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Fibroids, myomas, fibromyomas are very common tumors (swellings in simple language) of the womb (uterus). A cause of serious concern to women as there is a fear of any tumor being a cancer. Even a small little fibroid can cause huge concerns in some affected women while on the other side of the spectrum there are women who have massive fibroids no symptoms and therefore continue harboring them. Sometimes the structure and the function of the womb is
distorted to an extent needing removal but women still continue to hold on to them for fear of surgery and its complications.
The womb (uterus) is made of a layer of special muscles which are necessary to perform the function of enlarging to accommodate the growing baby when the woman is pregnant and to push the baby out during delivery. In a non-pregnant woman, it helps in expelling the menstrual blood and in a woman undergoing miscarriage it helps in expelling the products of conception ( abortus ). This special muscle has the capacity to grow thus under the influence of important reproductive hormones such as estrogen and progesterone. The tumorous growths of this special muscle of the womb called as the myometrium are fibroids. They consist of the connective tissue and the muscular tissue
In the recent times, the genetic background has been identified to be the cause and these are different genes for different types of fibroids. Some women can have a small fibroid, while some with one or two massive ones or others can have multiple small fibroids. Irregular hormonal stimuli, nutritional deficiencies have also been identified as contributory factors to cause fibroids
Obesity, vitamin B 12 deficiency, folate deficiency, nulli-gravid women (never conceived), family history of fibroids, Asian ethnicity, delayed pregnancy planning are some identified risk factors. But all may not be in synch and despite all these preventive measures women will still have fibroids.
Yes, the fibroids seem to be on rising. This can be due to better identification of this condition by sonography, changed lifestyle and stress, nutritional deficiencies due to wrong dietary practices, delayed conceptions.
Fibroids are commonly non-cancerous growths. Rarely there can be cancer but this is usually seen in older women or in a fast-growing tumor. By and large, fibroids are benign.
Fibroids are diagnosed when women present with heavy or abnormal menstrual bleeding. Sometimes they can be diagnosed when women present with difficulties in passing urine or stools, or when women have recurrent miscarriages or when women are unable to get pregnant. Sometimes women may be diagnosed as an incidental finding when a sonography has been performed as a part of health evaluation or for workup of some other disease.
Most of the fibroids are without any symptoms. but symptomatic fibroids are associated with heavy or abnormal uterine bleeding, painful bleeding, inability to conceive ( infertility), obstructive or pressure symptoms such as urinary retention or constipation, backache. Clinical examination helps the doctor to diagnose and sonography helps in confirming the diagnosis with more details.
First, it confirms that it is a fibroid, it tells us about the size, numbers, presence of vascularity, degeneration and location in the context of the womb. The location is important especially in situations where infertility is to be evaluated and to plan appropriate surgery. In addition, it also informs about the level of distortion caused by the fibroids and the uterine cavity whether it is obliterated or its lining has increased.
Fibroids are treated either with medicines which give symptomatic relief or hormone modulators which can help installing the growth or hormones which can influence the growth and help in avoiding a surgery. Some fibroids may not be treated and the woman may be guided to just be under careful surveillance on a 6 monthly basis. Fibroids can be treated by conservative surgery called a myomectomy where only the fibroid is removed and the womb is sutured back or a definitive surgery where the womb is removed ( hysterectomy )( http://drgirijawagh.com/hysterectomy-removal-of-womb)
The severity of the disease, effect on daily lifestyle and the normal functionality of the woman, age of the woman, size and location of fibroids, the rate of growth, suitability of medications decide the choice of treatment in fibroids.
Shivani is 26 years old recently married young dancer who presents with severe vaginal bleeding. She has been having this complaint for the past 7-8 months but had taken some painkillers then. This time the bleeding was very heavy and she came for consultation. Examination revealed a huge mass equivalent to a mid-size papaya and she had severe bleeding. She was hospitalized and sonography revealed that there was a huge vascular mass arising from the
womb and occupying the entire womb. Her lab tests revealed severe anemia so blood transfusions were given. Some medications were given to stop the bleeding and to shrink the fibroids. She was then posted for laparoscopic myomectomy wherein a laparoscope is used to remove the fibroid and keep the womb intact. After 2 years she conceived and had to be delivered by a planned cesarean section as she had undergone myomectomy.she is perfectly
Sunita is a 32 years old woman who has been married for 7 years but had avoided pregnancy as she had educational and career demands. She has been trying for 2 years now and is unable to conceive. She suffers from very heavy and painful bleeding. Sonography revealed a 3cm by 2cm by 2cm intra-cavitatory fibroid ( sub-mucous fibroid). This was removed by hysteroscopy (telescope which is inserted in the womb ) and she conceived after 8 months and went on to have a healthy baby girl.
Renuka had a fibroid and this was diagnosed during her second pregnancy. Her pregnancy continued uneventfully. At the time of cesarean delivery (done for cephalopelvic disproportion as she is short), the fibroid was noted on the uterine wall well burrowing inside (intramural fibroid ). After her delivery after 3 months, a LNGIUS ( intrauterine hormonal system ) was placed in her womb to prevent the growth of the fibroid and associated excessive bleeding. It’s been 13 years now and she is pain-free and the fibroid too has not grown in size nor have new ones come
Fibroids are common and here to stay. They do not always mean cancer, surgery or any
serious adversity. But they need to diagnosed early and treated appropriately.
Dr. Girija Wagh, MD (Obstetrics & Gynaecology), FICOG, FICP, Diploma (Endoscopy, Infertility), Fellowship of Indian College of Ob-Gynec, Women health care specialist, Academician, Acclaimed Orator & Researcher, B. J. Medical 1990-1992, Topper University Of Pune 1992
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