Uterine fibroids are the most common pelvic tumour. It is a benign growth that develops from muscles forming the wall of the uterus. They are usually round or semi – round in shape. It usually affects women above the age of 30 years, rarely seen in women below 20 years of age and usually shrinks in size after menopause. The cause of development of these tumours is still unknown; however the hormone estrogen seems to promote the growth and development of these tumours. Hence once the hormone levels decline post menopause, the fibroids too gradually shrink and reduce in size. Based on their location in the uterus there are divided into myometrial, subserosal, submucosal and pedunculated. Myometrial fibroids arise from the myometrium which is the muscular wall of the uterus, subserosal arise from just below the covering of the uterus, submucosal arise from just below the uterine lining and pedunculated are those which bear a stalk and hence project from the uterus outside or within the uterine cavity.
Symptoms of Uterine fibroids: Heavy menstrual flow also called menorrhagia, may or may not be associated with the passage of blood clots. Menstrual flow is prolonged in most patients. Patients may complain of irregular bleeding or bleeding in between periods. Severe pain in the lower abdomen or back during menses also known as dysmenorrhoea is another common symptom. Most patients complain of a sensation of abdominal fullness and distension. Some patients may complain of pain during intercourse, increased frequency of micturition and a sensation of fullness or pressure in the lower abdomen.
Signs on examination: On examination, on per abdominal examination one would be able a mass in the lower abdomen, especially if the mass is big enough. When aided with per vaginal examination, the physician is able to find out the approximate size and position of the fibroid. However the differential diagnosis for a mass felt in the pelvis may be ovarian tumours, pregnancy, pyosalpinx or hydrosalpinx, endometriosis and uterine adenomyosis. Many diagnostic tests can be done, but a transvaginal ultrasound or pelvic ultrasound is most important to diagnose Uterine Fibroids. An MRI or CT scan of the pelvis will help to confirm the diagnosis. In a few cases however, a laparoscopy or endometrial biopsy may be required to rule out the differential diagnosis.
Complications of fibroids: Menorrhagia can lead to anaemia, torsion of a pedunculated fibroid, recurrent urinary tract infection if a fibroid hampers complete voiding of urine due to pressure on the urinary bladder, cancerous or malignant changes in the fibroid and infertility. In case a woman having a fibroid is pregnant she may suffer from recurrent miscarriages, red degeneration of the fibroid and heavy bleeding post partum.
Treatment: The treatment of Uterine fibroids varies vastly depending on the needs of the woman. It depends on the severity and intensity of symptoms such as menorrhagia, dysmenorrhoea, infertility, and age of the woman, the size of the fibroids and the rate of growth of the tumour and whether or not the woman desires to conceive and bear children in the future. Myomectomy means removal of the growth, keeping the uterus intact. Hysterectomy is done once the woman does not desire to have any more children. Symptomatic treatment would include administration of iron supplements, non steroidal anti-inflammatory drugs, oral contraceptive pills and insertion of intrauterine devices.
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