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Uterine fibroid

With the present lifestyle and eating habits, we are very much aware of the deadly disease called cancer. Till date, we have not found the exact cause of cancerous cells being multiplied in our body. On the other hand, there is also another type of tumor cells which are noncancerous and do not multiple within called the fibroids.

What are fibroids?

Fibroids are the most frequently seen tumors of the female reproductive system. Made of smooth muscle cells & fibrous connective tissues, fibroids are firm & compact tumor cells that develop in the uterus.

It has been found that about 30-50% of the women in the reproductive age have fibroids although, all of which are not diagnosed. So, fortunately, in about 99% of the fibroid cases, the tumors are non-cancerous. These tumors are in no way associated with cancer and do not increase the risk of uterine cancer in women.

Uterine fibroids also called as leiomyomas or myomas are non-cancerous cells that develop in the uterus often during the pregnancy periods. They are not associated with the increased risk of uterine cancer and never develop into cancer.

Fibroids are undetectable by the human eye and often range from the size of a seedling to bulky masses that can distort or enlarge the uterus. You may develop a single fibroid or multiple ones. Sometimes, the fibroids may expand the uterus so much that it will reach the rib cage.

It is most commonly developed at the time of menopause as well. Most women do not know that they have uterine fibroids as it does not cause any symptoms.

Your doctor may detect the presence of fibroids at the time of pelvic exam or prenatal ultrasound.

What are some of the noticeable symptoms?

Most women with fibroids have no symptoms at all. Some develop mild symptoms while others have severe & disruptive symptoms. The following are the most common symptoms of uterine fibroids:

  • Irregular  menstrual periods
  • Abnormal bleeding during menstrual periods
  • Pelvic pain
  • Frequent urination
  • Pain in the lower back
  • Pain during intercourse
  • A firm mass located near the pelvic region

In some cases, irregular menstrual periods, or the abnormal bleeding between periods, can lead to iron-deficiency and result in anemia, which then requires treatment. The treatment for fibroids depends on the location, size & number of fibroids. However, these symptoms may differ from individual to another individual. A fibroid can cause acute pain when it gets less amount of blood supply and begins to die.

Fibroids are classified depending on their location.

Intramural fibroids develop in the uterine wall. Those fibroids that develop in the uterine cavity are called submucosal fibroids. The fibroids that project outside the uterus are called subserosal fibroids.

What causes fibroids in women?

Doctors do not know the exact reason of uterine fibroids. Researches & studies have found out the following to be the main causes of uterine fibroids. The causes include:

  • HORMONES: the 2 main hormones, estrogen & progesterone that play a vital role in the development of uterine lining at the time of pregnancy or menstrual cycle are responsible for stimulating the growth of fibroids in the uterus. Fibroids contain a large number of these hormones than the normal muscle cells do. After the menopause, the amount of hormone secretion gradually reduces. As a result, the fibroids tend to shrink.
  • GENETIC CHANGES: many fibroids contain changes in genes which are quite different from those in the normal muscle cells.
  • OTHER GROWTH FACTORS: insulin-like growth factors that help the body to maintain tissues might affect the growth of fibroids.

The uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus. A single cell divides repeatedly forming a rubbery mass. The growth patterns of fibroids largely depend on person to person. The growth may appear slowly or rapidly. At times, it seems to remain in same size throughout.

 What are the risk factors associated with uterine fibroids?

Other than being a woman of reproductive age, there are other risk factors associated with uterine fibroids. Other factors that influence the fibroid growth include:

  • HEREDITY: if your mother or sister had one, then even you are at increased risk of developing a fibroid.
  • RACE: Black women are more likely to have fibroids than women of other racial groups. They are likely to develop one at an earlier age and may also have fibroids of larger size.

Other complications that affect the growth of uterine fibroids are:

  • Onset of menstruation at an early stage
  • Use of birth control pills
  • Obesity
  • Vitamin D deficiency
  • Diet higher in red meat & lower in green vegetables, fruits & dairy
  • Excessive alcohol consumption

Fibroids do not interfere with getting pregnant. However, fibroids might cause infertility or loss of pregnancy. Other complications that result from fibroids include placental abruption, fetal growth restriction & preterm delivery.

How are uterine fibroids diagnosed?

Uterine fibroids are found during the pelvic exam. The doctor may observe some abnormalities in the shape of your uterus thereby suggesting the presence of fibroids.

Your doctor may suggest you take up the following tests:

  • Ultrasound: Ultrasound is used to confirm the presence the fibroids. It uses sound waves to detect the presence of fibroids and also to measure its size and location. The doctor places the ultrasound device over your abdomen or places it inside your vagina to get the images of the uterus.
  • LAB TESTS: if you have abnormal menstrual bleeding, then your doctor may suggest you take up a lab test to identify the potential cause. This might include complete blood count (CBC) to see if you are anemic due to abnormal blood loss and other types of blood tests to rule out issues like thyroid problems & bleeding disorders.

