Everything You Need To Know About Fibroids
Center Head: Dr. Neena, can you just guide on what exactly the fibroid means?
Dr. Neena: I would like to start the session of fibroids since it is a very common problem nowadays. Now out of maybe 5, we get 1 or 2 patients in the OPD, they are coming with the sonography reports for the complaints with fibroids. So, we need to know what is fibroid and why it is important to know about fibroids. I will just try to explain on a dummy, so that it is better to understand. Now, fibroids is what? Fibroids is a tumour which is noncancerous, mind it, it is not cancerous so do not worry. It is a tumour which is soft. It can be in the uterus or in and around the uterus, okay. Now there are 3 types of fibroids: the fibroid which is inside the uterine cavity, which is called a submucosal fibroid. The fibroid which is in the muscular layer of the uterus is called as intramyometrial fibroids and the fibroids which is outside the uterus is called as subserosal fibroids. Now, it is important to know the type of fibroid you are having because the symptoms depend upon the type of fibroid and the position of the fibroids. So when the fibroid is next to the uterus, it is called as broad ligament fibroids, which is very important to know because it causes pressure changes on your kidneys, your rectum and all.
Center Head: So, I think though the classification looks simple but difficult to understand a bit, but like as you said that the symptoms vary according to the position of the fibroids. So what are the common symptoms which are there?
Dr. Neena: Now, the young girls do come to us in the OPD with the complaints of severe dysmenorrhoea, as in painful menses. They have lot of bleeding, painful menses, which are not easily treated with the simple painkiller, so they come to us. Second, patients of age group of 30 to 50, who are desirous of conception, they do come to us, not able to conceive that is called as infertility. So, it can range from white, small things like painful menses to infertility to postmenopausal females, you know the females who are nearing their menopause, age of 40 to 50, those who are having severe pain and again severe bleeding for which they require surgeries. So symptoms vary according to the different age group and we need to manage them according to the complaints they come to us.
Center Head: So, there is no specific age group where we expect the fibroids are present or can be there?
Dr. Neena: Yeah, this is more commonly seen in childbearing age group because the aetiology of that fibroids is thought to be excess in a hormone called as oestrogen, which starts rising as you go into the childbearing age, and near menopause it starts dropping. So if you have fibroids, say multiple fibroids ranging from 2 cm to say 4 or 5 cm, usually they don’t require treatment, if they don’t have any symptoms, like maybe pain or maybe any excessive bleeding in your menses because by menopause, when your hormone level starts dropping, they are known to regress. So it is definitely age related and mostly in the childbearing age group, from the age of 30 to 50 years.
Center Head: Another question that comes to my mind is, as you said, the aetiology or the cause of the fibroid, so is it that only hormone is the culprit or there are other causes also?
Dr. Neena: See, the main aetiology of fibroids is yet not known but it is usually seen hereditary, like if the mother is having fibroids, the daughter may land up having fibroids, so she needs to keep a check in that. And any condition like polycystic ovaries or hormones which are being taken, excess of oestrogen hormone in any form can give increase in the size of the fibroids. As we’ve also seen in pregnancies, where the level of our hormones is very high like oestrogen and progesterone, which are very high, the fibroids tend to grow in size, and post-delivery, again they start shrinking. So, it is definitely hormone dependent, and exactly for that, we use… for management also, we do use these hormones.
Center Head: Okay, as you said like post-delivery, the fibroids shrink.
Dr. Neena: Yeah.
Center Head: So one can have baby or deliver with the fibroid also?
Dr. Neena: Yeah, definitely, if the fibroid is not in the uterine cavity that is the submucosal fibroid as I shown, they can conceive, they can carry the pregnancy till term, in maximum patients. But in few patients, like if the fibroid is obstructing, they may require a caesarean section. The natural birth passage, if it has been obstructed with the big fibroids then we cannot deliver the patient normally. In that case, they require caesarean section. Many times, these patients do require… they land up in the preterm delivery because the space is inadequate and they start getting premature contractions. And the third thing is during delivery, even if they deliver at the full-term, normal delivery, there are chances that the patient will end up in postpartum haemorrhage, that is excessive vaginal bleeding post-delivery and patient may require transfusions. So, these patients are labelled as high-risk patients and they need to be under the care of a good obstetrician and they should deliver in the institutes where all the facilities with ICCU setup or backup is available.
Center Head: That’s really good information what you passed on.
Dr. Neena: Yeah, yes.
Center Head: Dr. Neena, as you said, the fibroids are not cancerous, right?
