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Uterine Fibroids: Types, Symptoms and Options for Management


Uterine Fibroids

You visit a gynecologist with heavy periods and the gynecologist gives you a news. You have a fibroid in the uterus. Like most of people, you will be alarmed with this news because Dr. Google tells you that fibroid is a tumor in the uterus.

But my sister, tumor is just an abnormal growth in the body and most of the tumors are benign and the fibroid is no exception. 

In this post, we will be talking about this common gynecological problem which is known as fibroids. So what are fibroids? What causes fibroids? Should they be treated? Should they not be treated? Should we be doing a surgery for them? When to do a surgery? What type of surgery? And a lot more. 

What are Fibroids? 

Fibroids are non-cancerous growths of the uterus which actually appear during the childbearing years. The risk of fibroids developing into cancer is very very minimal. Fibroids are also known as myomas or leiomyomas. 

The fibroids could vary in size from a very small tiny seedling size to so much so that it can actually become very big, reach the rib cage also can actually distort the uterus also. 

They can be single also they can be multiple also so much so that the entire uterus is studded with the fibroids. The fibroids could be absolutely asymptomatic which means that they are not causing any symptoms while there could be a small fibroid that too is causing severe symptom.

 Types of Uterine Fibroids 

1. The most common type of uterine fibroid is intramural fibroid, this is the commonest type of the fibroid and it typically appears in the muscle of the uterine wall. 

2. There is another fibroid which is known as sub-serosal fibroid, this typically starts forming on the outer layer of the uterus which is known as serosa. 

3. Sometimes these sub-serosal fibroids may actually outgrow from the uterus, develop a small stem and actually form what is known as a pedunculated fibroid. So its actually hanging in there from the uterus. 

4. There are some kind of fibroids which are known as submucosal fibroids. These fibroids actually start forming in the muscular layer of the uterus but ultimately they start protruding inside the uterine cavity. Now these fibroids are actually the culprits behind the heavy and the painful periods. 

Causes of Uterine Fibroids 

What causes the fibroids? Till now as doctors we really do not know what exactly causes the fibroids. Why some women develop it and why some women do not develop it, we really do not know the cause. Fibroids are actually estrogen dependent tumors. So that's why the fibroids tend to increase in size during pregnancy and after menopause they typically shrink in size. 

There are some genetic theories also. It is said that in case your mother, sister or grandmother had a fibroid uterus, your possibility of having a fibroid also increases. 

Also certain races like Africans, Black Americans have been found to have increased incidence of fibroids. 

There are other factors also which probably could increase the risk of uterine fibroids. These are, onset of menstruation at an early age, high BMI, drinking alcohol, taking diet which is rich in red meat, taking a diet which is less in plant-based options also increases the risk of fibroids. 

Symptoms of Uterine Fibroids 

So do all fibroids cause a symptom? No, not really. Sometimes even big fibroids may be just sitting there and not really causing any symptom. While a tiny small fibroid which is probably submucosal (is in the cavity of the uterus) may cause a very heavy bleeding. But there are some typical symptoms of fibroid.

1. They may cause heavy bleeding, menstruation which is longer than usual. 

2. They may cause pain in the lower abdomen, pain in the back, periods which are very painful, uterine cramping. 

3. They can cause increased frequency of urination which means that you feel like passing urine very frequently. 

4. Sometimes there could be actually inability to pass urine, there could be constipation, you may actually feel a fibroid in case the fibroid is actually very big. 

I still remember I had a young girl who came to me and her only complaint was that she was not able to pull up her jeans and zip it up. So that's how unusual it can be also. 

5. It can also cause infertility, it can cause abortions, it can cause pregnancy complications, example, bleeding in pregnancy, there could be decreased growth of the baby. 

How to Diagnose Uterine Fibroids 

How are fibroids diagnosed? Many times fibroids are diagnosed just accidentally which means that you went to the doctor for something else, you got an ultrasound done for something else and here comes a fibroid. If you have symptoms like heavy periods or maybe painful periods, swelling in the abdomen, obviously your doctor is going to take a detailed history, examine you abdominally, maybe do an internal examination, ask for an ultrasound examination and maybe an MRI of the pelvis. 

How to Treat Uterine Fibroids 

Here I want to make a very important point. Not all fibroids need to be treated. Just because there's a fibroid there, we do not have to treat it.  A small fibroid which is just sitting there, not growing, not causing a problem is best left untouched. 

The treatment of the fibroid actually depends upon your symptoms, age, size, number and location of the fibroids and your desire and plan to have further pregnancies. 

Do all Fibroids Need a Surgery

Not really, most of the symptoms of the fibroids can be managed very easily with certain medications. However, there is no medication which can completely dissolve a fibroid. We have certain medications which can actually shrink the size of fibroid and can reduce the symptoms associated with fibroids.

However, their effect is temporary which means the effect lasts till the time you are taking these medications. So these medications are actually GnRH agonist, antagonist, drug called uliprisal, mifepristone. However, once again take these medications only after the advice of your doctor. 

There are certain other medications like tranaxamic acid, mifenamic acid which we commonly use to decrease the bleeding and pain associated with fibroids. 

Few of the cases might actually require a surgical treatment in the end despite trying all conservative medical options. So the surgery which is usually done for the uterine fibroids is either removal of the fibroids which is known as myomectomy or in some extreme cases removal of the uterus also. Both these surgeries can be done either abdominally or laparoscopically.

Laparoscopy is a specialized surgical technique whereby by we make small tiny incisions on the abdomen, even big surgeries can be performed through the small incision. So laparoscopy offers advantages over the conventional surgery in terms of smaller cuts on the abdomen, lesser pain, lesser blood loss and the faster recovery. 

There are some worth mentioning non-invasive or minimally invasive techniques to treat the uterine fibroids also.

1. MR guided HIFU, It is high intensity focused ultrasound. Here specialized sound waves are actually directed towards the uterine fibroid tissue to actually destroy them. 

2. Then there is uterine artery embolization, where certain specialized particles are actually used to block the blood flow in the blood vessels which are supplying blood to the uterine fibroid.

Can We Dissolve Fibroid Naturally?

The most common question which patients ask their doctors, is there anything which can be done to naturally dissolve a fibroid? Unfortunately the answer is no. However there are lots of things which can be done which can help you to manage the symptoms of fibroids. These include:

1. Take the iron rich diet, a diet which is rich in green leafy vegetables, dried apricots, raisins, bananas. If prescribes you can take an iron supplement maybe vitamin C, B12, folic acid supplements. 

2. Avoid a diet which is estrogen dominant diet. So what is that? It means avoid a diet which is packaged, processed or refined. Avoid non-organic red meats. Avoid soya foods which has got GMOs into it. 

3. Avoid alcohol, food additives, plastic packaging, water and foods because plastic contains a compound which is known as xenoestrogens which can actually leach into the food and fibroids are actually estrogen dependent tumors. 

4. It's also a good idea to keep your weight under check, your BMI under control and exercise regularly. Whenever possible follow a plant-based diet and obviously avoid smoking. 

Closing thought

If you are diagnosed with a fibroid do not panic, do not worry. Not all fibroids require treatment and very few fibroids actually require a surgery. Most important is to get a right diagnosis made, follow your doctor's advice, trust your doctor completely. 


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