Uterine Fibroids

Disease name

Uterine fibroids are non-cancerous lumps that form in the uterus of females. They mostly  occur during the childbearing age, contributing to infertility or delayed pregnancy. Many  women with uterine fibroids have reported their genes and obesity to be the cause of the  condition.

Associated Anatomy

The Uterus or the womb

Epidemiology

Uterine fibroids are more commonly seen in women of African origin than in white women.  As seen earlier, women in their reproductive age and older women are at a higher risk of  contracting uterine fibroids.

Uterine Fibroids Causes

  • Genes/Family history: Any disease of the uterus or the breast can be genetic. So, if  your mother or sister or second-degree relative had the condition, it is likely that you  may also get it.  
  • Genetic changes: The food we eat and the pollutants around us may bring about  changes in the genes and their functioning. These changes may give way to the  development of fibroids. 
  • Hormones: A woman goes through a roller coaster of hormones, especially during  her childbearing ages. Any alteration or disturbance in the hormonal signalling  pathway may contribute to the development of fibroids. 

Risk Factors  

There are certain factors or conditions that may or may not increase your chance of  contracting uterine fibroids.  

  • Age - older women are at a higher risk of contracting the disease than younger  women
  • Family history of uterine fibroids - if your first-degree or second-degree relatives had  this condition, there is a possibility that you may also get it 
  • Obesity - women who are obese are more likely to get uterine fibroids than women  with a healthy BMI 
  • Blood pressure - women with hypertension are at a risk of contracting uterine  fibroids 
  • No history of pregnancy 
  • Deficiency of Vitamin D 

Signs Or Symptoms of Uterine Fibroids 

Signs and symptoms that women with uterine fibroids experience differ with age and body  type. No two women with the condition have the same set of symptoms, and no two  symptoms occur together for different women. However, some of the common symptoms  are: 

  • Heavy menstrual bleeding 
  • Menstruation that lasts more than 7 days 
  • Pelvic pain 
  • Spotting or bleeding between periods 
  • Frequent urination 
  • Difficulty emptying the bladder 

Diagnosis 

  • Ultrasound: If you experience any symptoms of uterine fibroids, you may be asked  to undergo an ultrasound for confirmation. In an ultrasound scan, sound waves are  used to detect the presence of lumps in the uterus.  
  • Hysteroscopy: A small lighted telescope is inserted into the uterus through the  cervix and saline is released to expand the uterine cavity and obtain clear images of  the uterus. 
  • MRI: It is useful for mapping of fibroid for planning of surgery. 

Possible Treatment of Uterine Fibroids 

Medical management 

  • GnRH agonists: The first line of treatment for uterine fibroids is medication, which  includes GnRH agonists (drugs that mimic Gonadotropin Releasing Hormone). These  drugs stop menstrual bleeding, thereby enabling the fibroids to shrink. 
  • Oral Contraceptives: There are other oral contraceptives that help in preventing  menstruation and shrinking the fibroids.  
  • Progesterone releasing Intra uterine devices : It provides symptomatic releif in  reducing heavy menses. It doesnot shrink fibroid or make it disappear.  
  • Tranexamic acid: It is a non hormonal medication to ease heavy periods. Its taken  only on heavy bleeding days.  

Medication for uterine fibroids can cause undesirable side effects like hot flashes,  depression, mood swings, etc. So, it is often advised to opt for surgery and get the lumps  removed. 

NON INVASIVE PROCEDURE:

  • MRI-guided focused ultrasound surgery (FUS): This is a non-invasive procedure that restores maximum healthy uterus tissues.

MINIMALLY INVASIVE PROCEDURES:

  • Uterine artery embolisation: Blood supply to the fibroids is blocked by inserting small particles in this minimally-invasive procedure.
  • Radiofrequency ablation: Radiofrequency waves are used to ablate fibroids and stop blood flow to the fibroids.

DEFINITIVE MANAGEMENT:

  • Open / Laparoscopic/ Hysteroscopic/Robotic Myomectomy : To remove fibroids leaving uterus in place for fertility preservation. Hysteroscopic myomectomy is ideal for submucosal fibroid ( in cavity of uterus).  

 Most of the times Laparoscopic surgery is possible even for large or multiple fibroids.  Maximum number of fibroids removed during myomectomy in BLK MAX is 106.  

  • Hysterectomy: Removing the uterus is only a solution if you do not wish to get pregnant anymore. However, this is the only proven permanent solution for uterine fibroids. It can be done via Lap/ Robotic/ Open techniques.  

Primary Prevention

There are no proven methods to prevent the occurrence of uterine fibroids, but a healthy  diet with less sugar, gluten, and processed items, and an active lifestyle can reduce the  chances.

Secondary Prevention

Uterine fibroids may keep reoccurring, depending on your age and the severity of your  condition. There are certain ways through which you can prevent fibroids from reoccurring:

  • Keeping your blood sugar level and blood pressure in check
  • Eating non-inflammatory food free from sugar, gluten, etc.
  • Maintaining an active lifestyle

Alternate Name

Uterine fibroids are clinically called leiomyomas or myomas.

Expected Prognosis

Uterine fibroids are generally one of the reasons for infertility or delayed pregnancy.  Anaemia is the immediate effect observed in women with uterine fibroids. They do not  manifest any symptoms for several years after developing. However, in some women,  symptoms like heavy menstrual bleeding and prolonged menstruation may progress sooner,  causing anaemia.

Natural Progression

Uterine fibroids may take many years to present symptoms and progress. However, once  they grow, there are high chances of them recurring.

Pathophysiology

Uterine fibroids are benign lumps that can grow on the uterus, extending into the  underlying muscular layer (submuscular leiomyoma) or into the uterine cavity (subserosal).  Natural hormonal response mechanisms get enhanced, leading to the rapid growth of the  uterine lining leading to endometrial thickening. This results in pelvic pain and heavy  menstrual bleeding.

Possible Complication

One of the most common complications of uterine fibroids is anaemia. There is a heavy  blood loss associated with uterine fibroids, and it results in anaemia. When left untreated,  uterine fibroids may give way to uterine polyps, which are slightly difficult to treat and  remove. So, a timely diagnosis and up taking proper measures to treat the condition is  paramount.

Our BLK-Max Medical Experts

If you are facing any similar signs or symptoms please contact the BLK-Max team to schedule an appointment at : +91-11-30403040

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