Friday, April 22, 2011

Patient Education: Fibroids in Uterus

Uterine fibroids ( ഗര്‍ഭപാത്രത്തിലെ  മുഴ) are very common in women. They are benign masses, and rarely cause cancer, and they are not cancer. They don't spread or infiltrate other tissues. They occur in upto 25% of women and are often harmless. Fibroids grow only till menopause, and regress after that. 

They are often incidentally diagnosed, when the patient visits the doctor with some abdominal or menstrual symptoms. A Pelvic Ultrasonogram (Ultrasound scan) reveals the fibroid. It's often better to do by vaginal route. 

 They can occur at different locations in uterus : submucous, subserous or intramural.

They can cause heavy menstrual bleeding or severe pain during menstrual bleeding. But it should be remembered that, not all menstrual problems even in women with fibroids are not due to the fibroids at all, and menstrual problems occur in women without fibroids too. Fibroids rarely cause non-menstrual pain, back ache, urinary or bowel symptoms, leg swelling or pain. They are often wrongly attributed to fibroids. 

The nearer the fibroid to the endometrium, (or deeper the fibroid in the uterus is) the more the symptoms. A small fibroid deep in the uterus can cause more symptoms than a large fibroid on the surface. 

Deeper fibroids can also cause infertility, and may require removal. A surface fibroid may not be the cause of infertility, and if removed by surgery, may lead to infertility due to adhesions of surgery.

There's no medicines to treat fibroids. Often people go for alternate medicines which claim to have treatments for it, and are relieved of symptoms which were wrongly attributed to fibroids in the first place.

Surgery for fibroid can be: myomectomy (removal of fibroid alone) or hysterectomy. Both can be done by laparoscopy or laparotomy (conventional surgery). Myomectomy can also be done by Hysteroscopy. Actually Hysteroscopy is better, since it doesnt cause a scar on the uterus, and often the fibroids which cause the symptoms can be better removed by hysteroscopy, since they are deep in the uterus. But hysteroscopy is risky procedure and requires advanced skills at surgery. 

Recently other less invasive modalities like myolysis, uterine artery embolisation, have been available, but they have not yet come to India.