Uterine Fibroids

Uterine Fibroids Treatment in Hyderabad

Uterine Fibroids, also known as Uterine Myoma are the growth of non-cancerous tumors that develop in a woman’s uterus. The fibroids are constructed out of the uterus muscles and connective tissues. Also known as ‘leiomyomas', while these growths are not directly related to being cancerous, they can cause a variety of inconsistencies in the woman’s body depending upon their size. 

In addition to the size, shape, and location in the uterus, even the number of fibroids has a direct impact on the prolonged effect on the body. The size ranges from being almost undetectable to being a stem-like weighted structure, extending till the ribcage. The fibroids can be located in a woman’s uterine wall, inside the uterus, or even on its outer surface. 

Fibroids are a common phenomenon observed in the female body at any given age however are diagnosed mostly in the case of childbearing years. 

Symptoms

Given that the fibroids don't carry a strong impact on the female body i.e. they don’t show any immediate symptoms in the initial stages, it is almost impossible to diagnose the same individually. In fact, many women might contain these fibroids for their life spans but might not be aware of it till the very end. A pelvic examination or prenatal ultrasound is recommended to be aware of this condition. 

Even so, in the case of an abnormal spread- of multiple branching nodules, a few symptoms commonly noticed, are as follows:

• Dense menstrual bleeding

• Prolonged/extended menstruation (bleeding) cycle

• Pelvic ache and discomfort

• Frequent urination or urinating tendency

• Bad stomach and constipation

• Back pain and sore leg muscles

• Urinary retention

They are generally classified by their location with Intramural fibroids (the most common ones) appearing within the muscular wall, Subserosal fibroids forming outside the uterus (serosa), Pedunculated fibroids being an extension (stem-like) of subserosal ones, and Submucosal fibroids developing in the middle layer known as the myometrium of the uterus. Out of all these, Submucosal is the rarest kind. The growth patterns of these fibroids may also vary from a slow pattern to a plunged growth spurt. One can also expect a change (even a decrease) in the size of these fibroids.

Causes 

Clinical research and experience point out the following directions to map the causes of the fibroids since there are no firm findings on the same-

• Family History and Genetics: Due to a pattern in genetic history, fibroids can be observed which are differing from the normal uterine muscle cells.

• Hormonal Factors: The two hormones, Estrogen, and Progesterone which act as the stimulators in the regeneration of the uterine lining with each menstrual cycle might also be a stimulator in the growth of these fibroids. Comparatively, fibroids have more estrogen and progesterone reception capacity than the uterine muscles. A shrinkage tendency is also observed in them after the menopausal stage due to a loss in hormone production by the body.

• Pregnancy: Fibroids may be developed during pregnancy since the body develops an enhanced level of hormonal secretion.

• Growth-Related Factors: Any additional substances which might alter or be used to maintain the body's hormonal and chemical levels such as insulin can also be singularly responsible for fibroid growth.

• Extracellular matrix or the ECM: Similar to the brick-and-mortar arrangement, ECM is the compound that is responsible for the cells to stick together. It also facilitates a change in growth factors and thus can cause biological changes in the cells leading to the formation of fibroids.

Risk Factors

Other than the female body through reproductive age, some focused risk factors that are known to have an impact on fibroids are as follows:

• Age

Older women are known to be at a higher risk than younger women in case of developing fibroids, say within the age group of 30-40 years. Additionally, experiencing menstruation at a younger age than what is normal can also suggest a hormonal impact which in turn can show up in the form of fibroids.

• Race

A question of some genetic element that increases the tendency of developing severe fibroids is suggested for African-American women through a study.

• Birth Control Measures

The birth control measures like pills or the like leading towards a change in the hormonal composition of the body might lead to a fibroid formation.

• Environmental Factors 

Factors such as diet and eating habits (pointing towards deficiencies or even conditions such as obesity i.e., which are not under the normal healthy body set), a history of abuse leading to overall psychological conditions like stress or anxiety can also lead to an increase in the risk of developing fibroids. Alcohol consumption too can be considered a contributing factor to the condition.

• Family history

It has been observed in the case of traced family histories that if the female members say an individual’s mother or sister has had a history of fibroids, it is most likely that the body of the person in question might have a greater risk or tendency to bear the same. This can be attributed to the cell composition and body characteristics in the family.

