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Uterine Fibroids – Treatment & Complications

About Uterine Fibroids

Fibroid Uterus or Uterine Fibroids are very common with women and most of the times they are too small to cause any problems. These are round or semi-round shaped benign tumors found in the uterus, made of the same smooth fibers as the myometrium or uterine wall. Though, at times they are comparatively denser than the fibers of the wall of the uterus. Also known as Leiomyomas or Myomas, these tumors are not cancerous.

Types of Uterine Fibroids

Based on its location, Fibroid Uterus is of the following types:

  1. Myometrial Fibroids – Found in the muscular wall of the uterus
  2. Submucosal Fibroids – Found under the interior surface of the uterus or inside the uterus
  3. Subserosal Fibroids – Found on the outside wall of the uterus
  4. Pedunculated Fibroids – Found outside of the uterus but connected to it by a base or stalk

Causes

The exact cause for Fibroid Uterus is unknown. However, some of the probable causes include:

  • Genetic changes and abnormalities
  • Abnormalities in the Vascular System
  • Stimulation from Estrogen and Progesterone Hormones
  • Tissue response to injury
  • Family history
  • Race of the woman; women of African descent are more susceptible to Fibroid Uterus
  • Having the first menstrual period before the age of 10 years
  • Excess consumption of alcohol, especially beer
  • Uterine Infections
  • Increased Blood Pressure or Hypertension

Symptoms

Usually Uterine Fibroids cause no symptoms. However, few women experience symptoms which include:

  • Heavy Menstrual Bleeding
  • Prolonged Menstrual Periods (7 days or longer)
  • Pelvic Pressure or Pain
  • Constipation
  • Frequent Urination
  • Bloating of the Belly or Pelvis
  • Pain in the Lower Belly or Pelvis
  • Pain with Intercourse
  • Backache or Pain in the Legs

Consultation

A Gynaecologist or Obstetrician is the subject matter expert.

Tests and Investigations

If there are symptoms of Uterine Fibroids or if the physician doubts their presence during a routine pelvic exam, then he recommends the following tests:

  • Ultrasound
  • Blood Tests
  • Magnetic Resonance Imaging (MRI)
  • Hysterosonography
  • Hysterosalpingography
  • Hysteroscopy
  • Uterine Biopsy
  • Sonohysterogram

Treatment Modalities Available

There are a number of treatment modalities available to treat Uterine Fibroids. The physician is the best judge to choose which treatment is apt for his patient.

The treatment options include:

Watchful Waiting: Usually Uterine Fibroids are non-cancerous. If there are no, or bearable symptoms, physicians recommend to wait and watch. Usually these tumors shrink after menopause.
Medication: Medications do not cure the tumors but regulate the menstrual cycle and treat symptoms such as heavy menstrual bleeding and pelvic pressure.
Non-invasive Procedure: The Focused Ultrasound Surgery (FUS) is a MRI-guided noninvasive procedure that does not need incision. The physician locates the tumors with a high-energy ultrasound transducer equipped MRI scanner. The transducer focuses sonications or sound waves into the fibroid to heat and destroy small areas of the fibroid tissue.
Minimally Invasive Procedures: The following surgical procedures destroy the fibroids without removing them through surgery:

  • Uterine Artery Embolization: This procedure includes injecting embolic agents into the arteries connected to the uterus. These agents cutoff the blood flow to the fibroids as a result of which they shrink and die.
  • Myolysis: This Laproscopic procedure destroys the fibroids by passing an electric current or laser.
  • Cryomyolysis: This procedure freezes the fibroids and destroys them.
  • Laparoscopic or Robotic Myomectomy: This procedure involves making small incisions to remove the fibroids.
  • Hysteroscopic Myomectomy: This procedure involves the removal of fibroids by inserting instruments through the vagina and cervix into the uterus.
  • Endometrial Ablation and Resection of Submucosal Fibroids: This procedure destroys the lining of the uterus using various means which include heat, hot water, microwave energy, or electric current.

Traditional Surgical Procedures: These procedures include Abdominal Myomectomy and Hysterectomy. Abdominal Myomectomy involves removal of fibroids through an open Abdominal Surgery and Hysterectomy includes the removal of the uterus.

Complication in Management

Uterine Fibroids are harmless and usually not cancerous. However, they may cause discomfort and may result in complications such as heavy blood loss. Fibroids usually do not cause problems for those who wish to conceive or get pregnant. In some cases, however, they may cause infertility or pregnancy loss.

Pregnant women may face the following complications due to Uterine Fibroids:

  • First trimester bleeding
  • Placental abruption
  • Breech presentation
  • Problems during labor

Fibroids may result in an increased risk of Cesarean Delivery. The size and site of the tumors decide the level of obstetrical complications.

Risk of Infection to other Family Members

Fibroid Uterus is not infectious. However, a major cause behind their development is heredity.

Prevention to Avoid Recurrence

There is a risk of recurrence of the fibroids, even after completion of the treatment. The recurrence does not happen after a Hysterectomy or uterus removal. There is no scientific evidence available to prevent them from recurring.


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