HC: What are fibroids ?

Dr Gauri: Uterine fibroids (also called as myomas) are non-cancerous (benign) growths that develop from the muscle layer of uterus.

HC: Are all fibroids the same?

Dr Gauri: Fibroids can differ with respect to their size, location, number and by the symptoms that they can produce.

Uterine fibroids are generally classified as:

• Subserous – growth is directed outwards
• Intramural – growth centred within the uterine walls
• Submucosal – growth towards the cavity of uterus

Rarely, fibroids can also form in cervix and broad ligament of uterus.

The size of the fibroids does not seem to be related to the severity of the symptoms. So even a small fibroid (especially submucosal type) can cause considerable symptoms and sometimes a woman with a large fibroid may be asymptomatic.

HC: Who is most likely to develop fibroids?

Dr Gauri: Approximately 60 to 80% of women will have fibroids. The following are some of the risks factors for uterine fibroids:

• Obesity (obese women produce more estrogen)
• Early age at first periods
• Family history of fibroids in mother or sister
• Metabolic syndrome( diabetes+hypertension+high cholesterol+obesity)
• Women with polycystic ovarian disease and irregular periods
• Age (older women are at higher risk than younger women )

HC: How are fibroids formed?

Dr Gauri: The exact cause of fibroids is not well understood but multiple factors play a role in their growth.

• Genetics
• Estrogen and progesterone hormones
• Environment and lifestyle

HC : What are symptoms in women having fibroids?

Dr Gauri: Most women with fibroids are asymptomatic.

However, some may have the following symptoms:

1. Changes in menses
2. Heavy menstrual bleeding
3. Painful menses ( cramps)
4. Irregular bleeding

These women are generally anemic (low hemoglobin) and complain of easy fatigue.

• Pressure of fibroids on surrounding organs can cause
• Difficulty in passing urine or frequent urination
• Difficult bowel movements
• Abdominal cramps
• Back pressure on kidneys causing swelling of kidneys(hydronephrosis)
• Feeling full in the belly

• Pain
• Dull ,aching pain in  abdomen and lower back
• Pain during sexual intercourse

• Difficulty getting pregnant

• Problems during pregnancy like miscarriage, preterm birth and pain in abdomen

• Feeling lump in abdomen or increase in girth of abdomen

HC: What tests are done to diagnose uterine fibroids?

Dr Gauri: Unless a woman has symptoms, it is unlikely that she knows she has fibroids. They can sometimes be detected during routine pelvic examination done by a gynecologist.

Some common types of investigations done are

• Ultrasound- mainstay of diagnosis.
• MRI indicated in large and multiple fibroids
• Hysteroscopy uses a small camera to visualize the inside of uterus.

HC: Is it true that pregnant woman with fibroids have complications in pregnancy?

Dr Gauri: Yes. The following problems may be encountered during pregnancy and childbirth

• Pain: especially in large fibroids more than 5 cm
• Recurrent miscarriage
• Preterm birth
• Premature separation of placenta (abruption)
• More chances of baby being in abnormal position (breech,oblique) thus requiring caesarean delivery.
• Excessive bleeding after delivery of baby .

Generally in pregnancy, fibroids can grow in 30% of patients, shrink in 30% and remain unchanged in 30%. The above mentioned complications are usually seen in patients with multiple fibroids and in whom the fibroids have grown during pregnancy. In the remaining, pregnancy may be uneventful.

Q: If I have fibroids, will it be difficult to get pregnant ?

A: Fibroids can impact fertility in the following cases

• Submucosal fibroids which grow and bulge in uterine cavity
• Multiple fibroids distorting the normal cavity and architecture of uterus
• Fibroids near the tubal opening or in cervical canal.

However it is prudent to also evaluate other causes of infertility before attributing the issue to fibroids.

HC: When is treatment necessary for fibroid uterus?

Dr Gauri: Several factors are considered before recommending treatment to a patient viz;

• Age
• Severity of symptoms
• Location, size and number of fibroids
• General health of the patient
• Whether patient is desiring pregnancy in future

Fibroids that are small and do not cause any symptoms may not need treatment. However surveillance will be important by regular check-up or ultrasound, to watch for increase in size or any obstructive symptoms. This is especially important in a woman nearing menopause where the hormone levels drop and the fibroid may shrink on its own.

Certain conditions which necessitate treatment are:

1. Heavy , painful, irregular menstrual bleeding
2. Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor.
3. Rapid increase in growth of fibroid
4. Infertility
5. Obstructive urinary and intestinal symptoms

HC: Can medicines be used to treat fibroids?

Dr Gauri: Medications can be used as a temporary option in some women to reduce pain and bleeding. Some newer medicines may also help to shrink fibroids. However they have to be taken only under strict medical supervision.

HC: What type of surgery is done for fibroids?

Dr Gauri: Myomectomy is the surgical removal of fibroids leaving the uterus in place.

It can be done endoscopically (laparoscopy or hysteroscopy) or open surgery.

Hysterectomy is the removal of uterus. Laparoscopic and open surgery options are available.

HC: Do fibroids turn Cancerous?

Dr Gauri: Fibroids are almost always benign (non cancerous)

Very rarely (less than 1 in 2000) a cancerous fibroid called leiomyosarcoma can occur.

HC: Can fibroids be prevented?

Dr Gauri: Though they can’t be totally prevented, certain lifestyle habits can reduce your chances of developing fibroids. Regular exercise can help. So also, include plenty of fruits and vegetables in diet. Avoid alcohol, red meat, processed foods and refined sugars. Remember, excess body fat is an important risk factor for fibroids.

I believe our Lifestyle is a major determinant of Health and well being.