Saturday, 8 July 2017

Know More About Fibroids

More than two million women worldwide are operated for hysterectomy every year and approximately one third, that is, 6,00,000 are performed because of fibroids. So what are fibroids? Fibroids are noncancerous growth of the muscle wall of the uterus. Fibroids behave differently depending on their size, location, number and associated disorders and hence have a unique behavioural personality. 30 per cent of women have fibroids and a large proportion of these will become symptomatic later on.

Know More About Fibroids 


Large fibroids in the wall of the uterus, multiple fibroids and fibroids near the inner lining are responsible for heavy bleeding. The normal uterus has two basic ways to stop this bleeding.The first is the blood clotting mechanism that works throughout the body by forming plugs in the blood vessels. The second is unique to the uterus, which has an ability to contract and squeeze the bleeding vessels in the muscular walls. The presence of fibroids possibly does not allow the uterus to squeeze down properly, and so it can’t stop the flow of blood from the vessels and thus it is common for fibroids to cause an increase in the amount of menstrual bleeding.


Fibroids grow because they receive blood flow from the arteries supplying the uterus. They grow at different rates. Some slowly and others quickly. When they grow at a very fast rate, the blood vessels feeding the fibroids may not be able to supply enough blood, resulting in cell death in some parts of the fibroid. This is called degeneration. Due to this degeneration, chemical substances are released that cause pain. This pain can be severe and incapacitating but usually not associated with any other serious problem. An extremely large fibroid can cause pelvic discomfort and a dragging pain continuously. Such fibroids need to be removed. Medicines like anti-inflammatory agents can take away the pain and provide temporary relief.


The uterus lies directly beneath the urinary bladder and they are partially attached at one point. If a fibroid begins to grow forward, it may push the bladder so that it cannot fill properly, this increases the urge to pass urine frequently. Very large fibroids may obstruct the ureters (which is the tube that carries urine from kidneys to bladder), thereby resulting in back pressure changes in the kidney. Such large fibroids definitely need to be removed.


A small group of fibroids may not allow pregnancy. Fibroids that are located close to the inner endometrial lining and those, which distort the uterine cavity can be responsible for infertility. Also very large fibroids can interfere with pregnancy. These fibroids can be easily treated with hysteroscopy (telescope inserted inside the womb). Larger fibroids are removed laparoscopically.

(telescope inserted inside the womb)


Some fibroids, especially the inner lining ones, can interfere with the growth of the developing embryo. These change the internal milieu resulting in a miscarriage. Such fibroids warrant removal hysteroscopically. During pregnancy, fibroids also grow faster.


Fibroids by definition, are benign (non-cancerous) growths. However, very rarely, fibroids can undergo cancerous changes. The incidence is 1:750. Out of all women who have surgery for fibroids one out of approximately 750 would have leiomyosarcoma (fibroid cancer). The treatment in such cases is removal of the uterus and the ovaries if the patient is over 50 years and if her fibroids are growing rapidly.


Once a fibroid has been removed, it doesn’t come back. However, new ones can grow from other muscle fibres. Clinical recurrence occurs in 15-20 per cent of women within 10 years. The recurrence of fibroids does not depend on the technique with which it was removed the first time, but it is solely dependent on genetic tendencies. Women with only one fibroid in the past have a lower recurrence rate, while those with multiple fibroids have a higher recurrence rate. Fibroids that come back can also be treated laparoscopically.


If the fibroids are not very large and without bothersome symptoms a patient can wait. She must get an annual pelvic examination and sonography. If the fibroids are growing rapidly and symptoms appear, laparoscopic removal is advised. Fibroids must be dealt with judiciously and if surgical treatment is necessary, endoscopy is the answer.

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