Care for WOMEN by WOMEN

Treatment of Fibroids

Generally, fibroids on themselves do not cause any problems. But occasionally can be associated with infertility, miscarriage and premature labour. Other symptoms can include heavy, long and painful periods.

Fibroids are known as growths or benign tumours that form inside the uterus (womb). Around four in 10 women over the age of 40 years will be likely to have fibroids.

The reason why fibroids develop is not known, but it is thought that the sex hormones, oestrogen and progesterone, could play key roles in this process. This is because fibroids will rarely grow in girls before puberty and women after menopause. Pre-existing fibroids generally stop growing and can even shrink in women after menopause.

Treatment depends on the size, number and location of the fibroids, but can involve medication, procedures done under local anaesthetic, ultrasound procedures and surgery. Fibroids rarely become cancerous.

Most women with fibroids do not present any symptoms. When symptoms are present, they can include:

• heavy, long and painful periods
• spotting between periods
• pain during sex
• feeling of heaviness
• pressure in the back, bowel and bladder
• urinating often
• a lump or swelling in the lower abdomen

Fibroids are categorised by their location, which includes:

  • Intramural – the most common type, growing in the wall of the uterus
  • Submucosal – growing in the lining of the uterus (endometrium), sometimes causing heavy, long and painful periods
  • Sub serosal – growing on the outside of the wall of the uterus, sometimes appearing like long stalks.

Some of the complications Fibroids can cause include:

  • Anaemia – Excessive menstrual blood loss can cause anaemia, where the body is not able to carry enough oxygen in the blood. Symptoms of anaemia include breathlessness, fatigue and paleness.
  • Problems while urinating – Large fibroids can make the uterus bulge, pressing against the bladder. This can cause a feeling of fullness or discomfort and the need to urinate often.
  • Infertility – Fibroids can interfere with implantation of the fertilised egg in several ways. For example, the egg may try to implant into a fibroid, or fibroids may change the shape of the uterus and make it difficult for an egg to implant.
  • Miscarriage and premature delivery – Fibroids can reduce blood flow to the placenta or compete for space with the developing baby.

Fibroids can be detected using an ultrasound, where sound waves create a two-dimensional picture. The inside of the uterus can be seen with a hysteroscope, which is a thin tube that is passed through the cervix (entrance to the womb). A small camera may be placed at the tip of the hysteroscope to see the inside of the uterus on a monitor.

Non- Surgical Management

Dr Joshi will discuss with you different treatment options like hormonal treatment, or intrauterine device.

  • Monitoring – If the fibroids are not causing any symptoms and are not large, the condition can be watched over time for any changes.
  • Medication – A combination of hormones or other medication can be used to shrink the fibroids before surgery.

Surgical Management

Dr Joshi also offers Surgical Treatment where necessary.

  • Hysteroscopy – The fibroids are removed through the cervix using a hysteroscope (a thin tube with a light on the end, which is inserted into the vagina to examine the cervix and inside the uterus).
  • Myomectomy – Removal of fibroids while preserving the uterus. It can be done as a hysteroscopic myomectomy, or abdominal or laparoscopic myomectomy
  • Laparoscopy  or ‘keyhole surgery’– A thin tube is inserted through the abdomen to remove the fibroids.
  • Open surgery – Larger fibroids need to be removed through a cut in the abdomen. Please note that this procedure weakens the wall of the uterus and makes Caesarean sections for future pregnancies more likely.
  • Hysterectomy – The surgical removal of some, or all, of the uterus. Pregnancy is not possible after a hysterectomy.

Most of the surgical procedures are performed under anaesthesia. Recovery time varies with the type of procedure chosen and it is important to have a talk with Dr Joshi regarding the care and precautions to be observed after the surgery.

All surgical procedures come with their own risks, some of them could be life-threatening. Your doctor will explain to you all the risks associated with a particular procedure, to assist you in your decision making.

After surgery, following symptoms require contacting the doctor – increasing nausea or vomiting, persistent abdominal pain or bleeding, Fever more than 38 degrees  or chills, dizziness, to name a few.