All You Need To Know About Fibroids | Aakash Healthcare
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All You Need To Know About Fibroids

Abnormal tumour growths that develop within or on the uterus are known as fibroids. Even though fibroids are non-cancerous or benign; they can still swell up and grow large leading to intense abdominal pain or heavier than usual menstruation and in some cases, they cause no pain or difficulty at all. The reasons or causes for developing fibroids are yet unknown though it seems they develop during the time women can have children or childbearing years. Myomas, leiomyomas, uterine myomas and fibromas are some other names for fibroids. Fibroids are fairly common and around one million cases are reported in India alone and some statistics reveal that about eighty percent of all women have fibroids by the time they turn fifty, most of them never even realise they have fibroids as the symptoms are nonexistent. 

There are a few types of fibroids listed below: - 

- Intramural Fibroids: these are the most commonly occurring kind of fibroid and grow inside the walls of the uterus. These can also grow larger and stretch the womb owing to their position. 

- Subserosal Fibroids: form on the “serosa”: the outside of the uterus. These can also grow in size, causing the womb to be more enlarged on one side. 

- Pedunculated Fibroids: these are subserosal fibroids that grow a “stem” that supports the tumour. 

- Submucosal Fibroids: these occur in the myometrium (the central muscle layer of the uterus) and are rarer than the other three fibroid types. 

Causes of Uterine Fibroids

As stated earlier the exact causes related to the development of fibroids are yet unknown but experts have wagered some plausible causes that might influence the possibility of fibroid growth. 

Hormones - the ovaries produce two hormones, namely Estrogen and Progesterone; which regenerate the lining of the uterus during menstruation. Higher levels of these might lead to excess regeneration, eventually causing fibroids. 

Family History - fibroids, like other diseases; can also be attributed to family history or genetic predisposition. One should be on the lookout in case preceding generations of women in the family have had fibroids. 

Pregnancy - higher levels of estrogen and progesterone are produced during pregnancy and this can lead to sudden fibroid growth. 

High Body Weight - has also been touted as a potential cause. 

Contraceptives and Birth Control when used regularly can also lead to fibroid complications. 

Symptoms of Uterine Fibroids

The symptoms will be relative to the location, size, positioning and number of fibroids that develop. For example, submucosal fibroids are the most painful and create complications with respect to conceiving children. 

In case the fibroid is small or occurs only during menstruation; there might be no symptoms whatsoever. The levels of estrogen and progesterone fluctuating up and down during and after a period can cause shrinkage of the fibroids. 

Some common symptoms are listed below: 

- excessive bleeding during or in between menstruation accompanied by blood clots in the discharge is the most common symptom. Clots and heavy bleeding should merit a visit to the gynaecologist in any case. 

- Pelvic pain that occurs outside a period cycle or pain in the lower back may be felt due to pressure applied by the presence of a fibroid. 

- Higher and more intense menstrual cramps along with higher than usual urination. 

- Painful intercourse is a potential symptom 

- Longer than usual or extended menstruation, or even irregular menstrual cycles can be cause for concern. 

- Experiencing unprecedented pressure or a feeling of fullness (like having a large meal) in the abdomen.

- A swollen or abnormally enlarged abdomen might point towards an expanded womb, which might be caused due to fibroids.

Note the symptoms mentioned above and if you experienced or continue to experience any of them, see your gynaecologist for a proper diagnosis aka a pelvic examination, which assesses the size, condition and shape of the pelvis. 

Diagnosis can be also be done by: 

Ultrasound- high frequency sound waves are deployed to render images of the uterus on a screen. This will display the internal state and structure of the uterus, revealing any fibroids, if present. 

Transvaginal Ultrasound- involves inserting an ultrasound “wand” into the vagina and provides a closer clearer look into the uterus as the vagina is closer to it during such a procedure. 

Pelvic MRI- an in-depth imaging test that renders a clear picture of the uterus, ovaries and overall pelvic region. 

Treatment of Uterine Fibroids

There are a range of options, from home remedies to surgery. 

Home remedies - acupuncture, yoga, a healthy diet, heat applied for cramping (except during heavy bleeding), ideal weight, avoidance of meat and high calorie food, green leafy vegetables and seafood diets, stress redressal are some remedies. 

Medication:

Hormone control medication in order to shrink fibroids, Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron) will decrease estrogen and progesterone levels. 

Ganirelix acetate and cetrorelix acetate (Cetrotide), also help to shrink fibroids. They work by stopping your body from producing follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

Surgery is the final option and a gynaecologist must be consulted if no improvements are made after a course of medication and lifestyle improvements. 

Medical Management

Hormones in form of oral contraceptives or cyclic progestins to reduce the amount of bleeding. LNG-IUS may also be an option for increases menstrual flow. GnRH agonists are used to decrease the size of fibroids before surgery, ulipristal acetate causes amenorrhea thereby reducing blood loss.

Surgical Management

Still represents the main strategy for fibroid management. It may be selective removal of fibroids i.e. Myomectomy, which can be removal for sub mucus fibroids. Laparoscopic Myomectomy or Open Myomectomy Hysterectomy is the final option for big myonias or with rapid increase in size or continuous abnormal bleeding despite hormonal treatment.

Dr. Madhulika Sinha
Senior Consultant
Obstetrics & Gynaecology

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