Download Health Vision Article fibroid uterus For March-16

FIBROID UTERUS
Dr. C. SHARATH KUMAR
Uterine Fibroids is the one of the most common disease women face in their childbearing age. About
77% of the women of their age group have this problem. Most of the women will not know that they
have fibroids because most of the them are harmless and produce no symptoms.
Anatomy of the Uterus
The reproductive system of a woman is made up of the
following parts: (Fig 1)





Vagina
Womb or uterus
The neck of the womb-cervix
Fallopian tubes
Ovaries
The uterus is part of a woman’s reproductive system.
It is the pear-shaped muscular bag that protects a
growing baby during pregnancy.
Fig 1: Anatomy of Uterus
Anatomy of the Uterine Fibroid
Uterine fibroid are tumors or lumps made of muscle cells and other tissue that grow within the wall of
the uterus. Fibroids may grow as a single tumor or in clusters. A single fibroid can be less than one
inch in size or can grow to eight inches across or more. Some times they appear as bunch or
clusters like grapes.
Types of Fibroid
Fibroids are classified according
three primary types of fibroids: (Fig 2)
to
their
location
within
the
uterus.
There
are
A. Subserosal Fibroids: Fibroids that develop in the
outer portion of the uterus and continue to grow
outward.
B. Intramural Fibroids: Fibroids that develop within
the uterine wall and expand, which makes the
uterus feel larger than normal.
C. Submucosal fibroids: A type of fibroid that
develops just under the lining of the uterine cavity.
Fig 2: Types of the Fibroids Uterus
Symptoms of Fibroid
Many women don’t feel any symptoms with uterine fibroids. Only 25% of the fibroids cause
symptoms. Fibroids can cause the following symptoms:
• Heavy bleeding or painful periods
• Bleeding between periods
• Pelvic pressure
• Urinating often
• Pain during sex
• Lower back pain
Complications of Fibroids
Women with fibroid uterus may land up in reproductive problems, such as infertility, multiple
miscarriages, and early onset of labor during pregnancy.
Causes of Fibroids
There are three main factors that cause fibroids. They are includes, Hormonal, Genetical,
Environmental Factors.
Diagnosis of Fibroid
Fibroids can be diagnosed by Pelvic examination (pervaginal examination), Scanning
(ultrasound/CT/MRI) can confirm the diagnosis. Sometimes HSG (Hysterosalpingography),
Hysteroscopy may be required for the diagnosis.
Treatment
There are both medical and surgical treatments available.
a. Medical therapy
Anti-inflammatory drugs, such as ibuprofen, or other painkillers such as acetaminophen can be used
for mild pain.
Anti-hormonal agents, such as mifepristone also can stop or slow the growth of fibroids. These drugs
only offer temporary relief from the symptoms of fibroids;
Gonadotropin releasing hormone agonists (GnRHa), it can decrease the size of the fibroids.
Sometimes they are used before surgery, to shrink the fibroids, making them easier to remove.
Side effects of the medications: Include hot flushes, depression, not being able to sleep,
decreased sex drive, and joint pain
b. Surgical Techniques
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


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Fig 3: Fibroid seen through Laparoscopy
Open surgery through abdomen
Open surgery through Vagina
Laparoscopy
Hysteroscopy
Combined surgery using two or more of the above
techniques
Types of surgery
 Myomectomy- Removal of fibroids from the uterus. This is done for women who want children.
 Hysterectomy – Removal of the uterus. This surgery is done for women who already have
children.
 Endometrial ablation–The endometrial lining of the uterus is destroyed. This surgery controls
very heavy bleeding. This is done in women who already have children or who don’t want
children.
 Myolysis: This uses electric shock to shrink the fibroids.
 Embolization: Cuts off the blood supply to the uterus and the fibroid. This is a common
procedure when symptoms are not severe.
Complication of the Surgery
Following complications may arise after surgery: Risk of needing a blood transfusion,
Infection, Difficulty in intercourse, Pain, Urination problem.
Precaution to be taken before surgery:
There is growing tendency of removing the uterus even for younger women although the fibroids
are small and symptomless.There are incidences of removing the uterus even in young women who
have not completed their child bearing duty. This should be strongly avoided both by doctors as well
as patients. It is always ideal for the patient to seek second opinion whenever surgery is advised by
one doctor. Medical line of treatment should always be tried before surgery. Surgery is indicated only
if they are very large and give lot of problems or come in the way of fertility
Conclusion
Fibroids are a common condition, causing symptoms in about 25% of cases. A range of
conservative treatments now exists for the management of these symptoms. Some of which may
improve the chances of conceiving, either following fertility treatment or natural conception. Careful
investigation and evaluation is recommended, together with a full and frank discussion with your
doctor in order that an appropriate management plan can be developed, taking into account your
age, symptoms, desire for further pregnancies and social factors such as the demands of a busy
career and sexual life.
******
Dr. C. SHARATH KUMAR
M.B.B.S., M.S. Ph.D (Infertility)
Director and Chief Fertility Surgeon,
Mediwave I.V.F & Fertility Hospital
City X-ray Complex, Sayyaji Rao Road,
Mysore-570021
Phone: 0821-2444441 / 3265002