Fibroids or leiomyoma are benign smooth muscle tumours of the
uterus which are most commonly seen during the child bearing ages of
women. Fibroids are very common and some series of studies have put the
incidence of these at 5-7%. This means that out o every 100 women 7 will
suffer from fibroids and maybe 3-4 out of them will require surgery.
The exact cause of fibroids is not known, but oestrogen is known to play a major role in the development and growth of fibroids. This is demonstrated by the absence of fibroids in post menopausal women. But how exactly does oestrogen affect the growth of fibroids is not clearly known. Other than oestrogen, genetic factors have also been implicated in the development of fibroids. Other than this not much is known about the development of fibroids.
These benign tumours originate from the smooth muscle cells of the uterus. A cross section of the fibroid is likely to show whorls of smooth muscle cells arranged in a circular pattern. The size of these may vary from small fibroids measuring a few millimetres to huge fibroids weighing many kilograms.
The major symptoms of fibroids are
1. Abnormal vaginal bleeding: It can take many forms. Women may notice heavy bleeding during periods or inter-menstrual bleeds. They may also have prolonged bleeding lasting many days. In fact bleeding is the commonest way with which fibroids present.
2. Pain abdomen: Pain localized to the lower abdomen and pelvis is a very common symptom of fibroids. The pain is typically dull or dragging in nature and is constant. It may be aggravated by prolonged standing or lifting weights. In some cases fibroids may cause a sharp pain in pelvis. This is especially true during pregnancy, when under the influence of oestrogens; they enlarge in size and may degenerate with bleeding into the fibroid. This is known as red degeneration and is associated with severe pain abdomen, fever, and signs of systemic infection. But there is no systemic infection.
3. Urinary symptoms: The fibroid may press on the bladder or ureters causing frequent urination and urinary obstruction. The obstructed flow of urine may lead to recurrent URI.
4. A Pelvic Mass may be palpable, if the fibroid is large enough. Medical history is replete with anecdotes which mention fibroids weighing as much as 13 kilograms and extending way into the abdominal cavity.
5. Infertility: Fibroids very rarely cause Infertility. This is exceptionally rare and infertility should never be attributed to fibroids alone unless all other causes have been ruled out after exhaustive investigation.
6. Recurrent Abortions: Sub mucosal Fibroids may lead to recurrent abortions. This is seen only in sub mucosal fibroids and the other types of fibroids do not cause recurrent abortions.
The diagnosis of fibroids is a combined clinical and imaging based. Based on the history of complaints, the doctor would like to do a pelvic exam. A pelvic exam is mandatory to assess the size of the uterus and also to assess any other co-existing pelvic diseases.
This is followed by a pelvic ultrasound. Ultrasound imaging is a simple, cost effective and very accurate way to diagnose fibroids. Ultrasound scans will be able to tell us the number, size and position of these fibroids. USG will also be able to assess the local pelvic anatomy and any distortion of the pelvic architecture due to fibroids.
Once fibroids are diagnosed, the management depends on the symptoms and distress level of the lady. Fibroids do not have any medical management. This means that there are no drugs which can shrink these fibroids and surgery is the only option. Therefore the management is dictated by the need to conserve fertility or not. If a woman is not desirous of future fertility, then the best course of action will be a hysterectomy. However if there is a requirement to conserve fertility then conservative measures need to be undertaken. The measure undertaken in these cases is a myomectomy, wherein the fibroid is removed by surgery. This is just a temporary measure as these myomas tend to grow again, but it is the best that can be done under these circumstances.
The exact cause of fibroids is not known, but oestrogen is known to play a major role in the development and growth of fibroids. This is demonstrated by the absence of fibroids in post menopausal women. But how exactly does oestrogen affect the growth of fibroids is not clearly known. Other than oestrogen, genetic factors have also been implicated in the development of fibroids. Other than this not much is known about the development of fibroids.
These benign tumours originate from the smooth muscle cells of the uterus. A cross section of the fibroid is likely to show whorls of smooth muscle cells arranged in a circular pattern. The size of these may vary from small fibroids measuring a few millimetres to huge fibroids weighing many kilograms.
The major symptoms of fibroids are
1. Abnormal vaginal bleeding: It can take many forms. Women may notice heavy bleeding during periods or inter-menstrual bleeds. They may also have prolonged bleeding lasting many days. In fact bleeding is the commonest way with which fibroids present.
2. Pain abdomen: Pain localized to the lower abdomen and pelvis is a very common symptom of fibroids. The pain is typically dull or dragging in nature and is constant. It may be aggravated by prolonged standing or lifting weights. In some cases fibroids may cause a sharp pain in pelvis. This is especially true during pregnancy, when under the influence of oestrogens; they enlarge in size and may degenerate with bleeding into the fibroid. This is known as red degeneration and is associated with severe pain abdomen, fever, and signs of systemic infection. But there is no systemic infection.
3. Urinary symptoms: The fibroid may press on the bladder or ureters causing frequent urination and urinary obstruction. The obstructed flow of urine may lead to recurrent URI.
4. A Pelvic Mass may be palpable, if the fibroid is large enough. Medical history is replete with anecdotes which mention fibroids weighing as much as 13 kilograms and extending way into the abdominal cavity.
5. Infertility: Fibroids very rarely cause Infertility. This is exceptionally rare and infertility should never be attributed to fibroids alone unless all other causes have been ruled out after exhaustive investigation.
6. Recurrent Abortions: Sub mucosal Fibroids may lead to recurrent abortions. This is seen only in sub mucosal fibroids and the other types of fibroids do not cause recurrent abortions.
The diagnosis of fibroids is a combined clinical and imaging based. Based on the history of complaints, the doctor would like to do a pelvic exam. A pelvic exam is mandatory to assess the size of the uterus and also to assess any other co-existing pelvic diseases.
This is followed by a pelvic ultrasound. Ultrasound imaging is a simple, cost effective and very accurate way to diagnose fibroids. Ultrasound scans will be able to tell us the number, size and position of these fibroids. USG will also be able to assess the local pelvic anatomy and any distortion of the pelvic architecture due to fibroids.
Once fibroids are diagnosed, the management depends on the symptoms and distress level of the lady. Fibroids do not have any medical management. This means that there are no drugs which can shrink these fibroids and surgery is the only option. Therefore the management is dictated by the need to conserve fertility or not. If a woman is not desirous of future fertility, then the best course of action will be a hysterectomy. However if there is a requirement to conserve fertility then conservative measures need to be undertaken. The measure undertaken in these cases is a myomectomy, wherein the fibroid is removed by surgery. This is just a temporary measure as these myomas tend to grow again, but it is the best that can be done under these circumstances.
No comments:
Post a Comment