cause of fibroids is unclear, with genetics and hormonal changes being the more widely suspected factors. Fibroids are very common and affect approximately 80 percent of all women, however not everyone will have noticeable symptoms.

What's Inside?

When should you be concerned?

Commonly observed symptoms of uterine fibroids include:

  • Heavy and painful periods. Fibroids alter the shape of the uterus and cause irregular contractions of the uterus thus causing heavy bleeding. Such persons may also suffer from anemia due to heavy blood loss.
  • You may also experience pain or pressure in the pelvic area, and enlargement of the uterus that presents as a lump or swelling in the abdomen.
  • Intermenstrual spotting or bleeding.
  • Painful/frequent urination: Large fibroids or groups of fibroids may apply pressure on surrounding organs including the bladder. Difficulty in emptying the bladder is also commonly reported.
  • Pain during sex.
  • Infertility and miscarriages. An abnormal contour of the uterus makes it difficult for a baby to enlarge within or for an embryo to implant itself in the first place.

 

A large fibroid that may compress surrounding structures in the pelvis.Compression of the rectum may cause constipation and compression of a vein or nerve may cause leg pain.

When should I visit a physician ?

If you experience any of the above symptoms, it may be a good idea to visit a physician.

What are my diagnosis and treatment options?

On consulting a gynaecologist, you will first be asked to describe a history of your symptoms and examined in the clinic. If your doctor feels necessary, they may ask you to get an ultrasound of your belly and pelvis. In some cases, an MRI is required.

Ultrasounds or MRI scans are used to identify abnormalities in the uterus or uterine wall. In some cases, doctors may recommend a hysteroscopy, a procedure through which a small telescopic device is inserted into the uterus through the cervix in order to visualize the fibroids better and remove them. 

Your treatment depends on the severity of your symptoms and the size of your fibroids.

Anaemia as a result of heavy bleeding is first corrected with iron and multivitamin supplementation. Pain is managed with over the counter NSAIDs such as Crocin (Paracetamol). After the symptoms are taken care of, you can discuss alternatives of therapy with your healthcare provider based on your healthcare preferences.

  • NSAIDs
    • Nonsteroidal Anti Inflammatory Drugs may be recommended to reduce pain during menses. Commonly available drugs include ibuprofen and naproxen, which do not require a prescription.
    • Inexpensive with few side-effects, however may not reduce bleeding as well as some of the other alternatives.
  • Hormone therapy
    • Medication that adjusts the levels of hormones which might be aiding growth of the fibroid. Hormonal birth control may reduce the effects of fibroids on your periods, including cramps, heavy bleeding, and pain. Hormonal birth control options include the pill, the shot and the IUD. You can discuss the appropriate one with your healthcare provider.
  • GnRH analogues
    • GnRH analogues are drugs that suppress the menstrual cycle and reduce the size of fibroids by suppressing the hormones (estrogen and progesterone) that help it grow.
    • This form of medication requires some time to take effect. In some cases these drugs may cause an initial “flare” or increase in hormone levels that aggravate the symptoms. If you already experience severe bleeding, this may be a cause for concern.
  • SERMs
    • Selective Estrogen Receptor Modulators are drugs that suppress or aid the production of estrogen, known to affect the menstrual cycle.
    • The term ‘selective’ implies that the drug can be used to target cells in one particular area of the body.
  • Endometrial ablation
    • A process that affects the lining of the uterus and helps decrease heavy bleeding caused by fibroids. It does not affect the size of the fibroid itself.
    • This form of treatment may affect your chances of pregnancy, making it difficult.
  • Embolization
    • A process that targets the arteries supplying the fibroid. By injecting the arteries with polyvinyl alcohol, bloody supply to the fibroid is reduced, shrinking its size.
    • Common side effects may include nausea and pain 
  • Surgery

Surgery may be considered an alternative if –

  1. You wish to conceive.
  2. You are not having a successful response to medical therapy and are distressed with symptoms.
  3. Your fibroid is so large that it compresses other surrounding structures and is bothersome.
    • Fibroids may be removed through laparoscopic surgery or vagially through a procedure called hysteroscopy. The procedure is also called a myomectomy, wherein a small incision is made in the abdomen. In some cases, where a fibroid is heavy and the patient is not desirous of a pregnancy in the future or has completed childbearing, a hysterectomy may be advised to surgically remove the uterus.
    • Surgical removal of fibroids does not guarantee that more fibroids will not occur in the future.