About Uterine fibroids

Uterine fibroids, medically termed leiomyomas, are benign tumors that form within or around the uterus. Made up of smooth muscle and connective tissue, fibroids can be as tiny as a pea or as large as a melon. These non-cancerous growths are quite prevalent, particularly among women of childbearing age. Although the precise cause is unknown, hormonal fluctuations—especially involving estrogen—and genetic tendencies are significant contributors. While many women have no symptoms, fibroids can lead to heavy menstrual bleeding, pelvic pain or fullness, frequent urination, discomfort during intercourse, or fertility challenges. They’re typically detected through ultrasound or other imaging tools. Management options vary based on the fibroids’ size, location, and symptoms, and may involve medications, hormone therapy, or surgical procedures like laparoscopic myomectomy or, in severe situations, hysterectomy.

What Are Uterine Fibroids?

Fibroids, also called myomas or leiomyomas, are benign (non-cancerous) tumors that grow within the uterus. Originating from the uterine muscle layer (myometrium), they are composed of muscle cells and fibrous tissue. These tumors arise from a single abnormal cell that multiplies uncontrollably, forming a mass. Their size may range from 1 mm to over 20 cm, and they can occur as a single mass or multiple growths. The symptoms and treatment strategies largely depend on where they’re located within the uterus.

Types of Uterine Fibroids

Fibroids are categorized by their position in the uterus:

• Intramural Fibroids
  Grow within the uterine wall (myometrium).
  ➤ Most common form.
  ➤ May cause heavy bleeding, cramping, or a sense of pressure.
• Submucosal Fibroids
  Develop just under the uterine lining and may bulge into the cavity.
  ➤ Less frequent, but often lead to infertility and severe bleeding.
• Subserosal Fibroids
  Positioned under the outer uterine lining, sometimes extending outward.
  ➤ Can become large and press against nearby organs, impacting bowel or bladder function.
• Pedunculated Fibroids
  Connected to the uterus by a stalk either inside or outside.
  ➤ Mushroom-like growths that may twist, resulting in sharp, sudden pain.

Uterine Fibroids : Signs & Symptoms

Some women don’t notice any effects, but when fibroids are symptomatic, issues can include:

• Excessive or long-lasting menstrual bleeding
• Cramping and painful periods
• A sensation of fullness or pressure in the pelvis
• Frequent need to urinate or trouble emptying the bladder
• Constipation or feeling bloated
• Discomfort in the lower back
• Pain during sexual activity
• Noticeable swelling in the abdomen
• Acute pain from fibroid degeneration

Uterine Fibroids : Causes

Although not fully understood, fibroid development involves several biological and genetic elements:

Hormonal Triggers

• Estrogen and progesterone fuel fibroid growth.
• Fibroids contain more hormone receptors than normal uterine tissue.
• Growth often occurs during reproductive years and shrinks post-menopause.

Genetic Influence

• Mutations in genes like MED12 and HMGA2 are common in fibroid cells.
• These changes affect how cells grow and divide abnormally.
• A family history increases personal risk.

Extracellular Matrix (ECM) Changes

• ECM offers structure to tissues but is overproduced in fibroids, making them dense.
• This excess may worsen hormonal signaling and promote growth.

Growth Signals

• Compounds such as IGF and TGF-β stimulate fibroid enlargement and ECM accumulation.
• These signals are often more active in fibroid cells.

Additional Risk Factors of Uterine Fibroids

• Age: Often seen between 30–50 years
• Ethnicity: Higher incidence and earlier onset in African-American women
• Obesity: Linked to higher estrogen levels
• Diet: High intake of red meat and low vegetables may raise risk
• Vitamin D Deficiency: Associated with fibroid growth

Complications if Left Untreated

• Severe iron-deficiency anemia due to heavy bleeding
• Difficulty conceiving or complications during pregnancy
• Urinary or digestive tract blockages
• Degeneration causing intense pain
• Rare malignant change into leiomyosarcoma

How Are Fibroids Diagnosed?

Pelvic Exam

Conducted manually to assess the uterus.
May reveal:
➤ Enlarged or irregular uterine shape
➤ Presence of firm nodules
Often leads to further imaging for confirmation.

Ultrasound

Primary imaging method used for confirmation.
➤ Can be done abdominally or transvaginally
➤ Identifies size, location, and type of fibroids
➤ Safe and non-invasive

MRI (Magnetic Resonance Imaging)

Utilized for complex or unclear cases.
➤ Offers detailed soft tissue views
➤ Helps distinguish fibroids from other uterine issues
➤ Supports surgical planning

Hysteroscopy

A camera-equipped tube inserted through the cervix into the uterus.
➤ Ideal for viewing and removing submucosal fibroids
➤ Can diagnose and treat during the same session

Fibroids Treatment Approaches

Medications:

• Pain relief: NSAIDs (e.g., ibuprofen)
• Hormonal control: GnRH agonists to shrink fibroids
• Bleeding control: Tranexamic acid
   Note: Always taken under medical guidance.

Fibroids Minimally Invasive Procedures

At MASSH MANAS, several minimally invasive techniques are available for the effective treatment of uterine fibroids, offering precision, reduced trauma, and quicker recovery. These procedures are especially beneficial for women who wish to avoid open surgery and preserve their reproductive health whenever possible.

Laparoscopic Myomectomy

Laparoscopic Myomectomy is a preferred option for women who want to remove fibroids while retaining their uterus. This procedure involves making small incisions through which surgical instruments and a laparoscope—a thin tube with a camera—are inserted. Using 2D imaging, surgeons can clearly visualize the uterus and fibroids, allowing for high surgical accuracy. Because the uterus is preserved, this approach supports future fertility. Additionally, it is less invasive than traditional surgery, resulting in reduced postoperative discomfort, minimal scarring, and a significantly faster recovery time.

Laparoscopic Hysterectomy

Laparoscopic Hysterectomy is recommended in cases where fibroids are numerous, very large, or unresponsive to other treatments, and when the patient does not plan to conceive in the future. This procedure involves the complete removal of the uterus through small keyhole incisions, guided by advanced laparoscopic tools. The technique ensures a safe and thorough removal while minimizing complications such as blood loss and infection. Since it is performed laparoscopically, recovery is quicker, hospital stay is shorter, and patients experience less postoperative pain compared to open hysterectomy.

Laparoscopic Fibroid Excision or Ablation

Laparoscopic Fibroid Excision or Ablation is another organ-sparing approach that targets fibroids while keeping the uterus intact. In the excision technique, the fibroid tissue is surgically removed. Alternatively, ablation uses energy sources like heat or lasers to destroy fibroid cells. These procedures are tailored to the type, size, and location of the fibroids, making them ideal for women who wish to avoid uterus removal. With enhanced accuracy provided by laparoscopic visualization, these interventions offer excellent outcomes with minimal discomfort and downtime.

Hysteroscopic Myomectomy

Hysteroscopic Myomectomy is specifically used for submucosal fibroids—those that grow into the uterine cavity. Unlike laparoscopic techniques, this procedure is performed entirely through the vaginal canal using a hysteroscope, which is a thin, lighted instrument inserted through the cervix. There are no abdominal incisions required. Hysteroscopic myomectomy allows for direct visualization and removal of fibroids within the uterine cavity. It is often done in a day-care setting, providing both diagnosis and treatment in a single sitting. This method is highly effective in managing abnormal uterine bleeding and improving fertility in suitable candidates.

Fibroids Surgical Options:

• Myomectomy: Fibroid removal for fertility preservation
• Hysterectomy: Entire uterus removed, definitive cure