Dr. Neena: Yeah.
Center Head: But if they are like not diagnosed or not treated at the time when they should be, so can they turn malignant or what?
Dr. Neena: It’s a very good question, I should say, Center Head. Now, the incidence of malignancy in fibroids is seen less than 1%. But still whenever a patient comes to us, we do investigate the patient, we get fibroids ranging from a size of 1 to 2 cms, up to 8 or 9 months pregnant uterus also, so they can vary from few grams up to maybe 5 to 10 kgs also. So, these patients usually undergo MRI before undergoing the surgery, so beforehand, we know what are we dealing with, whether it is a benign, whether it is a malignant, but 99% of the cases usually are benign and they don’t have any after effects. Usually, surgery is the solution for all these cases, and post-surgery also, we do send the specimens for histopathology examinations to confirm a diagnosis that the malignancy is not there, so we rule out the malignancy in this way.
Center Head: Okay, so I think majority cases, we should not have that fear in mind like once the fibroid is diagnosed…
Dr. Neena: Yes.
Center Head: Another question is how to diagnose the fibroid or how to come to a conclusion that, yes, the patient is having fibroid?
Dr. Neena: Now, how do we know we have fibroids? First of all, if there is excessive vaginal bleeding or there is intermittent vaginal bleeding. You have a painful menstruation, the second thing. The third thing is that if you have a painful intercourse and you have problems in defecation or a vague type of a pain in the lower abdomen, it may be associated with the distension of the abdomen too, then you need to contact your gynaecologist. And usually by clinical examination, the per vaginal examination, we can definitely tell you that it is fibroid, and to support our diagnosis, they usually undergo basic investigations like sonography which can tell us about the mass and then to confirm the diagnosis, in certain cases, whether tumour is huge, we do MRI also. So that is the way, this sonographies and MRI do help support our diagnosis and it is very easy. You can just meet your gynaec, get your things conformed and checked, and I think it should solve problems.
Center Head: So basically, the diagnosis per se is a non-invasive procedure in the case of fibroids.
Dr. Neena: Yes, yeah.
Center Head: And finally, it comes to what is the treatment, like only surgery is the treatment, everybody has to undergo surgery or there is any way out, I mean just to avoid surgery?
Dr. Neena: Yeah, now see, the management of the fibroids depends upon the symptoms of the patient. If the patient is having small fibroids which is not bothering, like there are no symptoms of for menorrhagia, bleeding or pain, then we leave those fibroids as it is, we just need to follow-up the patient. Maybe, every year we do a sonography just to see how the fibroid is behaving.
Center Head: Okay.
Dr. Neena: Yeah… if the fibroid is growing gradually and it is reaching a size of maybe 5 or 6 cms then we advise surgery or else if the patient is desirous of pregnancy and the fibroid is obstructing the way then we definitely need to go in for surgery. Latest techniques like laparoscopy, hysteroscopy is available, so that we can get away with those fibroids. And the third thing is in usually pregnancy, we do not touch the fibroids, like post-caesarean… if the patient is undergoing caesarean then definitely we can remove the fibroids at the time of surgery.
Center Head: At the time of surgery…
Dr. Neena: Initially, we were not doing the surgery, but now with the latest technologies, we have started removing the fibroids in the same sitting of the caesarean sections also, so that is beneficial for the patient. Then the third thing is if there is no like if the patient is in menopausal age group, so fibroids as it is are going to shrink, so we do not advise any surgery, we usually just keep on monitoring the patient’s Pap smears and this is how we treat the patient. Now, latest technologies have also come in like uterine artery embolization by which we just embolize the vessel and the fibroid shrinks. Medical management, yes, we have. For small fibroids, patients waiting for surgery, or big fibroids which require time, we do put them on a new drug which has come in, we put those patients on those medicines, which has few side effects, so those medications have to be taken under your gynaecologist’s guidance and I think they should do the purpose.
Center Head: The treatment part is little difficult to understand, but the main underlying thing is that we should consult our gynaecologist whenever we come across such symptoms and whenever we have some doubt about fibroid or anything like that. So with this, I would like to thank Dr. Neena and yes…
Dr. Neena: So to sum up everything, the take-home message from this is do not worry if you have fibroids, it’s a non-cancerous, it’s a benign type of a condition.
Center Head: Yes.
Dr. Neena: And if you are under a good guidance, I think you can do away easily with the fibroids, not all the fibroids require surgery. So we can definitely manage with medicines as well. So do not worry if you have fibroids, and please contact us. Thank you.