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Fibroids


OVERVIEW OF Fibroids :

The fibroids are the non cancerous growth that tend to develop in and around the uterus. The growth is made of the fibrous and muscle tissue. They are also known as leiomyomas and uterine myomas.


STRUCTURE of Fibroids :

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus


COMMON CLINICAL SIGNS AND SYMPTOMS :

Heavy menstrual bleeding

Menstrual periods lasting more than a week

Pelvic pressure or pain

Frequent urination

Difficulty emptying the bladder

Constipation

Backache or leg pains


DIAGNOSTIC :

Uterine fibroids are detected during routine the pelvic examination. The diagnosis are as follows:

Ultrasound:

The ultrasound uses sound waves to get the best image of the uterus.

A physician might place the ultrasound device which is called as the transducer over the abdomen that is the transabdominal region or places it inside the vagina (transvaginal) to get the images of the uterus.

Lab tests:

If the patient has abnormal menstrual bleeding the physician might see to the complete blood count to determine the presence of anaemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

Other tests are follows:

Magnetic Resonanace Imaging(MRI):

This test provides the more detail the size and location of fibroids and also detect the different type of tumours and help to determine the final treatment. An MRI scan is very much useful in women with a larger uterus or in women who is under  going menopause.

Hysterosonography:

It is also called as saline infusion sonogram which uses sterile saline to expand the uterine cavity making it easier to get the images of submucosal fibroids and lining of the uterus in women  attempting pregnancy or who have heavy menstrual bleeding.

Hysteroscopy:

The physician might inserts small, lighted telescope called as hysteroscope through the cervix in the uterus.  The physician might use saline water for irrigation to get the best view of the uterus and fallopian tube.

Ultrasound:

The sound waves are used to get the pictures of the uterus to confirm the diagnosis to map and measures the size of the fibroids.
Fibroids are typically rounded growths that can look like nodules of the smooth muscles. In some cases, they can be attached with a thin stem, giving them a mushroom-like appearance.

FIGO classification of the uterine fibroids:

Stage 0: A sub mucosal pedunculated intra uterine cavity fibroid

Stage 1:  A  sub mucosal located less than 50% intra murally

Stage 2: A submucosal located greater than 50% intra morally

Stage 3: A fibroid which is 100% interstially or intra morally located in contact with the endometrium

Stage 4: A fibroid which is completely interstially or intra morally located.

Stage 5 : A sub serosal fibroid which is greater than or equal to 50% intra morally located

Stage 6 : A sub serosal fibroid which is less than 50% intra murally located

Stage 7: a sub serosal  pedunculated fibroid

Stage 8: others, parasite( round cervical ligament , large ligament)


TREATMENT AND PROGNOSIS :

Medications:

These medicines results in heavy menstrual bleeding and pelvic pressure. They also regulate  the menstrual cycle. The following medicines might shrink the fibroids.

Gonadotropin releasing hormone agonists:

They treat the fibroids by blocking the release of estrogen and progesterone. These medications might put you in the temporary state of menopause like state.

Progestin-releasing intrauterine device (IUD):

A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear. It also prevents pregnancy.

Tranexamic acid :

 This nonhormonal medication is taken to ease heavy menstrual periods. It's taken only on heavy bleeding days.

Other medications. Your doctor might recommend other medications. Noninvasive procedure

MRI-guided focused ultrasound surgery (FUS) is:

It is a non invasive technique

It is useful in embolization of the uterine artery:

Small particles which are called as embolic agents are injected into the arteries supplying the uterus, cutting off blood flow to fibroids resulting in shrinkage of the fibroid and make them die.

Radiofrequency ablation:

In this technique radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids.

Laparoscopic or robotic myomectomy:

In this procedure the fibroid are removed leaving the uterus in place. If the fibroids are little number then the physician might opt for laparoscopic procedure in which the small incision is made and the tumour is made.

Larger fibroids are removed through smaller incisions by breaking them into the pieces which is termed as morcellation .

Hysteroscopic myomectomy:

 This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.

Endometrial ablation:

This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow.

Abdominal myomectomy:

If multiple fibroids are present and if fibroids are larger then this surgical procedure is preferred.

Hysterectomy:

It is main surgery performed which might result in the removal of the uterus and also sometimes along with vagina. It is complete solution of the uterine fibroids. The physician can give the chance for removal of the ovary also. The treatment process depends upon the individuals decision.

Morcellation during fibroid removal:

Morcellation — a process of breaking fibroids into smaller pieces — may increase the risk of spreading cancer if a previously undiagnosed cancerous mass undergoes morcellation during myomectomy. There are several ways to reduce that risk, such as evaluating risk factors before surgery, morcellating the fibroid in a bag or expanding an incision to avoid morcellation.

All myomectomies carry the risk of cutting into an undiagnosed cancer, but younger, premenopausal women generally have a lower risk of undiagnosed cancer than do older women.

 


PROGNOSIS :

Mostly the uterine fibroids shrink when the women attains the menopause.

If the fibroid are concerned only to localized area the 5 year survival rate is 63%

If it is malignant then the 5 year survival rate is 34%.


PREVENTION :

Maintain healthy lifestyle

Reduce the weight

Consume healthy diet

Follow healthy lifestyle

Delay in attending age

Have regular pelvic examination.


Medicines used in the Treatment :

Progestin

Gonadotropin releasing hormone agonist

Transexamic acid in case of heavy bleeding