There are many facts which a woman should know about fibroids. About 30 to 50 % of women in the reproductive age group (about 12 to 45) are likely to suffer from fibroids.
- Fibroids are non cancerous tumours of the uterus.
- They appear and grow only in the childbearing years and often shrink after menopause.
- They grow slowly in most cases and sometimes not at all.
- They may not cause any symptoms (and may be left alone).
- Some of them may cause heavy (and or painful) periods or symptoms due to pressure on the urinary bladder or other adjacent organs.
- Fibroids may present difficulty in conceiving or early abortions or they may not cause any symptoms at all. That would again depend on their size and location within the uterus (whether in the inner or outer or middle part of the uterus).
- Fibroids tend to recur and new ones may appear until you attain menopause.
- Some of them may affect your chances of getting pregnant.
- They usually grow (often rapidly) during pregnancy and may shrink a little after delivery.
- Some of them may increase your risk of miscarriage, premature delivery or caesarean section. Rarely bleeding after delivery may occur due to large fibroids, but is usually manageable.
- Fibroids which cause symptoms or interfere with conception, may need to be treated.
The treatment of fibroids can be undertaken in many ways:
Myomectomy is the surgical removal of fibroid(s) without removing the uterus. This surgery can be performed laparoscopically (the commonest route) or through an abdominal incision or hysteroscopically (through a scope within the uterine cavity). The route of surgery would depend on the location of your fibroid(s). Fibroids located in the wall or its outer part may be removed laparoscopically and those in the inner part of the uterus may need hysteroscopic removal. Open surgery (using large abdominal incisions) is becoming increasingly uncommon, however, may be preferred in some cases with extremely large fibroid(s).
Young women or women who desire childbearing can opt for this surgery.
Hysterectomy is the surgical removal of the uterus along with the fibroid(s). This option works best for women who are older and do not desire future childbearing. Hysterectomy may be performed laparoscopically (the commonest route) or through an abdominal incision.
Uterine artery embolization:
This technique involves blocking of the blood supply to the fibroid(s). A tube is inserted through a blood vessel in the groin and some particles are injected into the uterine artery which supplies blood to the uterus and fibroid(s). This cuts off the blood supply and causes shrinkage and necrosis of the fibroid(s).
Like any other procedure, it has its own side effects and risks, but they are rare in expert hands. Occasionally, the procedure may fail or infection may ensue. Rarely the particles may block some other blood vessel and cut off the blood supply of the organ it supplies. There are some reports that the ovarian blood supply may get reduced or stopped, resulting in premature menopause or reduced fertility. Thus it is not recommended for women who desire to have children in the future.
HIFU (Focussed ultrasound):
The use of high intensity focussed ultrasound is the latest non-surgical on the block treatment for fibroids. Here, under MRI guidance, the fibroid(s) is destroyed using heat generated from highly focussed ultrasound beams. The fibroid(s) undergoes shrinkage and reduces in size and symptoms usually settle down. However, it requires technical expertise and is expensive. Results are usually good, but not guaranteed. It is quite safe if proper precautions are taken and it is performed by skilled personnel. This procedure is performed in selected centres in India, however, it is gaining popularity.
Non-surgical treatments as described above are best suited to patients who are not fit for major surgery or who do not wish to undergo a major surgery.
These are injections containing certain hormones which cause temporary shrinkage of fibroid(s). as mentioned, the effects are short-lived and side-effects may be many. Hence, they are not very popular and are used only in select indications by the gynaecologist.
Thus, all fibroids do not need to be operated upon. Fibroids which are large or which cause heavy or painful periods or which interfere with conception need to be treated. The final decision would depend on your age, symptoms, size and location of the fibroid(s), and whether they are interfering with conception.