Uterine fibroids

Uterine fibroids are benign tumors that develop in the uterus, they are non-cancerous in nature. They are made up of the same muscle fiber which makes the uterine wall.  These are generally semicircular or circular in shape. Fibroids are of varied shapes as well, they may be so tiny that could not be seen properly without a microscope, or are sometimes so big that they can fill the whole uterine cavity. Based on their location in the uterus the fibroids are classified as under:

• Myometrial – When the fibroids are located in the muscle wall of the uterus
• Submucosal – This is when the fibroids are situates right below the surface of the uterine lining
• Subserosal – This is when the fibroids are located beneath the lining membrane on the outside of uterus.
• Pendunculated – When the tumours are occurring on a long stalk inside the uterine cavity or on outside of the uterus  

Causes and Incidence

The problem of fibroids usually occurs in women over 30 years of age, as many as 1 in every 5 women is affected with this ailment during the childbearing age i.e. post menstruation and before menopause. Though the exact cause of the disease is not known, but it seems to depend on the hormone estrogen as it has been found that till the time the women is menstruating the fibroid continues to grow slowly.

Symptoms

The common symptoms of uterine fibroids are as follows:

• Abdominal fullness,
• Gastric troubles
• Constipation
• Bleeding in between periods
• Increased urinary frequency
• Heavy menstrual bleeding 
• Longer menstrual periods
• Cramping and pain with periods
• Sensation of pressure in lower abdomen
• Pain during intercourse

Diagnosis

A thorough diagnosis is to be done to confirm the presence of Fibroids, as many times fibroids are mistaken for pregnancy, ovarian tumors, inflammation of fallopian tubes and uterine adenomyosis. Following needs to be done to confirm fibroids:

• Physical examination of pelvic region which may show an unevenly shaped, lumpy, or enlarged uterus.
• Trans-vaginal ultrasound
• Pelvic ultrasound
• Pelvic MRI
• At times an endometrial biopsy or laparoscopy may be required to rule out cancer.

Treatment

Treatment of fibroids in based on several factors including the age, general health and severity and type of the disease. Treatment may be different for women who are pregnant or if they require children in future.

Following are different treatment options:

1. Drug Therapy: This is mainly for the treatment of the symptoms of fibroids

• Oral contraceptives to help control heavy periods
• Intrauterine devices that releases Progestin hormone may be used to reduce heavy bleeding and pain
• Iron supplements to treat anemia caused due to heavy periods or even to avoid the same.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for cramps or pain

2. Hormonal therapy: This therapy helps in shrinking the fibroids. This is a short term treatment done either before surgery to remove a fibroid or when a woman is expected to reach menopause soon.

3. Surgery: Following are the different surgical procedures done to cure fibroids

• Hysteroscopic resection of fibroids: In this procedure a small camera and instrument is inserted trough the Cervix for removal of the fibroid tumours. This is done in women who have fibroids inside the uterine cavity.
• Uterine artery embolization: Embolization is the method through which blood supply is stopped to the fibroid, as a result the fibroid shrinks and dies.
• Myomectomy: This procedure is the best option for women who are planning to have children as it preserved fertility, this surgery removes the fibroids.
• Hysterectomy: This is an invasive surgery usually the last treatment option, as it involves total removal of the uterus. It is used only if the disease is not cured by medicines and other surgical procedures.