Uterine fibroid’s are one of the most common benign tumors occurring in almost all women above the age of 50, usually in the latter part of their reproductive years. The medical term for uterus fibroid is Leiomyoma, which indicates that this is a tumor that occurs in the smooth muscle layer of the uterus. Some medical journals may also refer to them as myoma, fibroleiomyoma etc. In general, these tumors do not cause notable symptoms, discomfort or danger to the person and only very rarely are they diagnosed as being malignant.
- Uterus fibroids are more common in women between the ages of 40-50.
- Not all fibroids cause symptoms.
- Some cause severe discomfort, pain and anemia due to heavy bleeding.
- Most fibroids do not require treatment unless they cause severe symptoms.
- In general, fibroids tend to shrink post-menopause.
- Very rarely do they turn malignant.
- Uterus fibroids may occur as a single large tumor or there may be several smaller ones.
- They vary in size from being as small as a pea, to weighing several kilos and as large as a grapefruit.
- Their growth and development are controlled by the hormones estrogen and progesterone.
- They grow rapidly during pregnancy and shrink with anti-hormonal medications.
- The real causes of fibroids are unknown, but in general, they have a hormonal and genetic origin.
- Fibroids that occur only after menopause may be a cause for concern as they could turn malignant.
Though uterus fibroids are quite common, there are some definite risk factors that could contribute to the occurrence of fibroids.
- Family history
- Obesity or being overweight
- Being of African American descent
- Pregnancy-related fibroids are common
- Early marriage and pregnancy
- Married/Unmarried women who have never conceived.
Signs and Symptoms
- Symptoms generally depend on the location in the uterus and also the size of the tumor.
- Heavy menstrual bleeding, pain, frequent urination, rectal pain and pressure.
- Low back pain, painful intercourse, complications during pregnancy and feeling of fullness
- Very large uterus fibroids can make the stomach look distended giving the woman a pregnant appearance
- In pregnancy, they can cause miscarriage, premature labor, malformation of the uterus and could affect the health and development of the fetus.
Medical Classification of Fibroids
Uterus fibroids are generally classified according to their location vis a vis the uterus. This classification is important because the location can determine whether they cause symptoms or not and also to assist in deciding the kind of treatment required. Fibroids located inside the uterus could cause problems while those located on the outside walls may not.
Intramural: These tumors are the most common and are located on the inside wall of the uterus. They remain asymptomatic till they grow larger in size, causing distortion and distention of the uterus.
Submucosal: Are located in the inner lining of the uterus. They are less common and can cause heavy bleeding and infertility.
Subserosal: These grow on the outside of the uterus wall and generally grow very large in size. They can give your abdomen a distorted appearance.
Pedunculated: Fibroids which start as subserosal and grow in an elongated way.
Cervical: These are located in the entrance to the uterus at the cervix.
Fibroids can also become calcified, have cystitic changes, cause hemorrhaging or necrosis.
In most cases, fibroids are detected when the patient seeks treatment for heavy bleeding, severe pains or bloating. A pelvic exam, ultrasound, MRI, X-rays, CAT Scan, hysterosalpingogram or sonograms may help to confirm the diagnosis. Laparoscopy and hysteroscopy are other tests to determine the exact size and location of the fibroids.
Some of the things your doctor should tell you about your uterus fibroids include:
- Number of tumors
- Estimated rate of growth
- Present rate of growth
- Likely problems that the uterus fibroids can cause
- Tests that can help to track the growth
- Treatment options if and when the fibroids become troublesome
- Doctor’s opinion on treatments
It would be a good idea to seek a second opinion if you’re not satisfied with the information provided by your doctor. Getting the right treatment for fibroids involves an inter-disciplinary approach. You will require the advice of a gynecologist, a nutritionist/weight-loss professional, surgeon, medical technologists and pharmacologists.
Since most women hardly experience any symptoms or only very mild ones, the medical approach to treatment of fibroids is to leave them alone while recommending regular monitoring/observation for changes.
However, treatment can alleviate the discomfort caused by the symptoms.
Exercise: Regular moderate exercise could prevent and control the growth of fibroids.
Medication: is given to reduce or stop bleeding and to shrink the tumor. These may be certain types of hormones or anti-hormonal medications. They include medications which reduce the estrogen and progesterone levels.
Ultrasound fibroid destruction: is another viable option which is minimally invasive. Ultrasound waves are used to locate and destroy the tumor.
Myolysis and Cryomyolysis: These procedures are conducted with the use of laser. They can be used either to shrink or freeze the tumor and destroy it.
Endometrial ablation: is another minimally invasive procedure which uses a special device to destroy the endometrium of the uterus through microwaves, heat, hot water or electric current.
Surgery: is generally seen as the last option and recommended when the fibroid causes severe symptoms and puts the patient’s life at risk. Hysterectomy is one of the major surgeries that may be recommended in cases where the fibroid is non-responsive to other treatments and if the woman has completed her family and is not planning to have any more children. If the size of the fibroid is between 12-25 cm, surgery may be recommended if the hormonal/medication treatment option does not work.
When surgery is the recommended treatment, it is important to arm yourself with as many facts as possible before you opt for this procedure.
- The procedure is done under general anesthesia.
- The doctor should inform you clearly about the risks involved in surgery.
- Pre-operative procedures should be strictly followed and properly explained.
- Physical exams, blood tests and reviews should be done well in advance.
- Information about allergies should be shared with the doctors and medical staff.
- The time taken for surgery is between 1-2 hours.
- The patient should be aware that if any cancerous growth is discovered during surgery, hysterectomy will be done.
- Overnight stay in the hospital is required.
- Blood replacement or requirement should be arranged in advance.
- If you’re taking blood-pressure medications or aspirin regularly, the doctor will recommend stoppage.
- Full recovery will take between 4-6 weeks.
- The cost of fibroid surgery in India depends on the kind of procedure involved. In general, hysterectomy may cost upwards of Rs 4000, while other procedures like embolization or myomectomy may be between Rs 4000-5000. Costs in India are among the lowest in the world.
Post surgical advice should be strictly followed along with the recommendations and medications prescribed by the doctor. If you require help post-surgery, you should get a relative or friend to help you. You should be well-informed about the precautions to be taken and also keep yourself informed about any unusual symptoms to watch out for. The risks include infection, bleeding and non-healing of the wound if surgery has been undertaken.
In conclusion, uterus fibroids are a common feature in women of a certain age but with the right advice and proper precautions, they are also one of the least worrisome of ailments.