Fibroids are tumors of the muscle layer of the uterus (womb) and are usually benign (non cancerous in 99% cases but can rarely (less than 1% cases) turn malignant (sarcomas)
Fibroids are extremely common in 40-70% women in reproductive age group (Menarche-to Menopause)
CAUSES (1) Hormonal (Estrogen) stimulation of the smooth muscle cells of the uterus is the usual cause of fibroids hence they are found in women of child bearing age group (Rarely found before menarche & after menopause)
PARITY (2) Women who have their children early and breast feed are protected against fibroids to a large extent.
GENETIC PREDISPOSITION (3) Fibroids are extremely common in some races e.g. in blacks the incidence is much higher than in Caucasians.
The incidence is also high in the Arab population.
SYMPTOMS: Usually women present with menstrual problems like
- Heavy menstrual bleeding
- Prolonged Menstrual Bleeding & passage of clots
PRESSURE SYMPTOMS: Like increase frequency of urination because fibroids press on the urinary bladder or constipation rectal pain or dyspareunia (painful intercourse) due to the pressure of the fibroid on the rectum.
Also in some cases a woman may present with a large swelling / mass in her abdomen (especially embarrassing to unmarried girls) and we have had women present with kidney problems as the fibroid can press on the URETERS (Tubes carrying urine from the kidney to the bladder) and due to the back pressure the kidneys get damaged).
INFERTILITY: Fibroids can also lead to infertility specially if they project into the cavity of the uterus.
Fibroids can easily be treated by “Minimally Invasive Surgery”. In women who have completed their childbearing the uterus (Any size) can be removed by Laparoscopy.
For women who want to have more babies the fibroids can be removed Laparoscopically leaving the uterus completely intact for childbearing. Lap Myomectomy we also perform LUAL (Laparoscopy uterine artery ligation from origin) to the decrease recurrence of fibroids as fibroids frequently recurrent.
Also a new procedure (3-4years old) at International Modern Hospital is “Laparoscopy Gross Wedging of Uterus” where the central core of the uterus is removed Laparoscopically and the outer shell of the uterus is kept intact & sutured together in women who have completed their families but do not want their uterus removed.
Advantages of Laparoscopy over conventional surgery
|S.NO.||LAPAROSCOPY SURGERY||OPEN SURGERY|
|1||Only 1 Day Hospital Stay||Hospital Stay for 5-6 Days|
|2||Minimal blood loss (less than 100ml)||Patient loses at least 500ml of blood|
|3||No need for Blood Transfusion||Blood Transfusion often needed|
|4||No need for I.V Drip||I.V Drip needed for 24 Hours|
|5||Minimal pain (Most patients do not||More Painful (Pain Score charts higher)|
|need even oral pain killers)|
|6||Early return to work (2-3 Days)||Usually return to work only after 1 month|
|7||Less Costly||More Expensive|
- You have recently removed a fibroid that was 3.05 kgs, what was the procedure for that?
LAPAROSCOPIC MYOMECTOMY WITH LUAL was performed for that patient. As this young unmarried girl presented with a large mass in her abdomen (Uterus was so enlarged that it looked like she was 9 months pregnant)
She was unmarried and was hence obliviously looking at conserving her uterus for future child bearing and had visited many doctors all of whom told her that a Laparoscopic procedure was impossible and even in open Myomectomy she may have to have her uterus removed.
At International Modern Hospital her Uterine Arteries were clipped Laparoscopically and all the Fibroids were removed by Laparoscopy and her uterus is left completely healthy intact for future childbearing.
Also the additional benefits of LUAL are
- It prevents the recurrence of fibroids in 99% cases.
- Very small fibroids shrink on their own after LUAL.
- Future child bearing is not hampered by this clipping.
If a fibroid is small the Gynaecologist will look at several factors before deciding to remove/not remove the fibroid.
- It is symptomatic -> Leading to heavy bleeding, Infertility etc.
- It is causing any damage to the kidneys etc.
Which women are prone -> Genetically predisposed women in child bearing age group especially those who delay their pregnancies beyond 35years of age.