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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 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