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Fighting out fibroids!

What happens to fibroids once developed?

While the muscle cells made up of fibroids are abnormal in their genes, they are responsive to oestrogen, the female sex hormone.

During the years that a woman is menstruating, oestrogen stimulation leads to the continual growth of fibroids. In general, a fibroid increases in size by 1 cm a year.

During pregnancy, fibroids are recognized to grow more rapidly than during the non-pregnant period.

At menopause as oestrogen secretion ceases, many fibroids shrink in size slowly in the post-menopausal years. However, fibroids will not disappear completely, even years post menopause.

Some other growth factors are known to influence the growth of fibroids. These growth factors are not changed by menopause. This clarifies why some fibroids fail to shrink or may even continue to grow despite menopause.

It is very common for fibroids of different sizes and locations to be present on the same uterus.

Fibroids - Treatments

How can my fibroid be treated?

The majority of women have small or moderate size fibroids. In general, these women do not experience any distress from the fibroids and do not require treatment. In other women, the decision on initiation and choice of treatment of fibroids depends on individual circumstances. The treatment available includes the following:

Treatment of heavy menstrual flow 

Menstrual flow can be reduced with medication such as tranexamic acid, danazol, progesterone hormone or gonadotrophy releasing hormone analogues. This kind of treatment is apposite when the fibroid is small or moderate in size. It is also more fitting among women who are close to menopause when treatment may be limited to an ephemeral period of time before menopause ensues. This treatment is not a cure for fibroids.

Hysteroscopic resection of fibroid 

Submucous fibroid or fibroid polyp can be effectively removed by resection through a hysteroscope. It is a minimally invasive procedure through the vaginal and cervical approach. This technique is suitable for women of any age, including those considering pregnancy in the future.

Uterine artery embolization 

Solitary fibroid of moderate or moderately large size can be treated by blocking the blood flow (embolization) to the fibroid. This is an interventional radiology procedure involving inserting an arterial catheter to the uterine artery under fluoroscopic guidance. This technique is not a complete cure for fibroids.

Instead, after successful arterial embolization, the size of the fibroid can shrink by almost 60 percent and the heavy menstrual flow can be reduced by almost 80 percent. The treatment is apt for women who want to avoid the risk of surgery. It is not appropriate for women whose fibroids need to be submitted for pathological investigations.

Surgical removal of fibroids, also known as myomectomy 

In this operation, fibroids are removed and the uterus is repaired for resumption of its normal menstrual and childbearing functions. Fibroids of moderate to moderately large sizes can be effectively removed through laparoscopic surgery. Laparoscopy is proven to be efficient and is associated with less pain and shorter recovery time against conventional surgery. Robotic surgery is an alternative minimally invasive procedure for treating these types of fibroids.

On the other hand, traditional open surgery remains the most versatile approach to remove all fibroids, irrespective of the size and their location on the uterus. Good surgical repair on the incisions on the uterus confers additional safety on the integrity of the wounds in ensuing pregnancies.

Hysterectomy or removal of the uterus 

For women who do not desire to conserve the fertility potential, removal of the uterus (hysterectomy) confers the most appropriate and complete treatment.

Can fibroids recur after treatment?

Once the fibroids are removed, the uterus resumes its normal structure. There remains a potential risk that some muscle cells may develop genetic changes leading to development of new fibroids. There is a 10-30 percent chance that new fibroids will develop after the myomectomy operation. There is obviously no recurrence of fibroids if a hysterectomy is performed.

Would a fibroid turn malignant?

Fibroids are by nature non-cancerous tumors. The malignant form of fibroid is known as leiomyosarcoma. It is a very rare tumor developed from abnormal muscle cells unrelated to fibroids. It can occur in the uterus with existing fibroids or without fibroids. Development of malignancy within an existing fibroid is extremely rare and is not a consideration for decision for surgery on fibroids.

In case you are experiencing any of the above-mentioned conditions, consult your doctor at once!