Fibroids

(Laparoscopic view of a fibroid from the wall of the uterus)

Fibroids are non-cancerous lumps that develop in the uterus. They are caused by an abnormal growth of the muscle wall of the uterus and are technically known as "leiomyomas". They are extremely common among women of childbearing age group with a high prevalence of 50-70%. Fortunately most of them are small and do not cause problems. However, if they are large or located at certain places, they may cause problems.

What are the problems caused by fibroids?

Fibroids range in size from small seedlings which cannot be seen, to big masses that can distort and enlarge the uterus. They can be single or multiple and they can be located in different layers of the uterus. 3 out of 4 patients with fibroids live without any symptoms and fibroid will be usually an incidental finding on a scan or seen in an uterus removed for some other reason. The problems caused by fibroids are variable and commonly include the ones listed below. However, one should remember that any one person may have only one or two of the problems and not all of them.

• Heavy bleeding during menses
• Painful menses
• Lower abdominal pain
• Urinary and bowel disturbances
• Infertility
• Abortions

What are the risk factors for developing a fibroid?

While there is no one specific cause for the formation of a fibroid, there several factors that can increase the likelihood of getting a fibroid. Poor dietary habits including regular consumption of red meat increase the risk of fibroid formation. On the other hand, diets rich in green leafy vegetables and fruits appear to be protective against fibroids.

What are diagnostic options available for fibroids?

A qualified gynecologist will be able to suspect the presence of a fibroid based on your complaints and physical examination findings. Ultrasonography is an excellent investigation that is widely used to diagnose fibroids. 3D- ultrasonography will clearly delineate the type and number of fibroids. However, in certain situations when USG is limited by body habitus or distorted anatomy, an MRI scan may be required to image the uterus. Basic blood investigations are usually done to assess whether the fibroid has affected the general body condition or not.

Management options available for fibroid

Majority of fibroids are asymptomatic and do not cause any problem. In such cases, they can be safely observed without resorting to any major intervention. If the fibroid is large, ultrasound scanning is done at periodic intervals is to ensure that the fibroid is not increasing in size. Young patients who have fibroids causing problems such as heavy bleeding during menses, painful menses, lower abdominal pain, urinary and bowel disturbances, infertility, abortions can be treated with medicines such as hormonal medications and anti-inflammatory drugs. If the symptoms are not controlled with medications and hormones, surgery may be required. Most of the fibroids can be removed by laparoscopic surgery.

In laparoscopic surgery, a small key hole is made, a pen shaped camera is passed and the fibroid is visualized. Another small key hole is made through which special instruments that can remove the fibroid are passed under the guidance of the camera. With this method we can safely remove most fibroids without resorting to open surgery. Laparsocopic surgery allows rapid recovery and quicker healing as compared to open surgery. The postoperative pain is also minimal with laparoscopic surgery. If the fibroids are within the uterine cavity, we use a technique called hysteroscopic resection. In this technique, we are able to pass the camera (hysteroscope) and instruments through the vagina and into the uterus, under anesthesia. The fibroid is then taken out through the natural opening of the body- the vagina- and not through an incision.

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