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Fibroids are abnormal growth of the muscle of uterus known as Uterine fibroids.
It is the most common non-cancerous (benign) pelvic tumor in women.
Very rarely they may turn into a cancerous mass/tumor with chances being less than 2%.
Many a times, they are accidentally found in routine ultrasound examination or during C-sections. Most of the times the fibroids do not have symptoms hence do not require any treatment.
There many synonyms of Fibroids such as, Myomas, Leiomyomas, Fibroma, Fibromyoma, but most commonly they are referred as Fibroids.
The uterus is made of multiple layers of special type of muscle fibers, termed as smooth muscle cells. So, when one of these muscles shows abnormal growth due of some sort of genetic stimuli, they result in formation of small or big mass/tumor.
According to some theories, it is believed that Fibroid are estrogen hormone dependent mass. The hormones cause growth and periodic shedding of the uterine wall lining during each menstrual cycle. Due to this reason it is less common in post-menopausal or shows reduction in size of fibroid in a post-menopausal woman which may have existed previously.
They have tremendously rich blood supply hence during pregnancy when there is increased blood supply and increased estrogen levels it can grow extensively and may complicate the pregnancy.
Fibroids are seen in 20-30 % of women after the age of 35 years. If there is a history of fibroids in any of your family member, it increases your chances by 1.5-3.5 times since 40 % of fibroids show genetic predisposition (run in the family).
• Family history
• Age >30 years
• More common in African American – present at an early age and is more symptomatic
• Dietary factors- consumption of too much of red meat, beer or alcohol, increase your risk of developing fibroids.
• Fibroids are classified very simply according to the position of fibroid.
• The ones which occur in the wall of the uterus are called intra-mural and are the most common type.
• Submucosal fibroids are the ones which are found in the inner lining of uterus and when they project outside of uterus they are called pedunculated.
• Few fibroids are found within the outer layer of uterus are known as subserosal Fibroids.
• Few are found in the the cervix are called cervical fibroids.
The symptoms vary according to the size and position of the fibroids. In most of the cases it causes no symptoms especially when they are small in size.
• Increased bleeding- The lining inside of the uterus (endometrium) gets shredded under effect of hormones during menstruation and is responsible for bleeding. In case of fibroid the surface area increases hence causes more bleeding.
• Increased cramps/ pain- since the body treats fibroid as a foreign body and tries to expel it outside by contractions. It fails to expel it out and keeps causing more and more contractions which result in spasm like pain.
• Increased duration of menstrual cycle
• Increased urination and passage of stool- fibroids cause pressure on urine bag or the urine tubes or the rectum.
• Incomplete feeling after passing urine
• Low pelvic or low back pain
• Pain during sexual intercourse.
In general, symptoms also vary according to the age of the female. In very young girls it may cause menstrual problems and dysmenorrhea (Pain during menstruation).
In married women it may interfere with conception and also increased chances of having an abortion.
In pregnant women it may cause late abortions, preterm deliveries, fetal growth restriction inadequate labor pain, obstruction in labor (cervical fibroids) and etc. in women nearing menopause it may cause more bleeding and pain.
Fibroids usually don’t complicate unless they become very grows in size as the center of fibroid is not able to get enough blood supply and starts to degenerate, showing changes in its structure and may also cause increase in the pain.
• Spotting or heavy bleeding between your periods
• Continuous sever pain
• Difficulty in emptying your urinary bladder
• Fainting, lightheadedness or shortness of breath – caused due to lower numbers of red blood cells (Anemia)
• It is easiest, cheap and convenient method.
• It may be done trans-abdominally (probe of kept on the tummy) or transvaginal (thin cylindrical probe is introduced through vagina).
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.
• 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
• It is not a serious condition
• Most cases of Fibroids don’t require any treatment
• There are very less chances of uterine 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 uterine 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
M.S Obstetrics & Gynecology
Diploma Endoscopy , CICE (France)
Infertility Specialist, NUH (Singapore)
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