Definition and Prevalence
Fibroids, also known as leiomyomas, are the most frequently occurring benign, or non-cancerous, tumors found in the uterus of women during their reproductive years.
Symptoms and Effects
In many cases, fibroids do not present any symptoms and remain asymptomatic, leading to few or no complications. While often benign, fibroids can sometimes result in a range of symptoms. These may include heavy menstrual bleeding, pain during menses, irregular periods including frequent periods, intermenstrual spotting or sensations of pressure in the lower abdomen or lump in abdomen.
The classification of fibroids is based on their location within the uterus, which can be broadly categorized into types: submucous (situated next to or within the uterine cavity), intramural (found within the muscle layer of the uterus), serosal, or subserosal (located near or below the outer uterine surface). As a general rule, the closer a fibroid is to the uterine cavity, the more noticeable the associated symptoms tend to be.
Specific Types of Fibroids
– Submucous or Intracavitary Fibroids: These can lead to heavy menstrual periods, unexpected bleeding between cycles, and sometimes pain during menstruation.
– Intramural Fibroids: Often, these remain asymptomatic for extended periods without presenting any issues.
– Subserosal Fibroids: They typically create fewer menstrual complications, although they can exert pressure on the urinary bladder or ureters.
Fibroids and Pregnancy
During pregnancy, fibroids can undergo degeneration, which is a common occurrence. Larger submucous fibroids may lead to complications such as miscarriage, growth restriction in the baby, and, in rare cases, difficulty achieving pregnancy. Moreover, any fibroids can cause excessive bleeding post-delivery, which can lead to low hemoglobin levels due to significant blood loss.
Additionally, fibroids may be linked to an increased thickness of the uterine lining, which can cause hyperplasia, giving rise to a small risk of developing cancer (approximately 0.01%).
Diagnosis: The diagnosis of fibroids can typically be confirmed through examination and ultrasound imaging, although an MRI may be necessary in certain instances to provide additional information.
Treatment Options: For those experiencing symptoms, treatment becomes essential. This may include addressing anemia and employing medications to manage bleeding or to shrink the fibroids themselves. For patients with asymptomatic, smaller fibroids, careful observation is possible until they either manifest symptoms or increase in size. Conversely, large asymptomatic fibroids that cause the uterus to enlarge generally require treatment in the form of surgery
Surgical Interventions: In the case of a single large fibroid in a young patient, a myomectomy, which involves the removal of only the fibroid while preserving the uterus, may be performed. This procedure can be done either by laparoscopy or hysterscopy or through an abdominal incision depending upon sie and location of fibroid. The main advantage is that it helps conserve the uterus and offers the possibility of future pregnancies. However, there is a risk of recurrence, meaning the fibroid can occur again or new small fibroids may develop, or fibroids which were microscopic earlier increase in size along with the potential for further bleeding. Pregnancy after myomectomy can be risky as it includes major risk of rupture of uterus and adherent placenta.
For older patients who have completed their family, with multiple fibroids that are substantial in size, a hysterectomy, which entails the removal of the uterus, may be the preferred surgical option which can be done laparoscopically or by an abdominal inscion.
Alternative treatments that allow for the preservation of the uterus include use of medicines and uterine artery embolization(UAE) . Medicines may shrink the fibroids, but not completely eliminate them.
Conclusion
Understanding fibroids and their potential impact during pregnancy is crucial for women navigating this significant phase of life. While many may not experience symptoms, awareness of the possible complications they can cause is essential. Early diagnosis through ultrasound or MRI can facilitate timely interventions, whether through medication or surgical options. If you suspect you have fibroids or are concerned about their effects on your pregnancy or overall reproductive health, it’s vital to consult with a healthcare provider.
Take charge of your health today—schedule a consultation to discuss your options and ensure the best possible outcomes for you and your baby with our expert at Dr Anuya’s Gynoworld For Motherhood and Beyond…
ABOUT DOCTOR
Accomplished Obstetrician with vast experience in high risk pregnancy and various gynaecological surgeries.
