Fibroids are a common problem. It’s estimated one out of every four women get them.
The most common symptoms are
-Abnormal uterine bleeding-cyclical bleeding of increased quantity(menorrhagia) or duration
-Pain and discomfort in pelvic region can be associated with menses(dysmenorrhea), with intercourse(dyspareunia) or general pelvic pain.
-Fibroids can exert pressure and disrupt nearby organs and organ systems, causing urinary symptoms like increased urinary frequency, inability to empty bladder or constipation and chronic backache in posterior fibroids.
-Reduced fertility has been noted in some fibroid patients and there is increased risk of spontaneous miscarriage.
-Pregnancy with uterine fibroids have more incidences of preterm labor, preterm delivery, placenta previa, placental abruption, intrauterine growth retardation of fetus, premature rupture of membrane. These all lead to increased rate of caesarian section in such patients.
-Anemia- secondary to heavy and long lasting bleeding during menses.
-Fibroids that are attached to uterus by stem may twist causing severe abdominal pain, vomiting and fever requiring emergency procedure to remove them.
– In very rare cases they develop malignant (cancerous) changes.
-Infertilities and miscarriages.
Treatment options : They can be so problematic that a hysterectomy (removal of uterus) is the treatment of choice, but there are much less invasive options available.
“Hysterectomy is still a good option for some women, but for women who want to have children, or for women who want to keep their uterus, hysterectomy is not a good choice,” Women who don’t want to have a hysterectomy can now consider several newer procedures.
Other options include:
1) A laparoscopic myomectomy during which doctors remove the fibroid with microscopic tools. It is minimally invasive approach. There is decreased post-operative pain, and healing is faster due to very minimal surgical cut.
As healing is faster patients are mobilized early and thus no need for long term catheterization and other post op cares.
There is lesser blood loss in laparoscopic approach as compared to traditional open surgeries requiring lesser blood transfusion and other hematinic support.
Laparoscopic or key hole surgery for fibroids are routinely done in our hospital and the patients are active the very next day of surgery.
2) Medical line of management : Tablets are prescribed in less severe cases for 3-6 months, they help to relieve symptoms and in some cases reduce their size. These tablets put patient in amenorrhea (no menstrual flow) for the time period they are taken.
Tablets can be considered for patients who are not fit for surgery like patients with severe anemia or with lot many comorbidities.
Uterine artery embolization to cut off blood supply to the uterus, or Focused ultrasound which involves administering sound waves that break up the fibroids are also practiced however these have the downside that new fibroids may form down the line. And can be offered only to those who no longer want pregnancy.