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Uterine fibroids, which are noncancerous (benign) growths of the uterus, are one of the most common causes of female infertility. Uterine fibroids can impair fertility by obstructing the fallopian tubes or preventing a fertilized egg from implanting in the uterus. Due to reduced space in the uterus, large fibroids may prevent a fetus from fully developing. Fibroids can increase the risk of placental abruption because the placenta is blocked by fibroids and breaks away from the uterine wall, resulting in supplying less oxygen and nutrients to the fetus. As a result, the chances of preterm birth or miscarriage increase significantly.
Uterine fibroids are benign (noncancerous) tumors of uterine muscle tissue. They're also known as myomas or leiomyomas. Fibroids form when a single muscle cell in the uterine wall multiplies and grows into a noncancerous tumor. Fibroids can range in size from tiny seedlings to bulky masses that distort and enlarge the uterus. The location, size, and number of fibroids determine whether they cause symptoms or necessitate treatment.
Uterine fibroids are classified based on their locations. Fibroids are classified into three large categories:
Subserosal fibroids: These develop on the uterine wall's outer surface. This type of fibroid tumor can spread outward and grow in size. The growth of a subserosal fibroid tumor places increased pressure on the surrounding organ, resulting in pelvic pain as the primary symptom.
Intramural fibroids: Intramural fibroids begin within the uterine wall and grow from there. When an intramural fibroid expands, it causes the uterus to develop larger than usual. As these fibroids grow in size, they can cause excessive menstrual bleeding, pelvic pain, and frequent urination.
Submucosal fibroids: These fibroids form just beneath the uterine cavity's lining. Large submucosal fibroids can expand the uterine cavity and block the fallopian tubes, causing further fertility complications. Associated symptoms include heavy menstrual bleeding and prolonged menstruation.
Uterine fibroids are diagnosed using a pelvic exam, lab tests, and imaging tests. Imaging tests are used to visualize uterine abnormalities. These involve abdominal ultrasound, vaginal ultrasound, and hysteroscopy. A small, lighted telescope called a hysteroscope is inserted through the cervix into the uterus during hysteroscopy. The uterine cavity will be expanded after a saline injection into the uterus, allowing the gynecologist to examine the uterine walls and fallopian tube openings. In some cases, additional imaging tools such as MRI may be required.
Uterine fibroids medications target hormones that regulate the menstrual cycle to treat symptoms such as heavy menstrual bleeding. However, medications do not eliminate fibroids; instead, they may shrink them. Surgeries to remove fibroids include traditional surgical procedures and minimally invasive surgery. Surgeries such as " Laparoscopic gynecologic surgery" are minimally invasive procedures performed to safely remove uterine fibroids without the need for an open cut. Small incisions are made to insert surgical instruments such as a laparoscope, a narrow tube with a camera. This enables the gynecologist to clearly visualize every dimension of gynecologic organs on a monitoring screen prior to accurately and safely removing fibroids. Laparoscopic surgery with a smaller incision results in less pain and increased safety, as well as fewer post-operative complications such as a lower rate of infection, less blood loss, and less fibrosis formation. Post-surgery, patients are advised to take contraceptive pills for at least one month before considering pregnancy.
Uterine fibroids cause abnormalities such as high estrogen levels, uterine contraction, and ovulation dysfunction. More importantly, fibroids can impair fertility by blocking the fallopian tubes and preventing a fertilized egg from implanting in the uterus. Therefore, appropriate and timely treatments are important to eliminate fibroids.
The article is contributed by Dr. Ratna Saxena, Fertility Expert, Nova Southend IVF and Fertility, Bijwasan.
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