Diagnosis

A consultation with your gynecologist will help you identify the problem. The diagnosis process of uterine fibroids includes a pelvic exam through which your doctor will check your uterus for any abnormalities in the size, shape, or condition. After your pelvic exam, you can ask your doctor any questions or doubts you might have about uterine fibroids. You can discuss the number of fibroids, their size, where they are located if they are growing with time, and what are your treatment options. 

Uterine fibroids may also be found during a routine pelvic checkup if your doctor finds any irregularities during the consultation. Once your doctor confirms the presence of uterine fibroids, they may ask for the following tests for getting a proper diagnosis of your condition – 

• Ultrasound: An ultrasound will be the first diagnostic test that your doctor may order to confirm the presence of fibroids. An ultrasound uses sound waves to reflect an image of your uterus. This can help your doctor identify, map, and measure the size of the fibroids. The ultrasound can be done externally, where the device is placed over your abdomen or it can be a transvaginal ultrasound. 

• Blood Tests: Along with an imaging test like the ultrasound, your doctor may also ask you to get some blood tests done to identify the cause for the formation of fibroids. Fibroids can also cause abnormal menstrual bleeding, which could be an indicator of anemia due to blood loss, bleeding disorder, or thyroid issues.

• Magnetic Resonance Imaging (MRI): In case an ultrasound is not sufficient to get a good look at your uterus and the fibroids, your doctor may order an MRI scan that will help them take a better look at the issue. The test will show more details about the size, growth, and position of the fibroids. 

• Hysterosonography: Hysterosonography is also known as a saline infusion sonogram that helps your doctor see the inner lining of the uterus. In this diagnostic procedure, sterile saline water is put in the uterus to allow better visibility of the inner walls of the organ. This test can indicate any serious problems that may be happening due to the fibroids such as infertility due to the fibroids blocking the fallopian tubes. 

• Hysteroscopy: This diagnostic procedure includes the insertion of a telescope-like device in the cervix that allows a doctor to examine the cervical opening and the uterus lining. 

• Computed Tomography (CT) Scan: A CT scan uses X-rays to create detailed images of your internal organs from multiple angles.

• Sonohysterography: This test involves inserting a small catheter into the vagina and injecting saline into the uterus. The added fluid provides a clearer view of the uterus compared to a standard ultrasound.

• Laparoscopy: In this procedure, a small incision is made in the lower abdomen. A thin, flexible tube with a camera is inserted to closely examine the internal organs.

Treatment 

There are various treatment options available for uterine fibroids. Your course of treatment may depend on factors like the number, size, and position of the fibroid, your age, any additional issues you may have, etc. You can consult your gynecologist regarding the available treatment for uterine fibroids and discuss them in detail before making any decision. Some of the common treatments are – 

1. Medications

Medicines for uterine fibroids work by targeting hormones that control your menstrual cycle. They help manage symptoms like heavy bleeding and pelvic pressure. These medications don’t eliminate fibroids but may help shrink them.

Types of medicines include:

• GnRH agonists: These medications reduce the hormones estrogen and progesterone, putting you in a temporary menopause-like state. This stops periods, shrinks fibroids, and improves anemia. Examples include leuprolide (Lupron Depot), goserelin (Zoladex), and triptorelin (Trelstar). Side effects like hot flashes are common, and long-term use can lead to bone loss. They’re often used for no more than six months but may be combined with low-dose estrogen or progestin (add-back therapy) to reduce side effects and extend use up to 12 months. Doctors might prescribe these to shrink fibroids before surgery or help transition into menopause.
• GnRH antagonists: These medications manage heavy bleeding in people who haven’t reached menopause but don’t shrink fibroids. They can be used for up to two years, often with add-back therapy to reduce side effects like hot flashes or bone loss.
• Progestin-releasing IUD: This device can help reduce heavy bleeding caused by fibroids, but it doesn’t shrink fibroids or remove them. It also prevents pregnancy.
• Tranexamic acid: A non-hormonal medicine taken on heavy bleeding days to ease menstrual flow.
• Other medicines:
  • Low-dose birth control pills: Can help control bleeding but don’t shrink fibroids.
  • NSAIDs (e.g., ibuprofen or naproxen): Help with pain but don’t reduce bleeding or fibroid size.
  • Vitamins and iron supplements: Recommended for those with heavy bleeding and anemia.

2. Non-invasive Treatment

A non-invasive procedure to shrink the fibroid size could be a treatment option for you. In an MRI-guided focused ultrasound surgery, an ultrasound transducer is used while the patient is in the MRI scanner to see the exact position of the fibroids, and sound waves are focused on that area to heat the fibroids and shrink them. This technique is non-invasive, requires no incision, preserves your uterus, and can be done as an outpatient procedure.

