Saturday, May 5, 2012
Fibroids and its Management
Fibroids are the commonest tumours of uterus. They are mostly non cancerous in nature .Leiomyosarcoma, a highly malignant cancer can develop in approximately 0.26 % of the Fibroids.
Fibroids are most common in Africans.It is also common in women who have never been pregnant before.Fibroid is an estrogen ( Female Hormone) dependent tumor.
Symptoms of Fibroids
Painful heavy periods with heaviness in lower abdomen and pressure symptoms.
Types of fibroids
Uterine Fibroids are classified by their location which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus ( Submucous myomas) will often cause bleeding between periods and often cause severe cramping
Intramural myomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. Many intramural fibroids do not cause problems unless they become quite large. There are a number of alternatives for treating these, but often they do not need any treatment at all.
Subserous myomas are on the outside wall of the uterus, and may even be connected to the uterus by a stalk (pedunculated fibroid.) These do not need treatment unless they grow large, but those on a stalk can twist and cause pain. This type of fibroid is the easiest to remove by laparoscopy.
They can be diagnosed using Ultrasound, MRI or hysteroscope.
Treatment of Fibroid.
If asymptomatic and less than 12 weeks in size fibroids can be managed conservatively. Medical Management hasn’t been successful in preventing the growth of the fibroids.
If the woman is desirous of having child she should have myomectomy or removal of fibroids which can be removed Laparoscopically.
Total laparoscopic hysterectomy (Removal of uterus using laparoscope) can be performed if the family is complete. It is a myth that only small fibroids can be removed laparoscopically.At Max Hospital Gurgaon I have performed TLH on fibroids upto 28 weeks size weighing 1.8 kgs.
Other methods are Uterine embolization and HIFU are new additions in the treatment modalities of fibroids but not yet as widely used.