Uterine Fibroids

• Symptoms: Heavy and abnormal menstrual bleeding, prolonged bleeding in the menstrual cycle, pelvic pain, spotting, abdominal distension or cramping
• Causes: Family history or genetic predisposition, hormonal imbalance due to pregnancy hormones [exact cause is not known]
• Risk factor: Women who are 30 years or older, chronic obesity, menopause
• Severity: Mild to intense (depending on the location and size of the fibroid in the uterus lining)
• Which doctor to consult: OB-Gynaecologist

Overview

Fibroids are muscular tumours in the uterus lining that may or may not turn into cancer. The scientific term for uterine fibroid is leiomyomas, and this growth is made of connective tissues from the uterus wall.

Initially, fibroids are non-cancerous and vary in size and shape. It can either grow in the uterus wall or on its surface. All the fibroids have an attachment nodule like a stalk connecting them to the uterine walls. Doctors can’t detect fibroids at an early stage because these are invisible to the naked eyes.

Women are vulnerable to developing fibroids between the age of 30 and 40. Medical experts suggest that women are more likely to develop this problem during their childbearing age because hormones are at their peak during this phase.

These fibroids can grow as a single structure or in a cluster, and their sizes can range from 1 mm to more than 8 inches in diameter. The fibroid in each woman varies in size, number, and location. As a result, each patient faces unique symptoms depending on their condition. Thus, the treatment plan also differs in each case depending on the features of the fibroid.

When to consult a doctor?

While uterine fibroids are unfamiliar, nearly 75% of women are likely to develop at least one in their entire lifetime. Despite having a high probability, it is not on the list of common problems women suffer in their reproductive phase.

Below are the symptoms a woman need to observe and seek immediate help from a medical professional:

• Heavy menstrual bleeding

Having abnormally heavy menstrual bleeding is not a common phenomenon, especially when one experiences this in every cycle. Thus, if a woman observes an increase in the menstrual flow, it might be the right time to seek professional help from a gynaecologist.

• Pelvic pain

Persistent pelvic pain is a sign of problems in the uterus if an individual’s abdominal region is free from any other issues. A sharp pelvic pain could indicate fibroids and pelvic inflammatory diseases. Therefore, it is not wise to ignore these signs if a woman plans to have a child. A doctor can help her understand the significant signs and symptoms.

• Recurrent miscarriages

This is an unfortunate incident that many women face when planning a child. If an individual has suffered miscarriages frequently, it is time to consult a gynaecologist and find the reason for the same. In many cases, uterine fibroids make the uterus unsuitable for conception and lead to miscarriages within eight weeks of pregnancy.

• Enlarged lower abdomen

One of the biggest problems women face when developing fibroids in their uterus is the inability to lose belly fat despite consistent efforts. This is because many women realise that they have 2-3 kgs of fibroid in their uterus, making it challenging to bring their abdomen into shape. Thus, a woman must see a gynaecologist if she faces similar symptoms.

• Increased frequency of urination

Due to a large fibroid, the uterine walls start exerting pressure on the urinary bladder thereby increasing the urge to urinate. This is also an ordinary symptom women face during pregnancy due to the growth of the foetus. Hence, if a woman, who is not pregnant has similar symptoms, a diagnosis is essential to understand the cause.

• Other symptoms

Some other common symptoms include lower back pain, the feeling of fullness in the abdomen, and painful coitus. In addition, women also feel pressure in their rectum due to a large fibroid.

Diagnosis

• Regular examination

Many experienced doctors can diagnose the presence of a fibroid during regular uterus examination. It is easy to feel the fibroids if these are present in the body or corpus of the uterus. Additionally, a healthcare provider can diagnose the condition by correlating it with the symptoms.

• Ultrasound

This is one of the most common non-invasive imaging tests that gives a clear insight into the structure of the uterus and abnormal growth in it. Depending on the size of the uterus, the ultrasound may be through the transvaginal or transabdominal route.

• Magnetic resonance imaging (MRI)

MRI is an advanced imaging technique that uses magnetic energy and radio waves to get detailed images of the internal structure of the uterus. An MRI scan can also identify fluid buildup and other uterine abnormalities.

• Computed tomography (CT)

CT scan uses x-ray images from multiple angles. By examining the structure from various angles, a doctor can curate an appropriate treatment plan for the patient. A CT scan also helps assess the progress of the treatment.

• Hysteroscopy

This is a specific diagnostic procedure only suitable for a detailed examination of the uterus. This involves a thin, flexible tube with a camera at the end to look at the fibroids and their structure. Hysteroscopy is also helpful in understanding the attachment of the fibroid to the uterus. It enters the uterus through the vaginal tract, crosses the cervix, and reaches the uterus.

