Fibroid Uterus
Overview
Risk Factors
Multifactorial, more common in childbearing agegroup. Growth of fibroids is dependant on female hormones, i.e estrogens and progesterones.
- Not having children
- Family history
- Obesity
- Early age of menarche
- Late menopause
Symptoms
- Heavy menstrual bleeding, which can be in form of increased flow, passage of clots or prolonged cycles.
- Dysmenorrhoea or painful periods.
- Pain lower abdomen
- Difficulty in passing urine or retention of urine.
- Frequent urination.
- Constipation rarely.
- Backache.
- Difficulty in conception
- Recurrent abortions
Types
- Submucous: Located towards the uterine cavity
- Subserous: Located towards the outside of uterus
- Intramural :Placed inside the uterine wall.
Diagnostic Modalities
Clinical Examination: Per vaginal examination done by clinician.
Ultrasound: First line investigation of choice.
Transvaginal sonography(TVS) is more accurate than transabdominal ultrasound(TAS).
Saline Infusion Sonography (SIS)
Hysteroscopy: Useful for the diagnosis of fibroids located inside the uterine cavity.
MRI: Highly sensitive modality. Helps to differentiate fibroids from adenomyosis. Also useful in diagnosis fibroids with malignant change.
Treatment
Expectant Treatment: In asymptomatic cases. Yearly follow up recommended.
Medical treatment: Effective in certain cases. Various options include NSAIDs, Combined Oral contraceptives and other hormones. SPRMs, GnRH analogues are also used in selective cases.
Surgery Management
Myomectomy: Removal of only fibroid, is done in patients who wish to preserve the uterus, family is not complete, or in young patients. Chances of recurrence after surgery is 30-40%.
Myomectomy can be performed by Laparoscopic, hysteroscopic or abdominal route.
Hysterectomy: In perimenopausal patients, where family is complete hysterectomy is preferred. Hysterectomy can be performed by abdominal or laproscopic route.
Uterine artery embolization: Also used in patients who wish to preserve uterus.