Uterine fibroids (treatment)

How to treat fibroids?

Fibroids may be left untreated if they are asymptomatic (no complains) or if they show no significant change in size. The most important treatment is to carefully follow up, initially every 6 months and then yearly via help of ultrasound scan.

There are two types of management, Medical and Surgical.

Medical

• It is conservative management,

• Best fortiny to small sized fibroids

• May be done prior to surgery to shrink the size of a very large fibroid in order to reduce risk of blood loss during surgery.

• Nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen or mefenamic acid, may be used for the pain

• Anti-estrogens and testosterone containing drugs are used a medical therapy of fibroids. Gonadotrophin-releasing hormone (GnRH) analogues help in causing drop in estrogen and progesterone levels hence help in shrinking the size of fibroid.

• Intra-uterine devices containing progesterone like medication help in controlling the fibroid and its symptoms.

• Use of newer anti-progesterone drugs like ulipristal acetate as it helps in controlling the growth of the fibroid.

Surgical management

• Myomectomy – process of removing the fibroid only. The fibroid is removed and open part of uterus stitched carefully with suture material which degenerates itself. It can be done through method of laparoscopy, hysteroscopy or laparotomy. t is a better option for young and child bearing age females (<38 years of age).

• Endometrial ablation – process where lining of uterus is removed by help of lasers, freezing techniques or other methods used to control heavy bleeding. This procedure may cause infertility/ problem in having babies.

• Hysterectomy – process of removing the entire uterus along with the fibroid. This method is better for older aged females or who have completed their family.

• Laparoscopy- process where the fibroids are broken into pieces and sucked out via help of using a machine called morcellation. It is minimally invasive surgical option. Morcellation causes scattering of small particles of fibroids causing fibroids to spread at multiple sites, this is avoided by using endobags.

• Uterine Artery Embolization (UAE) process in which we put small catheter in the blood vessels and block the blood supply of uterus and fibroids size causing them to shrink in size.It is extremely effective and non-invasive method but is a very expensive procedure.

• Myolysis- process of causing destruction to the muscles of uterus via help of laparoscopically introduced laser or liquid nitrogen.

Dos and Don’ts for individuals at high risk

• Exercise- Fat cells increase estrogen levels hence increase the growth of the fibroid. Exercising helps in losing weight and preventing obesity.

• Eating right- Include from fiber ( vegetables, oats and dried fruits), Potassium (citrus food, bananas, avocados and cantaloupes), Green tea , turmeric and dairy products (get your vitamin D). Avoid consuming too much of sugar, red meat, soy milk/beans, tofu, falx seeds, fruit juices and junk food.

• Avoid consumption of alcohol

• Maintain your blood pressure levels- avoid too much intake of salt, exercise, and regularly check your blood pressure.

• Quit smoking

Some important facts about Fibroids:

• It is not a serious condition

• Most cases of Fibroids don’t require any treatment

• There are very less chances of fibroid growing into cancer

• Careful follow up is must in all cases of untreated fibroids

• 30% of women have fibroids after age of 30 years

• Fibroids even after removal of surgery have a tendency to grow again

• In young women with fibroids causing infertility Myomectomy gives excellent results

• Open surgery and laparoscopic surgery have almost similar success rate

• In some complicated cases, open surgery gives better results over laparoscopic surgeries

• During myomectomy procedure if bleeding is not controlled can end up in hysterectomy as a lifesaving procedure

• Laparoscopy if done by expert has excellent cosmetic value

• UAE (uterine artery embolization) is very effective non-invasive method

• Exact cause of fibroid still hasn’t been identified

• Not every fibroid requires Hysterectomy or Myomectomy