3. Minimally Invasive Procedures

Multiple minimally invasive procedure options can be considered for removing or shrinking uterine fibroids. The uterine artery embolization procedure is effective in shrinking fibroids. The blood flow to the fibroids is stopped by injecting small embolic agent particles into the arteries that supply blood to the uterus. This causes them to shrink and die and will help in managing other symptoms as well. Another procedure is radiofrequency ablation, where radiofrequency energy is used to shrink the blood vessels to the fibroids, effectively destroying them. Laparoscopic or robotic myomectomy is a procedure where a small incision is made in the abdominal area to remove the fibroids. Hysteroscopic myomectomy may be done if you have submucosal fibroids. In this procedure, instruments are inserted through the vagina and cervix to reach the uterus and remove the fibroids. You may also have the option of endometrial ablation wherein an instrument is inserted in the uterus and heat, current, hot water, or microwaves may be used to destroy the lining of the uterus. Most women who get this procedure done may not be able to get pregnant.

4. Surgical Procedure 

Surgical procedures like abdominal myomectomy and hysterectomy may also be considered if you have large and multiple fibroids that keep returning despite getting other procedures. Abdominal Myomectomy refers to a traditional surgical procedure where doctors remove the fibroids from the uterus. This surgical procedure could cause scarring in the uterus and may affect your chances of getting pregnant. On the other hand, Hysterectomy refers to the complete removal of the uterus and is the only permanent solution for treating uterine fibroids. Consult your doctor before making the decision to go ahead with a hysterectomy as this procedure is permanent. 

5. Traditional Surgical Procedures

Options for traditional open surgeries that involve a larger incision include:

• Abdominal Myomectomy: This procedure removes fibroids through a large incision in the abdominal area. It is often recommended for individuals with multiple fibroids, very large fibroids, or fibroids located deep within the uterus. While it can be an alternative to hysterectomy for some, scarring from the surgery may reduce the likelihood of future pregnancies.
• Hysterectomy: This surgery involves removing the uterus and is the only definitive, permanent treatment for uterine fibroids.
  • A hysterectomy eliminates the ability to have children.
  • If the ovaries are also removed, it induces menopause, after which you may choose to take hormone replacement therapy to manage menopause symptoms like hot flashes.
  • Many people with uterine fibroids can opt to keep their ovaries during this surgery.

Risks

Treatment for uterine fibroids, whether surgical or non-surgical, comes with potential risks. These risks depend on the type of treatment and individual factors. Common risks include:

• Bleeding: Excessive bleeding can occur during or after surgery, particularly with procedures like myomectomy or hysterectomy.
• Infection: Any surgical procedure carries a risk of infection, which may require antibiotics or additional care.
• Damage to surrounding organs: Treatments like surgery or uterine artery embolization may unintentionally affect nearby organs, such as the bladder or intestines.
• Scarring: Surgical procedures, such as myomectomy, can cause scar tissue formation in the uterus or abdomen, potentially affecting fertility or causing pain.
• Fertility challenges: Some treatments may impact the ability to conceive, either temporarily or permanently. For example, a hysterectomy eliminates the possibility of pregnancy.
• Menopause symptoms: If the ovaries are removed during surgery, early menopause may occur, leading to symptoms like hot flashes, mood changes, and bone loss.
• Recurrence: Non-surgical treatments, such as medication or uterine artery embolization, may not completely eliminate fibroids, and new fibroids may develop over time.
• Allergic or adverse reactions: Some people may experience side effects from medications or complications related to anesthesia used during procedures.

Prevention

Not a lot of scientific evidence is available that sheds light on the reasons why women of child-bearing age develop uterine fibroids. This makes it difficult for women to know what could potentially lead to the development of these non-cancerous growths in the uterus. Your doctor may share some common steps that you could take to help avoid getting the fibroids, however, with little scientific evidence available, prevention may not be possible. 

The bright side is that these are non-cancerous growths and often, do not require any form of medical treatment. The risk of getting fibroids can be decreased by following a healthy lifestyle, eating healthy food like vegetables and fruits, exercising regularly, and getting regular gynecology checkups, including options like uterine fibroid embolization in Hyderabad. Some research has also suggested that the risk of getting uterine fibroids may decrease if you take hormonal contraceptives. However, this is not a permanent or viable solution for everyone. Therefore, taking care of your body from a young age and following a healthy lifestyle is the best way to prevent getting fibroids.