03 Jan What are Uterine Fibroids and How are They Managed?
Uterine fibroids are benign (non-cancerous) growths or masses that develop in the uterus in females. These fibroids are classified and named according to their locations in the uterus:
- Intramural fibroids are located in the muscle-containing wall of the uterus.
- Submucosal fibroids extend into the cavity of the uterus.
- Subserosal fibroids protrude to the outer aspect of the uterus.
A point that is important to make here is that fibroids of the uterus are not associated with an increased risk of developing cancers of the uterus and rarely ever develop into malignant tumors.
The exact causes of uterine fibroids are not known, but the following factors are thought to be involved in the development of this condition:
- Genetic mutations – changes in the genes that are programmed for uterine cell development may be involved.
- Hormonal involvement – estrogen and progesterone may cause fibroids to develop as they are involved with the development of the lining of the uterus during each menstrual cycle.
- Various other growth factors – insulin-like growth factor may be involved with fibroid growth as it helps the body to maintain various other tissues.
Most women may not even display signs or symptoms of uterine fibroids but in those who do, the following are signs and symptoms that may be experienced:
- Heavy menstrual periods that may last for more than a week at a time.
- Increased pelvic pain or pressure.
- Increased frequency of urination.
- Difficulty in emptying the bladder.
- Leg or back pain.
Patients should consult with their primary care doctor or gynecologist as soon as possible if they experience problems such as:
- Persistent pelvic pain that doesn’t get better or go away.
- Prolonged and heavy periods that just won’t stop.
- Spotting or bleeding that occurs between periods.
- Not being able to empty the bladder at all.
There are various treatment protocols available for the management of uterine fibroids.
- Patients and their doctors may choose to wait and see if the pathology causes any problematic symptoms in those who are asymptomatic.
- Follow-up ultrasounds or MRI scans are performed to check on the size of the fibroids at regular intervals.
- Gonadotropin-releasing hormones may be prescribed to help reduce the production of estrogen and progesterone.
- Intra-uterine device (IUD) releasing progestin may be used to relieve heavy bleeding caused by the fibroids.
- Magnetic resonance imaging (MRI) guided focused ultrasound surgery (FUS) is performed where a patient is placed in an MRI scanner and sound waves from an ultrasound machine are used to heat and destroy small areas of fibroid tissue.
Minimally Invasive Surgery
- Laparoscopic or robotic myomectomy – small surgical incisions are made in the lower abdomen and pelvis and slender instruments are used to remove the fibroids from the uterus. The robotic version gives a 3-dimensional view of the uterus which offers better precision, dexterity, and flexibility to remove the masses. This is an extremely safe and effective form of therapy for those patients with subserosal fibroids and helps to improve the fertility in those women who are struggling to conceive.1
- Hysteroscopic myomectomy – the fibroids are accessed by using instruments inserted through the vagina and cervix to get to the uterus. This is a useful procedure when the fibroids are contained inside the uterus (submucosal).
- Abdominal myomectomy – in the case of multiple, very large, or deep fibroids, the surgeon may opt to perform an open abdominal procedure to gain full access to the uterus in order to remove the masses.