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Uterine fibroid: The treatments you need to know about

Uterine fibroid: The treatments you need to know about
Uterine fibroid is a benign tumour of the uterus that can potentially affect the overall quality of your life. © Shutterstock

While a new research reveals that a minimally invasive procedure for uterine fibroids is as effective as the surgical interventions, we tell you about all the available treatment options for this gynaecological condition.

Written by Juhi Kumari |Published : March 27, 2019 3:22 PM IST

A recent study presented at the Society of Interventional Radiology s 2019 Annual Scientific Meeting has revealed that the minimally invasive treatment option for uterine fibroids, known as uterine fibroid embolization (UFE), is as effective as the surgical treatment options. Moreover, the post-procedural complications are lesser than the latter.

In this procedure, small particles known as embolic agents are inserted into the arteries that supply blood to the fibroids. These embolic agents block the blood flow to the tumours causing them to reduce in size and eventually die. There is hardly any chance of complication in this procedure. However, there can be trouble if blood supply to the neighbouring organs like ovaries is affected.

WHAT IS UTERINE FIBROID?

Uterine fibroid is a benign tumour of the uterus, also known as leiomyomas or myomas. This muscle mass occurs when a single muscle cell in or around the uterus multiplies and forms a noncancerous tumour. But it can cancerous in rare cases. Generally, women develop multiple fibroids. However, single fibroid is also possible. These tumours are classified based on their location: Intramural fibroids (tumours within the wall of uterus), submucosal fibroids (the ones that grow into the uterine cavity) or subserosal fibroids (they develop on the outer wall of the uterus). Globally, 1 in every 4 women get affected by this condition annually," says Dr. Duru Shah, Director of Gynaceworld, The Center for Women s Health & Fertility.

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According to a research published in the Journal of Obstetrics and Gynecology and the Journal of Women s Health, uterine fibroids cause significant fear and morbidity and can compromise workplace performance. They can potentially affect the overall quality of your life. The severity of physical or lifestyle impacts depends on the location of the uterine fibroids. If they grow in the uterine cavity, your fertility can get affected, you may experience heavy blood loss, anaemia, chronic fatigue, and low immunity. When they develop in the uterine muscles, they can cause heavy and extreme painful periods. However, when these cells grow on the top of uterus wall, they can create problem in urine flow by putting pressure in the ureter, says Dr. Duru Shah. You may experience symptoms like heavy menstrual bleeding, exhaustion, frequent urination, constipation, backache, pelvic pressure, and difficulty in passing urine when the tumours become big in size. These symptoms can make you feel low, less attractive, and irritable that further may reduce your sexual desire and impact your personal life. However, you may not experience any symptom at all. This is because uterine fibroids grow slowly and even shrink on their own post menopause due to decreased levels of reproductive hormones. And,

Sadly, there is no exact known cause of uterine fibroids and that s why it is quite difficult to prevent this condition. "However, genetic changes or oestrogen and progesterone levels are usually held responsible for uterine fibroids, says Dr. Shah. There are certain factors including heredity, race, deficiency of vitamin D, early age menstruation, diet rich in red meat, obesity, and alcohol that can increase your likelihood of getting uterine tumours.

HOW CAN YOU GET RID OF THE TUMOURS?

Luckily, there are various effective treatment modalities available for uterine fibroids. The line of treatment includes medicines, non-invasive, minimally invasive, and traditional surgical procedures. Dr. Shah sheds light on all these options.

Medicines

The drugs used for the treatment of uterine fibroids basically target your reproductive hormones, namely oestrogen and progesterone that stimulate the growth of this tumour. These hormones are also responsible for the thickening of your uterine lining during menstruation. Medications do not help you completely get away with the tumours. They just suppress the growth of these tumours for a few years till you opt for surgery, says Dr. Shah. Here are the medications currently available in India.

Gonadotropin-releasing hormone (Gn-RH) agonists: These are used to treat fibroids temporarily. They reduce the production your reproductive hormones which, in turn, leads to the shrinkage of tumours. However, these medicines put you in a postmenopausal phase for some time. Remember, these medicines should not be taken for more than 6 months, or else you may experience serious side-effects like loss of bone mass.

Progestin-releasing intrauterine device (IUD): It is an intrauterine device releasing progestin medicine (generally used to avoid pregnancy). IUD is inserted into your uterus to reduce the symptoms of uterine fibroids including heavy bleeding. However, it does not help in the complete treatment of this condition.

Other options: There are several other medicines including non-steroidal anti-inflammatory drugs and oral contraceptive pills that can help you get away with the symptoms of this condition temporarily. They can just relieve pain but cannot decrease the lump size.

Surgical Procedures

There are two types of surgical intervention for uterine fibroids. One involves the removal of uterus and the other just takes away the tumour.

Abdominal myomectomy: It is a surgical procedure used to remove fibroids either through your abdomen or vagina. In the abdominal surgery, you require approximately 4 weeks to recover. However, the time reduces to just few hours in case of a vaginal surgery. Advantage of this operation is that it doesn t affect your fertility. However, there is another side of this coin too. Few fibroids may be missed during this surgical procedure or you may develop the tumours again in future.

Hysterectomy: It removes the uterus to completely dismiss the chances of getting fibroids again. The surgery can be done either through your vagina or abdomen and your recovery time depends on the way it has been done. In case of the former, you only require few weeks while for the latter, you need a couple of months. For faster recovery, you may opt a sedentary lifestyle and eat healthy foods rich in mineral and vitamins. The major drawback of hysterectomy is that you won t be able to bear child post this surgery.

Minimally Invasive Procedures

If you don't want to go for surgery, here are other options for you which are less complicated.

Myolysis: Fibroids are destroyed with the help of an electric current or laser by reducing the size of blood vessels that feed them.

Robotic myomectomy: Fibroids are removed through small incisions done by a robot without touching the uterus.

Hysteroscopic myomectomy: Instruments are inserted through your vagina and cervix to remove fibroids when they occur inside the uterus.

Endometrial ablation and resection of submucosal fibroids: Certain instruments are used to destroy fibroids in the inner lining of uterus by using heat, electric current, or microwave energy.

Non-invasive Procedure

This is a procedure known as MRI-guided focussed ultrasound surgery (FUS). While carrying out FUS, your doctor uses the MRI technology to spot the exact location of fibroids and targets them with a high-energy ultrasound transducer. This non-invasive treatment option is proven safe, doesn t require any incision and can effectively destroy small areas of tumour tissues.