Uterine Fibroids or uterine myomas affect more than 25-30% of women in reproductive age group. Most fibroids do not cause symptoms and do not require treatment. Fibroids may require treatment in the following circumstances:
1. Fibroids are growing large enough to cause pressure on other organs, such as the bladder.
2. Fibroids are growing rapidly
3. Fibroids are causing abnormal bleeding
4. Fibroids are causing problems with fertility.
Types of Fibroids
Uterine Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus will often cause bleeding between periods and often cause severe cramping. Fortunately, these fibroids can usually be easily removed by a method called "hysteroscopic resection," which can be done through the cervix without the need for an incision. Submucous myomas are partially in the cavity and partially in the wall of the uterus. They too can cause heavy menstrual periods (menorrhagia), as well as bleeding between periods. Many of these submucous fibroids can also be removed by hysteroscopic resection.
Diagnosis of Fibroids
Clinical examination
Pelvic ultrasonography
MRI in rare cases to differentiate fibroids from adenomyosis
Treatment of Fibroids-Do all of them need to be removed?
The most important question to ask is ‘do the fibroids need to be treated at all? The vast majority of fibroids grows as a woman gets older, and tend to shrink after menopause. Obviously fibroids that are causing significant symptoms need treatment. While it is often easier to treat smaller fibroids than larger ones, most of the small ones never will need to be treated. Many women have successful pregnancies without removing the fibroids as long as they are not inside the uterine cavity. The location of the fibroids plays a strong influence on how to approach them.
Treatment with medicines:
There are not any currently available medicines that will permanently shrink fibroids. Often heavy bleeding can be decreased with birth control pills.
Treatment by surgery:
Laprotomy, laparoscopic myomectomy (by use of laproscope) and hysteroscopic myomectomy (by use of hysteroscope through the cervix) are mainstay surgical procedures for treatment of fibroids. Submucous and intracavity fibroids are mostly removed by hysteroscopic myomectomy. Fibroids in the wall or outside the uterus that are not accessible to surgical removal through the cervix are removed by laprotomy or laproscopic myomectomy.
One of the major differences in how a myomectomy is done involves the surgical approach to the uterus. In a hysteroscopic myomectomy the surgical approach is through the cervix. In a laparotomy, an incision is made in the abdomen to reach the uterus. Alternately, fibroids can also be removed by laparoscopy and the procedure is called laparoscopic myomectomy. The laparoscope is a telescope placed in the abdomen through the belly button. Other instruments are inserted through small individual incisions in the abdominal wall. The advantage of laparoscopic myomectomy is that the postoperative recovery is fast, scar is small and hospital stay is short than a laparotomy. Although many fibroids inaccessible through the cervix can be removed through the laparoscope, the decision of which myomas should be removed laparoscopically and which by laparotomy depends on many factors to be decided by the surgeon.
Patients, who have completed family and reproductive function and are more than 45 years, can undergo laparoscopic hysterectomy (removal of the entire uterus) for fibroids
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