Excessive bleeding or prolonged periods are a glaring sign that something is wrong in your body, and you need to visit your gynaecologist. One of the most common conditions that causes these symptoms in women over the age of 20 is what doctors call ‘fibroids’, which are basically benign smooth muscle growths in the uterus. They can vary in size, from being as small as a pea to be as big or bigger than a melon.
In most women, a gynaecologist might incidentally notice the presence of fibroids during a routine sonography, since very few experience any noticeable symptoms.
Renowned gynecologist Dr Hrishikesh Pai says, ‘The cause of fibroids is not known completely, but it has been found that its growth depends on estrogen. They are known to grow continuously but steadily in menstruating women.’ It has been noticed that they tend to decrease in size once a woman reaches menopause because of the lowered production of estrogen during this period. Certain research also shows that genetics and insulin-like growth factor can also cause fibroids.
Being overweight and delay in bearing children increase the risk of developing them too.
Most women experience symptoms only when the fibroid grows to such an extent that it presses on the uterus, rectum, bladder or spinal column. Another possible cause for the symptoms could be the fact that when the fibroid outgrows its blood supply and is deprived of nutrition, it begins to die and releases by-products that causes pain and fever. If you notice any of the following symptoms, consult a good gynecologist:
- Prolonged menstrual bleeding that lasts for more than seven days
- Persistent pelvic pain even after menstruation (when the fibroid is pressing on the uterus or the back)
- Frequent urination and difficulty emptying the bladder
- Constipation (when the fibroid is present at the back of the uterus, exerting pressure on the rectum)
- Back or leg pain (when a fibroid either grows large and presses on the spinal column through the uterus or is formed behind the uterus)
A fibroid is formed from the smooth muscle tissues of the uterus and looks like a smooth, rubbery and pale mass that is distinct from the surrounding tissue.
When you visit a gynecologist for the above symptoms, he/she will take a detailed history first, followed by a physical examination. A doctor may suggest more tests like a complete blood count (CBC) to check for the general health of the woman, a blood test to check for clotting factors and for the presence of any disease that may cause excessive bleeding, and finally a test to check for anaemia.
Ultrasonography: An ultrasonography (USG) may be asked for to assess the exact size, type and location of the fibroid.
Hysteroscopy: A small lighted telescope called a hysteroscope is inserted through the vagina and cervix into the uterus to view it.
Sonography and X-ray: If the patient has uncontrolled and heavy bleeding, a sonography may have to be administered while the hysteroscope is being used. Sometimes, a dye is used to highlight the Fallopian tubes and the wall of the uterus. An X-ray is then taken. This technique helps the doctor to not only detect the presence of fibroids but also to see if the Fallopian tubes are open.
There are a number of treatment options available. Dr. Hrishikesh Pai says, ‘The treatment of uterine fibroid depends on age, general health, type of fibroid(s), pregnancy status and the severity of the case.’
Medications: Usually, the treatment is started with medications containing hormones that are meant to modify the hormonal levels within the woman’s body and control symptoms such as heavy bleeding and pelvic pressure. These medications do not completely eradicate the tumor, but are known to shrink it in size. Doctors usually prescribe contraceptive pills first.
A combination of estrogen and progesterone puts the woman in a temporary postmenopausal phase causing the fibroid to shrink, reducing excessive bleeding. It is usually prescribed right before a surgery to help the surgeon easily remove the tumor.
A synthetic agent (Danazol) that mimics testosterone effectively stops bleeding and shrinks the tumor and uterus. However, it is not widely used as it has severe side effects such as nausea, depression, anxiety etc. Sometimes, an intrauterine device that releases Progestin may also be used.
Surgery: When the medical methods do not work or if the fibroids are very large, a surgery may be required. According to Dr. Pai, ‘A hysterectomy is a great option for women with large fibroids, but only in cases where they do not wish to have more children. It is an operation where the surgeon will remove the entire uterus including the tumor.
A minimally invasive form of a hysterectomy can be performed using laparoscopic technique. Women who want to have children can opt for a laparoscopic myomectomy. The major advantage is that it can preserve fertility and small incision is enough to do the surgery’.
Non-surgical options: Other minimally invasive procedures include -
- Focused ultrasound surgery - where high frequency sound waves are used to remove the fibroid)
- Myolysis - a laproscopic procedure that uses laser to destroy the fibroid)
- Endometrial ablation - a procedure using heat and microwaves to remove the tumor)
- Uterine artery embolisation - a procedure where a catheter delivers small particles that destroy the fibroid through the uterine artery.
If untreated, fibroids can reduce the chances of getting pregnant. They may cause a distortion of the fallopian tubes leading to lack of ovulation, may block the entry of sperm into the uterus in the case of cervical fibroids and may cause disruptions in the implantation of the fetus in the case of submucosal fibroids.
In case a woman is already pregnant, fibroids can be quite dangerous. Complications during this phase include pain during the first and second trimester of the pregnancy. If a woman experiences multiple miscarriages or is unable to conceive after a year of trying, she should consult her gynecologist immediately.
The content has been verified by Dr Hrishikesh Pai, Renowned gynecologist.