• Hysterosalpingography (HSG)

HSG is an advanced x-ray imaging technique that uses a contrast material to obtain better imaging. This procedure is also used for uterus examination of people trying to evaluate the organ for infertility issues.

• Sonohysterography

Since ultrasound uses fluid as a medium to create images, the same principle is used to carry out the diagnostic process. In this imaging test, a catheter is inserted through the transvaginal route alongside injecting saline into the uterine cavity. Due to sufficient fluid, the sound waves travel efficiently and produce clear images of the fibroid.

• Laparoscopy

This technique uses a small cut in the lower abdomen to insert a thin and flexible tube with a camera. As a result, the doctor can look at the fibroids closely.

Treatment

The treatment for uterine fibroid depends on the size and location of the fibroids, alongside observing the symptoms they cause. However, doctors often suggest medications and non-invasive methods if the patient have any significant symptoms.

Below is a list of treatments one can choose from after discussing with a OB-gynaecologist:

Medications

• Over-the-counter drugs

OTC drugs help relieve pain so that the patient remains free from discomfort. These medications include acetaminophen and ibuprofen.

• Iron supplements

These are essential to prevent anaemia due to heavy bleeding during fibroid development. Iron supplements help balance blood loss and increase the body's iron content, which boosts haemoglobin.

• Birth control pills

Birth control pills are one of the most common medicines given to people to relieve the symptoms of fibroid development. There are several contraceptive pills like oral contraceptives, intravaginal contraception, injections, and intrauterine devices.

• Gonadotrophin-releasing hormone (GnRH) agonists

These formulations can be administered using nasal spray and injection. These are effective for shrinking the fibroids before undergoing major surgery. However, these are temporary solutions and do not entirely heal the problem. These are only suitable for making it easier to remove fibroids. Additionally, stopping these medications might trigger the growth of fibroids again.

• Fibroid surgery

Since surgery is not the only option, it is essential to consider multiple factors before finalising the surgery. Choosing the right treatment plan is crucial, especially when planning for future pregnancies.

Below are some surgical options for women suffering from fibroids:

• Hysteroscopy

As mentioned earlier, hysteroscopy uses a visual aid to identify the presence of fibroids and remove them strategically. This non-invasive technique does not use any cuts or incisions to insert the tube or any other device.

• Laparoscopy

Unlike hysteroscopy, laparoscopy involves a small incision in the abdomen to remove the fibroid using a visual aid.

• Laparotomy

This procedure includes one large cut in the abdomen, and the entire surgery is completed using this cut. As per the doctor’s strategy, this cut is the passage for inserting the visual aid and removing the fibroids. It is recommended for women with large fibroids that are difficult to pass through the cervix.

• Hysterectomy

In an advanced stage, the uterus is removed as the elimination of the fibroids alone is more damaging than removing the entire organ. Additionally, it is suitable for older women, as they are at risk of developing cancers and other complicated issues. This further eliminates the chances of the reappearance of fibroid.

• Uterine fibroid embolisation

Embolization is a procedure in which the blood flow to the fibroid is obstructed, leading to its shrinkage. As a result, it becomes easier to relieve the symptoms and make it easier to remove the fibroid using non-invasive techniques.

Risks and complications

Below are some risk factors and complications that might arise due to the presence of fibroid in the uterine walls:

• Cancerous growth

Initially, the fibroids are present as benign growth that does not spread and cause cancers in other parts of the body. However, if left untreated for a long time, these might lead to complications and become cancerous.

• Rupture

Many women have experienced fibroids rupture while undergoing multiple treatments to shrink the growth. To avoid this situation, it is essential to assess the treatment progress and work toward gradually improving the condition.

• Intensity of symptoms

With the prolonged presence of fibroids, managing the symptoms is challenging. As a result, it directly affects the quality of life because the pain and inability to do physical work make it difficult to complete basic tasks.

• Anaemia

Bleeding is one of the most common consequences of untreated fibroids. Thus, if a patient bleeds heavily for a long time, it might end up in anaemia. Additionally, some anaemic conditions cause permanent damage to the body, and it becomes difficult to recover haemoglobin through regular supplements and nutrition.

Additional information

Different types of fibroids

• Intramural fibroids

These fibroids grow in the uterus’ muscular wall and are one of the most common types of fibroids. These fibroids grow and stretch the uterine cavity and increase the abdominal size.

• Subserosal fibroids

These fibroids grow out of the uterus in the serosa layer of the membrane. These not only push other organs but also make the womb look bigger.

• Pedunculated fibroids

These are subserosal fibroids that feature slender stems that can support their growth.

• Submucosal fibroids

These fibroids grow in the uterus's myometrium or middle layer of the muscle. These are one of the rarest fibroids in the human body.