Uterine Fibroids Treatment : Overview

Uterine fibroids are noncancerous tissue growths that develop in the uterus during a woman’s fertility years. Uterine fibroids can grow as tiny as a seed to a large bulky mass and yet enlarge the uterus. Some fibroids are so bulky that they can expand the uterus and thus add weight. Uterine fibroids are common in a majority of women, however, in most cases, it goes undetected due to no symptoms. The fibroids might just be visible during a pelvic examination or prenatal ultrasound.

Clinical research suggests there are a lot of reasons for fibroid development. It prominently appears during the reproductive years of a woman and therefore could be associated with the following.   

• Genetic Factors: Fibroids are known to run in families, suggesting a genetic component in their development.
• Hormones: Hormones largely influence uterine fibroids. With estrogen and progesterone stimulating the development of the uterine wall during the menstrual cycle, it could promote the growth of fibroids. Fibroids are made up of estrogen and progesterone receptors. In some cases, fibroids tend to shrink post-menopause due to less hormone production. Insulin also might be a reason to trigger fibrous development.
• Age and reproductive status: Fibroids are most commonly diagnosed in women between the ages of 30 and 50, and they tend to shrink after menopause when hormone levels decrease.
• Obesity: Studies suggest that obesity may increase the risk of developing uterine fibroids.

Common symptoms of uterine fibroids include:

• Heavy bleeding during menstruation
• Prolonged menstrual periods (more than 7 days)
• Pain or pressure on the pelvic pressure
• Frequent urge to urinate
• Difficulty or incomplete emptying of the bladder
• Constipation
• Backache or leg pain

There are three main types of uterine fibroids: 

1. Intramural Fibroids: Fibroids that grow within the uterine wall are called intramural fibroids.

2. Submucosal Fibroids: Fibroids that develop just beneath the lining of the uterine cavity.

3. Subserosal Fibroids: Fibroids that develop on the outer surface of the uterus. 

Uterine fibroids are diagnosed by the following procedures:

• Ultrasound: This procedure makes use of sound waves to take a picture of the uterus from the inside through an ultrasound device to scan, map as well as measure the size of uterine fibroids.
• Lab Tests: A doctor might recommend a blood test including CBC to check if the patient is anemic. In case of abnormal menstrual bleeding, these investigations help check bleeding disorders or thyroid problems.
• Magnetic Resonance Imaging (MRI): The MRI technique gives better visibility and findings in terms of the size and location of uterine fibroids. This can further help the doctor decide the type of treatment. MRI technique is mostly suggested in women approaching menopause or with a larger uterus.
• Hysterosalpingography: This procedure makes use of a dye to highlight the uterine cavity and fallopian tubes to map on the x-ray. This procedure is used to check in case of women attempting pregnancy to check if the fallopian tubes are open or blocked due to submucosal fibroids.
• Hysteroscopy: This procedure too injects saline water into your uterus for expanding the urethral cavity and then the doctor inserts a small lighted telescope called a hysteroscope to take images of the interiors of the uterine wall as well as the opening of the fallopian tubes. This procedure is usually done in women attempting pregnancy or with women who have heavy menstrual bleeding.

Fibroids can be treated in various ways depending on the size, location, and symptoms they carry. The doctor suggests a treatment depending on your overall condition.

• Fibroid Embolization: This treatment procedure is done to shrink a fibroid. Your healthcare provider will inject polyvinyl alcohol (PVA) into the arteries that feed the fibroid. This blocks the supply of blood to the fibroid thus shrinking its size. It is a minimally invasive procedure where you can leave home the same day or the next day. In some cases, you might need to stay longer in case of any complications. 
• Endometrial Ablation: In this procedure, a doctor destroys the lining of the uterus to cut down on the bleeding that is linked to tiny fibroids.
• Myomectomy: It is a surgical procedure done to remove uterine fibroids. If you plan to get pregnant, your healthcare provider may recommend this over other procedures. This procedure can cause minimal scarring leading to infertility in rare cases. It is recommended that you wait four to six months after surgery before you try to conceive. A surgeon may use a hysteroscope or laparoscope to remove the fibroids by making a tiny cut on your abdomen. 
• Hysterectomy: This is a surgical procedure to remove the uterus. You won’t be able to get pregnant after this operation.

Some of the risks associated with uterine fibroids include:

• Heavy OR Prolonged Menstrual Bleeding: Fibroids can cause heavy menstrual bleeding, which can lead to anemia or iron deficiency.
• Pain OR Pressure In The Pelvic Region: Large fibroids can cause pressure or pain in the pelvis or lower back, and may interfere with sexual intercourse or bowel movements.
• Infertility OR Pregnancy Complications: Fibroids can interfere with fertility and increase the risk of miscarriage, preterm labor, and other pregnancy complications.
• Urinary Problems: Large fibroids can press against the bladder, causing urinary frequency, urgency, or incontinence.

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