Also called as myomas, firbomyomas or simply uterine fibroids, fibroids are tumors that grow in and around the muscles lining the uterus. Usually fibrous in nature, these growths can either be as small as a pea or as big as a watermelon. And while most fibroids are benign in nature, some can turn cancerous with time in which case the condition is called leiomyosarcoma (pertaining to the womb).
Fibroids are very common occurrences in women and can affect an individual at any point of time during her life. The risk of getting fibroids increases with age (women aged 30-50 years are more at risk) and other factors like obesity, menopause, hormonal imbalances and hormonal medications etc.
Symptoms of Fibroids
Fibroids usually do not cause any symptoms. However, if they grow large or tend to become cancerous, they can cause some serious side effects including heavy menstrual periods, painful menstruation, anemia, constipation, backache, leg ache, abdominal pain (usually resulting in swelling), abdominal pressure, painful intercourse, frequent urination, urine incontinence, miscarriage, pregnancy complications and infertility etc.
Different Treatment Options for Fibroids
In most cases, fibroids are left alone and monitored on a regular basis to check for possible malignancy. If the growths remain unchanged (the same size or benign), they are left untreated. With time, they would shrink and disappear on their own.
However, in cases the fibroids start growing in size or show signs of becoming cancerous, one or more of the following treatment options would need to be considered in order to suppress or remove them.
Medications for Fibroids
Oral Birth Control Pills
Usually prescribed to control pregnancy, oral birth control pills are sometimes recommended to treat small-medium sized fibroids that remain in the uterus for more than 3 months or so. In addition to reducing heavy menstrual bleeding, these pills would effectively help in shrinking the fibroids to miniscule levels. Certain pills can stop menstruation altogether, thereby preventing recurrences.
Oral pills can also be substituted contraceptive rings or patches that offer the same results. The only problem with this treatment option is that it would prevent pregnancy and so cannot be used by women who wish to conceive.
NSAIDs are usually prescribed for women who wish to get treated for fibroids without facing any fertility issues in the process. When taken regularly, these drugs can effectively reduce the bleeding caused by small-medium sized fibroids. They can also offer relief from the pain caused by these fibroids. The drugs need to be taken during the menstrual cycle and work by reducing the prostaglandin levels in the body which in turn would reduce the symptoms of fibroids to a great extent.
Available in the form or oral tablets, tranexamic acid needs to be taken from the start of the menstrual cycles to up to 4 days afterwards. These drugs effectively help the blood in the uterus to clot, thereby reducing excessive menstrual bleeding caused by fibroids.
The tablets need to be taken regularly for a period of 3 months or so, following which the individual’s condition is checked. The treatment is continued if there are signs of progress or stopped if there are no signs of improvement. The pills will not affect fertility and can be taken by women who wish to conceive.
Injections for Fibroids
Depo Provera Progestin Shot
In certain cases, a woman with uterine fibroids would be prescribed progestin shots to either reduce the symptoms of the fibroids or stop them from growing.
Administered via injections, these shots are given once every 3 months. However, in certain cases, these injections may have a reverse effect on the fibroids and cause them to grow following which they need to be discontinued immediately.
Gonadotropin Released Hormone Agonist (GnRHA)
Usually considered as the most effective treatment option available for small-medium fibroids, GnHRA injections are administered to the individual to reduce the estrogen levels in her body. The reduction of estrogen levels would automatically cause the fibroids to shrink. In certain cases, the injections are administered right before a surgery to either shrink the tumors or stop their growth.
GnHRAs usually stop the menstrual cycle altogether (for the duration of the treatment), but do not affect fertility. In addition to shrinking the fibroids, they also help to offer relief from the symptoms of the condition, including excessive menstrual bleeding, menstrual cramps and abdominal pain etc. The medication may cause a few negligible side effects like vaginal dryness, hot flashes and osteoporosis (very rare) etc. which would usually disappear after the treatment is completed (or discontinued).
Intra Uterine Devices for Fibroids
Intra uterine devices are usually recommended for women who experience excessive menstrual bleeding due to fibroids. Although these would not have a profound impact on the fibroids, they would help to offer relief from the symptoms to a great extent.
Levonorgestrel Intrauterine System (LNG-IUS)
Made of plastic, the LNG-IUS is a small device that is usually planted in the uterus. The device would release progesterone like hormones called levonorgestrels that would prevent the endometrial lining from thickening rapidly. This in turn would reduce excessive menstrual bleeding to a great extent (for a period of 6 months or more). Some possible side effects to using this device include discomfort (the feeling of something present inside the uterus), acne, headaches and breast tenderness etc.
Surgical Options for Fibroids
Surgery is usually opted for in cases where the patient does not respond to other forms of treatment. The various surgical options available for uterine fibroids include:
In this procedure, the doctor would opt to surgically remove the fibroids from the inner uterine wall. The endometrial lining would not be affected and so women opting for this procedure can conceive without difficulty.
Myomectomy is also considered as an effective alternative for hysterectomy which would prevent pregnancy. However, it may not be considered as the best option for large or cancerous fibroids, including those that are present in other parts of the uterus.
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This procedure is usually initiated to remove the endometrial lining in the uterus, and is most suited for fibroids that appear near on or near the inner uterine surface. The doctor would surgically remove the endometrial lining and the fibroids attached to it. This would effectively get rid of the fibroids in this region and curb symptoms like excessive menstrual bleeding caused by fibroids present in other areas of the uterus.
MRI guided Ultrasound Surgery
In this procedure, the fibroids are effectively shrunk using sound waves emitted from an ultrasound device. A magnetic resonance imaging (MRI) scan is first taken to determine the exact location of the fibroids in the uterus. The doctor would then use the scan results to aim the sound waves directly at the fibroids. The sound waves would effectively reduce the growths to miniscule levels.
MRI guided Percutaneous Laser Ablation
This procedure involves locating the fibroids using an MRI scan and then shrinking them with high intensity laser lights that are administered via fiber optic cables. The fiber optic cable used for the procedure is inserted into the uterus via very thin needles. These needles in turn are inserted via the skin and are pushed inwards to reach the fibroids. Once the needle reaches the fibroid, the fiber optic cable is inserted into the former and a high intensity laser light is sent to the fibroid, shrinking it in the process.
A hysterectomy would involve removing the entire uterus, and would be considered only in cases where the fibroids are too large to be removed by other means. A hysterectomy would also be recommended if a fibroid ruptures and causes extensive bleeding (internal as well as external). Removing the uterus completely would also usually stop repeated occurrences of fibroids. Possible side effects involved in opting for a hysterectomy for the removal of fibroids include early menopause and loss of libido etc.
Alternate Treatment Options for Fibroids
Uterine Artery Embolization
This procedure is considered better when compared to other forms of treatment for fibroids in the sense that it is more effective than medications and injections and does not require surgery. The basic principle behind UAE involves cutting off the natural blood supply to the fibroids in the uterus, thereby causing them to shrink and die on their own.
The procedure involves implanting a small needle into an artery in the leg, possibly near the groin. A catheter placed inside the artery via the needle would then identify the arteries that supply blood to the fibroids (via a test called anarteriogram).
Once identified, these arteries are injected with very fine polyvinyl alcohol particles (only the size of sand grains) that block the flow of blood to these arteries and the fibroids connected to them. The procedure is repeated for the right and left uterine arteries, and another test would confirm the same. With the blood supply blocked, the fibroids would eventually shrink and die.