Uterine fibroids also known as uterine leiomyomas are non cancerous smooth muscles tumors of the uterus. They typically occur in the middle & latter reproductive years.
SIGNS & SYMPTOMS OF UTERINE FIBROIDS
- Abdominal pain
- Iron deficiency
- Pain during sexual intercourse
- Rectal pressure
- Growing of the abdomen mimicking pregnancy
- Large fibroids extend out through the cervix
- Painful & heavy menstruation
- Frequent need to urinate
- Lower back pain.
- During pregnancy;
- Uterine bleeding
- Premature labour
- Interference with the position of the fetus
- Compression of the ureter may lead to hydronephrosis
- In very rare cases, malignant tumors may arise in the myometrium, called leiomyosarcoma.
CAUSES OF UTERINE FIBROIDS
- Diet like, eating red meat
- Genetic abnormality due to a change in the chromosomes.
- Racial background: Black women are way more likely to develop uterine fibroids than white women.
- Never having given birth
- Hormones like estrogen, progesterone & aromatase have a significant contribution in the growth of these fibroids.
- Polycystic ovary syndrome (PCOS)
- Renal cell cancer
- Reed’s Syndrome
- Ultrasound is the primary & standard method for the evaluation of uterus & the detection of fibroids.
- An MRI done for depiction of the size & location of the fibroids.
- CT scan applied for obtaining suitable images of the uterine fibroids.
- Hysterosalpingography: Utilizes application of a radiographic dye which taken the shape of the fibroids, assisting in mapping of the size & location of the outgrowth, as seen under an X-ray.
- Hysteroscopy: A viewing scope called a hysteroscope is inserted through the cervix into the uterus, the uterus is pre-dilated & the uterine cavity is assessed for fibroid growth.
TREATMENT FOR UTERINE FIBROIDS
- NSAIDs are used to reduce pain in menstruation.
- Iron supplements for anemia & weakness.
- Levonorgestrel IUDs, which releases Levonorgestrel in small concentrations at fixed times is effective in limiting menstrual blood flow.
- Oral contraceptive pills are prescribed to reduce menstrual bleeding & cramps.
- Cabergoline, an ergot alkaloid finds use due to its effectiveness in shrinking of the fibroids.
- Ulipristal acetate, a synthetic selective progesterone receptor modulator (SPRM) is used before surgerical treatment of fibroids.
- Danazol used to shrink fibroids & control symptoms.
- Gonadotropin-releasing hormone analogs/modulators are used before operation due to their property of decreasing estrogen levels which helps in temporarily shrinking the fibroids.
- Progesterone antagonists like mifepristone.
- Aromatase inhibitors like anastrozole.
Surgical & other procedures:
- Uterine artery embolization (UAE) is a noninvasive procedure that blocks blood flow to fibroids, causing them to shrink.
- Uterine artery ligation, a minimally invasive method to limit blood supply of the uterus by a small surgery that can be performed transvaginally or laparoscopically.
- Hysterectomy, the surgical removal of uterus.
- Endometrial ablation, is a surgical procedure to destroy the endometrial lining in the uterus. This particular procedure is performed only when the fibroids are relatively small & within the uterus.
- Radiofrequency ablation is a minimally invasive procedure in which a needle like device is inserted in the fibroids through the abdomen and heated with a radio frequency electrical energy to cause necrosis of the fibroid cells.
- Magnetic resonance guided focused ultrasound, a non-invasive procedure (requiring no incision) that uses high intensity focused ultrasound waves to destroy tissue in combination with magnetic resonance imaging (MRI), which guides and monitors the treatment.
- Myomectomy: Surgery to remove one or more fibroids. Three types of this surgery are classified as:
- Hysteroscopic myomectomy
- Laparoscopic myomectomy
- Laparotomic myomectomy.
- Management of underlying conditions like PCOS, hypertension, diabetes, etc.
- Diet high in Vitamin A, C, D & E can reduce chances of developing uterine fibroids.
- Diet rich in phytoestrogens, carotenoids & omega-3 fatty acids.
- Low consumption of red meat.