What are uterine fibroids?
Uterine Fibroids is the growth of non-cancerous tissue in the uterus. The growth of the tissue is typically seen in the productive life cycle of a woman. The growth can vary in size from small, undetectable to the naked eye to large bulky masses. The uterus can contain multiple fibroid tissues at the same time, and in some cases, it leads to the expansion of the uterus.

What are the symptoms of uterine fibroids?
The common symptoms of uterine fibroids include:

• Heavy bleeding
• Pelvic pain
• Longer menstrual cycles
• Frequent urination
• Constipation
• Back & leg pains

What are the risk factors of uterine fibroids?
Some of the risk factors of uterine fibroids have been determined to be – genetic factors, hormonal factors and growth factors. Typically, having a mother or sister who’s had fibroids increases the risk of you developing the same. Some of the other risk factors include – early onset of puberty, vitamin D deficiency, improper diet, excessive oral contraceptives and others.

What are the complications of uterine fibroids?
Uterine fibroids are common, with as many as one in every five women may have fibroids during their childbearing years. Fibroids can be so tiny that you need a microscope to see them. They can also grow very large and may fill the entire uterus. While most women do not experience any symptoms, they can cause significant problems in rare cases. The likelihood of complications occurring depends on factors such as the position of the fibroids and their size. Some of the common complications associated with uterine fibroids include – difficulties of conception and problems during pregnancy.

How are uterine fibroids diagnosed?
In most cases, uterine fibroids are diagnosed incidentally as part of the routine gynaecological examinations. If the doctor finds any abnormalities and suspects uterine fibroids, he/she may prescribe additional testing to ascertain and conform to the presence of fibroids.

Ultrasound
An ultrasound is a procedure that creates images of the internal organs of the body. This test allows the doctor to confirm the diagnosis and to map and measure fibroids. An ultrasound performed inside the vaginal cavity is known as a transvaginal scan.

Lab tests
A set of blood investigations may be required should you be suffering from abnormal menstrual bleeding. These blood investigations help ascertain the exact nature and cause of the abnormal bleeding, as well as understand if the individual is suffering from anaemic complications caused by chronic blood loss.

Other imaging tests

Hysterosonography
Hysterosonography, also called sonohysterography, uses sound waves to produce pictures of the inside of a woman’s uterus and help diagnose unexplained vaginal bleeding. It is best to perform hysterosonography one week after menstruation to avoid the risk of infection. Little or no special preparation is required for this procedure. Hysterosonography is performed very much like a gynecological exam and involves the insertion of the transducer into the vagina after you empty your bladder. Using a small tube inserted into the vagina, your doctor will inject a small amount of sterile saline into the cavity of the uterus and study the lining of the uterus using the ultrasound transducer.

Hysterosalpingography
A hysterosalpingogram or HSG is an x-ray procedure used to see whether the fallopian tubes are patent and if the inside of the uterus is normal. Abnormalities inside the uterine cavity may also be detected by the doctor observing the x-ray images when the abnormality disrupts the fluid movement. The HSG procedure is not designed to evaluate the ovaries or to diagnose endometriosis, nor can it identify fibroids that are outside of the endometrial cavity, either in the muscular part of the uterus or on the outside of the uterus.

Hysteroscopy
Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat the causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm the results of other tests, such as hysterosalpingography. The time it takes to perform hysteroscopy can range from less than five minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time.

Magnetic resonance imaging (MRI)
MRI shows greater detail of fibroids’ size and location, identify different types of tumours, and help determine appropriate treatment options. An MRI is most often used in women with a larger uterus or women approaching menopause (perimenopause).

What is the treatment for uterine fibroids?
Watchful waiting
Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside, on the outside, or in the wall of your uterus. If your fibroids are not bothering you, you do not need to do anything about them. The doctor will check them during your regular visits to see if they have gotten bigger and adopt a method known as watchful waiting, that’s because fibroids aren’t cancerous and rarely interfere with pregnancy.

