Uterine fibroids, also known as leiomyomas, are noncancerous tumours that can be found in the uterus and the uterus lining. Although the tumour might seem a serious threat, the fact that the fibroids are not likely to develop into any form of cancer is a relief. The smaller fibroids don’t pose any serious threat and don’t require treatment; they are often asymptomatic and will go away. Larger fibroids, however, come with a possibility of complication as they are likely to create issues in the menstrual health and complications in pregnancy in the long term.
When the fibroids seem to have outgrown the uterine capacity, they need to be treated with proper medication or surgery. Symptoms of fibroids include heavy menstrual bleeding, back pain and frequent urination.
The fibroids are diagnosed either through the routine pelvic examination or through ultrasound and other imaging tests. It is usually detected as the size of the uterus seems irregular.
TYPES OF FIBROIDS
The uterine fibroids are classified into three major types, primarily on the basis of location.
1 Submucosal: They are found in the uterine cavity. These fibroids hang in the cavity.
2 Intramural: They grow and develop in the muscles of the uterine walls. On the basis of positioning inside the uterine walls they are further classified into anterior, posterior and fundal fibroids.
3 Subserosal: They project themselves outside the uterine walls. The growth of the fibroid goes beyond the uterus.
CAUSE OF FIBROIDS
One of the major challenges in successfully preventing the growth of uterine fibroids is that the actual cause for the condition is yet to be understood in absolute possibility. But through years of diagnosis we have been able to pinpoint a few factors that increase the risk of uterine fibroids. Fibroids are diagnosed in women of reproductive age. The drastic hormonal change in the body is said to be the cause of the growth of fibroids in the uterus. They usually shrink when hormone production slows down during the menopause stage.
Fibroids can vary in size, number and location within or on your uterus, so the chances of risk caused by the fibroids will vary. Fibroids can be seen as a single nodule or as in clusters or even larger. The issues caused by fibroids will vary depending when the fibroid was formed in the uterus. The common risk factors for fibroid formation are:
History of fibroids: A family history of fibroids increases the risk by three times. The growth of fibroids is seen in older women as they have a higher risk than younger women.
Obesity: Obesity is another risk factor for fibroids in menstruating women. If the woman is considered obese it will result in the growth of fibroids.
Lifestyle: Eating red meat increases the risk of developing fibroids, which can be only reduced by eating plenty of green vegetables. Having a proper diet plan with plenty of fibre-rich food and liquids helps in the reduction of fibroid growth in the uterus.
Over-the-counter pain medications: These medications are given only to manage the discomfort and the pain caused by the fibroids, as these medications include acetaminophen, which is used to relieve the pain and reduce the fever. Also, ibuprofen is given to relieve inflammation, swelling and pain.
Gonadotropin-releasing hormone (GnRH) agonists: These medications are taken via nasal spray or injection that help in shrinking the fibroids. These medications are also used before the surgery to remove the fibroids.
Oral therapies: Elagolix is a new oral therapy indicated for uterine bleeding in people who haven’t experienced menopause with symptomatic uterine fibroids. Advice from a medical professional is required as these medications are to be used for up to 24 months. Iron supplements will be given if there is heavy bleeding, which makes them anaemic.
Surgery: The sustenance of the fibroids for a long period of time can cause complications for women during pregnancy and also while conceiving. If the size of the fibroids present in the woman’s uterus is large, doctors will suggest surgical removal of the uterus through laparoscopic myomectomy. This is suggested in specific cases only and is performed by a team of experts in laparoscopic surgery.
Uterine fibroids are treated with both medication and surgery. The doctor will suggest surgery as the final resolve to treat fibroids that outgrow the size of the uterus as they can cause severe complications than smaller fibroids. The surgical method also varies based on the size and location of the fibroids. Medication is advised when early detection of small fibroids is found in the uterus.
The writer is senior consultant obstetrician and gynaecologist, Apollo Cradle & Children’s Hospital, Jayanagar, Bengaluru.