I am Dr Mohini Vachhani a Gynaecologist who is going to be regularly updating you with the medical news.
Today I am going to talk about fibroid in the uterus. Ladies don’t get anxious and worried if your Ultrasound or in other words Sonography report says fibroid is found in the uterus.
Fibroids are non-cancerous masses of the muscles of the Uterus. 20% of women, which means one in 5 women, suffer from fibroids.
Although the actual cause of fibroids is not known, increased level of Oestrogen hormone in the body is associated with increased growth of fibroids. After menopause secretion of oestrogen by ovaries reduces and this causes shrinkage of fibroids.
A fibroid may present itself in various ways. There may not be any complaints by the patient and fibroid is accidentally diagnosed on ultrasound examination. It is well known that a fibroid may get undetected from “womb to tomb.” There may be heavy prolonged bleeding with passage of clots (Menorrhagia) resulting in anaemia. There may be a presence of a lump in the abdomen which presents as a firm irregular mass arising from lower abdomen. The fibroid can cause pressure on bladder giving frequent urination. Pressure on rectum gives rise to diarrhoea or constipation. Pressure on the nerves in the back results in Sciatica pain, which starts from back and goes down the leg to the feet. Patient can get continuous dull ache due to changes called “degeneration” in the fibroid. Also presence of fibroid can result in Infertility or even repeated miscarriages. Very very rarely (one in a thousand) a cancerous change called “sarcoma” starts but it happens only when fibroid grows rapidly.
The investigations that are necessary consist of a physical examination of abdomen and gynaecological check-up. An Ultrasound or Sonography examination will confirm a fibroid. A blood examination to check for Anaemia and for Thyroid Function is necessary as Hypothyroidism is associated with heavy periods also.
Endometrial sampling (biopsy of lining of the uterus) is done to rule out cancer. Traditionally D & C is performed using general anaesthesia and sample is sent for histology. However, at “In Sync Gynae Care” we offer one-stop Menorrhagia Clinic where history, gynaecological examination, pelvic Ultrasonography and endometrial sampling is done in one sitting without the need for either anaesthesia or going to a hospital.
The management of a fibroid depends on the symptoms suffered by a woman. If the fibroid is diagnosed on ultrasound examination done for some other purpose and woman has no problem, there is no need to take any action. However annual sonography is necessary to keep check on the size of fibroid.
A woman with symptoms needs to get treated. Anaemic patient with low haemoglobin requires Iron supplements. To stop bleeding, non-operative, operative and very recently destruction of lining of uterus by “hot water balloon,” “Novasure” or even MRI-guided ultrasound treatment is available.
- First line of medical treatment is Hormonal or Non-hormonal oral tablets.
- Second line of treatment is use of hormone containing coil inside the uterus which releases continuous hormone to shrink the fibroid.
- Third line is use of injections every one month to shrink the fibroid.
Non-operative line of treatment is offered in mild symptoms or when uterus is necessary for a woman to have more babies or when circumstances of women do not allow her for operation or she is approaching menopausal age.
Surgical treatment includes removal of fibroid using Hysteroscope i.e. using a camera inside the uterus, with no cut on abdomen or by Laparoscope that is with a cut on the abdomen and camera is put inside the abdomen; destroying lining of the womb by “hot water balloon,” “microwave rays” or “Thermal Novasure Ablation;” shrinking the fibroid by blocking the blood supply to fibroid, by method of “embolisation.” Another new and effective way of destroying lining of womb is with the use of high intensity magnetic resonance guided ultrasound that does not breach the skin. It is delivered in an outpatient setting with minimal sedation and the woman can return to work the next day. Then there is also the possibility of Hysterectomy, which is the removal of uterus with fibroid. This can be done either by vaginal route where a cut is made in the vagina or by abdominal route when a cut is made on abdomen. Newer methods are through keyhole surgery where 2-3 small cuts are made in the abdomen and camera and instruments are inserted through the openings. This is called Laparoscopic Hysterectomy.
In summary, Ladies, once a fibroid is confirmed by Ultrasound, management option depends on what is the need of hour. If woman has no complaints and diagnosis is coincidental then there is no need to take action. However, she should have an annual follow up with the scan. If woman is in late 40s or early 50s and bleeding is not a major problem, i.e. she is not severely anaemic and bleeding does not affect her lifestyle, she can be managed with medical drugs. However, if she is in her 30s or 40s and her family is complete, fibroid is large and it affects her lifestyle and she is anaemic, surgical management is an option after failure of trial of medical management.
So in short, diagnosis of a fibroid on Sonography does not always mean removal of uterus.