Medications

Gonadotropin-releasing hormone (GnRH) agonists
Gonadotropin-releasing hormone analogue (GnRH-a) puts the body into a state like menopause for as long as you take it. This leads to the shrinking of the fibroids. However, after you stop taking it, your fibroids may grow back. Taking GnRH-a can cause serious side effects, such as bone loss. GnRH-a therapy may be a good choice if you are close to menopause, have heavy bleeding from fibroids, or are planning surgery.

Progestin-releasing intrauterine device (IUD)
Progestin-releasing intrauterine devices or hormonal intrauterine devices (IUDs) are inserted into the womb (uterus) and can remain there for up to five years. Progesterone prevents the lining of the womb from building up during the menstrual cycle. Hormonal IUDs continuously release progestins, which also prevent the lining of the womb from building up. Hormonal IUDs are only suitable for treating fibroids that aren’t too big. Larger fibroids may change the shape of the womb, making it impossible to insert an IUD.

Other medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may effectively relieve pain related to fibroids, but they don’t reduce bleeding caused by fibroids. They are largely useful for women with fibroids that cause mild-to-moderate symptoms, such as pelvic discomfort and heavy menstrual bleeding. The goal is to relieve pain, reduce menstrual blood flow, and in some cases, shrink the growths.

Noninvasive procedure

MRI-guided focused ultrasound surgery (FUS)
Magnetic Resonance-guided Focused Ultrasound uses ultrasonic pulses to heat up and destroy fibroid tumours. This procedure works by delivering a series of targeted ultrasonic pulses, or sonication, to heat up and destroy the fibroids. The procedure, also known as focused ultrasound surgery or focused ultrasound ablation, is performed under MR guidance to ensure accurate targeting of the fibroids while avoiding harm to adjacent, healthy tissue.

Minimally invasive procedures

Uterine artery embolization
Uterine fibroid embolization is a minimally invasive procedure used to treat fibroid of the uterus which can cause heavy menstrual bleeding, pain, and pressure on the bladder or bowel. It uses a form of real-time x-ray called fluoroscopy to guide the delivery of embolic agents to the uterus and fibroids. In this procedure, the surgeon will use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms.

Radiofrequency ablation
Radiofrequency ablation is a minimally invasive procedure that uses heat to target fibroids one by one, reducing their size significantly. This shrinking of the fibroids reduces severe symptomatic effects for the patient. This procedure is best for a patient whose fibroids are not too large, uterus is located below the naval, and has not had complex abdominal surgeries in the past.

Laparoscopic or robotic myomectomy
Myomectomy is a type of surgery used to remove uterine fibroids. A laparoscopic myomectomy allows the surgeon to remove fibroids through several small incisions instead of a large one. It’s less invasive and recovery is faster than with abdominal myomectomy.

Hysteroscopic myomectomy
A hysteroscopic myomectomy is an option for fibroids that are inside the uterus and not on the lining. The surgeon removes fibroids using instruments that are inserted through the vagina and cervix into the uterus. This is performed under either local or general anaesthesia during this procedure. A liquid is also introduced into the uterus to widen it to allow the doctors to see the fibroids more clearly.

Endometrial ablation
An endometrial ablation is a procedure that destroys the lining of the uterus. Although this treatment does not shrink the fibroids, it helps decrease heavy menstrual bleeding caused by fibroids. Some women who have endometrial ablation stop having menstrual periods. Endometrial ablation is not a form of birth control, but pregnancy is not recommended after treatment and often not possible.

Traditional surgical procedures

Abdominal myomectomy
An abdominal myomectomy is a major surgical procedure for the treatment of fibroids. It involves making an incision through the skin on the lower abdomen to remove the fibroids from the walls of the uterus. After a myomectomy, doctors recommend a Caesarean section for the delivery of future pregnancies. This is to reduce the chance that your uterus could open apart during labour.

Hysterectomy
Total abdominal hysterectomy is an invasive procedure for women with large fibroids, when the ovaries also need to be removed, or when cancer or pelvic disease is present.