Fibroids are the most common benign uterine tumors in women, often appearing during their reproductive life. They are medically known as ‘Leiomyoma’, ‘Myoma’, or ‘Fibromyoma’. They can grow as a single tumor or multiple ones.
Incidence : About 20% of women at age of 30 have uterine fibroids.
Pregnancy and fibroids:
- Usually fibroids don’t interfere with conception and pregnancy.
- Rarely fibroids can cause infertility or pregnancy loss.
- Fibroids entering the cavity may prevent a pregnancy or cause miscarriages.
- Rarely fibroids can distort or block the fallopian tubes.
- Watchful waiting: Fibroids aren’t cancerous. If there is no annoying symptom, watchful waiting is an option.
- Medication: Medication for fibroids target hormones that regulate the menstrual cycle. They don’t eliminate fibroids, but may shrink them.
I} Gonadotrophin- Releasing Hormone Agonist (GnRH): GnRH agonist (Lupron, Synarel) treat fibroids by blocking the production of oestrogen and progesterones creating a temporary postmenopausal state. Side effect include hot flushes, vaginal dryness, and headache.
II} Progesterone – Releasing Intrauterine Device: Some women with fibroid associated heavy menstrual bleeding will benefit from treatment with an IUCD (coil) which release progesterone and this decreases the excessive bleeding.
III} GnRH Antagonist: Immediate suppression of endogenous GnRH by daily subcutaneous injection of GnRH antagonist may result in 29% reduction in fibroid volume within 3 weeks. Treatment, however is accompanied by menopausal symptoms.
IV} Selective Progesterone Receptor Modulator (SPRM) – Ulipristal Acctate (UA) belongs to this group of compounds. It reversely blocks the progesterone receptor in its target tissues and acts as a potent Anti-progestional agent. Recently it has shown efficiency with significant reduction in uterine bleeding and fibroid volume, and without the side effects seen with GnRH agonists. Treatment with oral UA 5mg/day for upto 13 weeks showed 91% control in uterine bleeding and decrease in size of fibroids.
- Non-invasive Procedure:
MRI Guided Focused Ultrasonography (MRgFUS) – Heat created by focused ultrasonogaphy can denature protein and cause cell death. MRI can direct targeting of waves to the fibroid and cause the fibroid cells to die. Advantages are very low complications and rapid recovery.
- Minimally Invasive Procedure:
I} Uterine Artery Embolisation: Small particles are injected into the arteries suppling the uterus, cutting off blood flow to fibroids causing them to shrink and die.
II} Myolysis: This is a laparoscopic procedure. An electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. It is not commonly used.
III}Laparoscopic or Robotic Myomectomy: A scope is introduced through the abdomen and the fibroids are removed from the uterus. It is associated with longer operating time but has reduced blood loss, less operative pain, and fast recovery.Robotic myomectomy gives a magnified 3-D view of the uterus giving more precision and flexibility.
IV} Hysteroscopic Myomectomy: Fibroids that encroach the uterine cavity and associated with increased menstrual bleeding or infertility can be removed hysteroscopically.
- Traditional surgical procedures.
- Abdominal Myomectomy: Open myomectomy (Removal of fibroids) is sometimes done for patients having multiple fibroids or very large fibroids.
- Hysterectomy: Removal of uterus is usually advised for patients with multiple fibroids who have completed their child bearing and are having symptoms of heavy bleeding.
The choice of approach may be dictated by factors such as patient’s desire to become pregnant and symptoms severity.