FIBROIDS (MYOMA)

       

Uterine fibroids are the most common tumours in women of reproductive age group with a prevalence of approximately 30%. They are benign growths of smooth muscle in the wall of the uterus.

There are four different types of fibroids,

· Submucosal fibroids- These protrude into the uterine cavity

· Subserosal fibroid (distort the contour of the outer surface of the uterus and project

outside of uterus

· Pedunculated submucosal/subserosal fibroids (are attached to the uterus by a stalk)

· Intramural fibroids (are entirely within the wall of the uterus)

 

The incidence of fibroids increases with age , fibroids develop during reproductive years, they have tendency to enlarge during pregnancy and reduce in size by once women reach menopause.

How fibroids affect women?

When symptomatic, the majority of the time fibroids cause significant burden to quality of life.

They include following,

1. Heavy menstrual bleeding

2. Urinary frequency or difficulty in passing urine

3. Difficulty in emptying bowel

4. Symptoms secondary to low iron levels (anaemia)

5. Abdominal pain

6. Subfertility

7. Cosmetic disfigurement because of large fibroids

Diagnostic modalities

If fibroids are massive, then they can be easily determined by simple clinical examination

The understanding of exact location of fibroids in the uterus ( also called as fibroid

mapping)can be achieved by

- Pelvic ultrasound

- MRI scanning

- Hysteroscopy (Telescopic examination of the womb)

How fibroid problems are dealt with ?

Medical treatments such as Anti-inflammatory medicines oral contraceptive pills are used to

control heavy periods 

Progesterone releasing uterine device (LNG-IUS)

A small, plastic device is placed in the womb and slowly releases a progestogen-based hormone (levonorgestrel) which slows growth of fibroids.

Gonadotropin releasing hormone analogues (GnRH agonists)

This kind of hormonal treatment is used to control acute episodes of intractable heavy periods which are not responsive to simple medications. GnRH agonists are also used to shrink fibroids before the operation to reduce heavy bleeding and reduce the size of the cut on the skin.

Ulipristal acetate

These tablets reduce the size of fibroids by preventing fibroid cells from multiplying.

Uterine fibroid embolisation (UFE)

UFE is a semi invasive option, here two feeding vessels of uterine arteries are blocked under X-ray control and by doing this fibroids start shrinking in size and problems start getting resolved.

Surgical therapy

The mainstay of surgical therapy of uterine fibroids involves procedures such as hysteroscopic removal, open removal (open myomectomy) and keyhole surgery

(laparoscopic myomectomy), and removal of uterus altogether called as hysterectomy.

Latest technique - Radiofrequency ablation of fibroid

The new system uses real-time intrauterine ultrasound guidance with targeted radiofrequency ablation in an incisionless procedure to treat symptomatic uterine fibroids.

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© 2020 by Mahantesh Karoshi.