If the traditional ultrasound does not provide necessary information then the doctor might suggest other advanced imaging techniques. These include:

  • MAGNETIC RESONANCE IMAGING (MRI): this test helps to identify the size & location of fibroids, different types of tumors and also help with appropriate treatment options.
  • HYSTEROSONOGRAPHY: this technique is also called as saline infusion sonogram. It makes use of sterile saline to expand the uterine cavity. This makes it easy to get images of the endometrium & the submucosal fibroids.
  • HYSTEROSALPINGOGRAPHY: it makes use of a contrast medium or a dye to highlight the uterine cavity & the fallopian tubes so that these areas are well seen under an x-ray This helps the doctor to identify any abnormalities in the shape of the uterus. It helps not only in detecting fibroids but also to identify if the fallopian tuare open.
  • HYSTEROSCOPY: in this medical procedure doctor inserts a small device called Hysteroscope through your cervix into the uterus. He then injects saline into the uterus, which expands the uterine cavity and allows the doctor to examine the uterine walls

What are the treatment options for uterine fibroids?

The noninvasive treatment procedures include:

Some of the minimally invasive procedures include:

Minimally invasive procedures include destroying the uterine fibroids without actually removing it through surgery.

Uterine artery embolization: the arteries supplying the uterus are injected with small particles. These particles will then prevent the blood flow to the uterine fibroids, thereby stunting its growth.  In due course, it will shrink the fibroids and causes it to die. We need to be aware of the complications that might occur if the blood supply to other ovaries and organs are blocked.

Myolysis: it is a laparoscopic technique that uses radiofrequency energy, electric current & laser to destroy the fibroids. This technique also shrinks the blood vessels that feed them. Cryomyolisis is a similar procedure that freezes the fibroids.

Robotic myomectomy: in this technique, the doctor removes the fibroids without disturbing the uterus.  If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses small instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Another procedure called as morcellation is a method by which the fibroids are removed by breaking them into smaller pieces.

Hysteroscopic myomectomy: if the fibroids are present inside the uterus, then this method may be opted. The surgeon removes fibroids using instruments that are inserted through your vagina and cervix into the uterus.

Options for traditional surgical procedures include:

  • Abdominal myomectomy.If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids
  • Hysterectomy: it is a major surgical procedure that involves the removal of the uterus to put an end to the uterine fibroids. It is a proven permanent solution for uterine fibroids.

In the next section of this article let us have a deeper look at the hysterectomy procedure.

Why is hysterectomy performed?

The doctor may suggest you undergo hysterectomy for the following reasons:

  • Uncontrollable vaginal bleeding
  • Chronic pelvic pain
  • Fibroids which are tumors that grow in the uterus
  • Cancers of uterus, cervix or ovaries
  • Pelvic inflammatory diseases which are the main causes of infection in the reproductive organs
  • Uterine prolapsed which occurs when the uterus drops through the cervix and comes out of the vagina
  • Endometriosis, a disorder in the inner lining of the uterus that grows outside of the uterine cavity causing pain.

Hysterectomy is a safest and low-risk surgical procedure. However, it should not be used on all women who still wish to give birth in the future. Fortunately, many conditions that are treated with hysterectomy can also be treated by others ways. For instance, hormone therapy can be used to treat endometriosis and fibroids can also be removed by simple surgery. Hysterectomy is the only option when it comes to uterine or cervical cancer.

Types of hysterectomy:

  • Partial Hysterectomy: during this procedure, only a part of your uterus is removed. The cervix is left intact.
  • Total Hysterectomy: during this procedure, the entire uterus is removed along with the cervix. You will have to have regular pelvic examinations.
  • Hysterectomy and salpingo-Oophorectomy: during this procedure, the entire uterus along with one or both the ovaries and fallopian tube is removed. One may need hormone replacement therapy if both the ovaries are removed.

How is hysterectomy performed?

Hysterectomy can be carried out in many ways. All the methods require general or local anesthesia. A general anesthesia will put you to sleep where as a local anesthesia will numb that particular area alone but you will still be awake. Sometimes anesthesia will be combined with a sedative so that you feel sleepy and relaxed throughout the procedure.

Abdominal hysterectomy: In this procedure, the uterus is removed through a large cut in the abdomen. The incision may be vertical or horizontal. Both these types will heal quickly and leave a scar on the surface.

Vaginal hysterectomy: In this procedure, the uterus is removed through a small incision in the vagina. There are no visible cuts and no scars seen on the outer body.

Laparoscopic hysterectomy: In this procedure, the doctor uses a small instrument called laparoscope. It is a long narrow tube, which consists of a high-intensity light and high-resolution camera to capture the images. These images will be displayed on the screen. In this, 3 or 4 incisions are made in the uterus instead of one large incision. The surgeon then cut the uterus into small pieces and removes one piece at a time.

What are the risks of hysterectomy?

This is considered to be the safest procedure. Any medical procedure has its own advantages and risks associated with it. Some of the risks associated with it are:

  • Heavy bleeding
  • Infection around the incision site
  • Injury to bladder, intestines and surrounding blood vessels

Once the surgery is over you will be monitored for your heartbeat and breathing. If everything turns normal then you can be discharged. However, you will have to stay in the hospital for 3 to 5 days. Doctors will encourage you to do light exercises such as walking as it helps to prevent blood clots. If you have undergone vaginal hysterectomy, then you may experience bloody or brownish drainage from the vagina for 10 days. So using a menstrual pad is advisable.

Even after you are discharged, you should avoid doing certain activities such as pushing or pulling objects, bending, lifting heavy objects, sexual intercourse, etc

Recovery time is comparatively longer if one undergoes an abdominal hysterectomy. Complete recovery will take about 4 to 6 weeks.

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