UTERINE FIBROIDS

 

UTERINE FIBROIDS

Uterine fibroids are asymptomatic; non-cancerous growth of the uterus that often occurs during pregnancy. It can also be names as leiomyoma or myoma; uterine fibroids have no relation with an increased risk of uterine cancer and can never develop into cancer. Fibroids are quite large in some cases and might be in a size of seed. A single or multiple fibroids may be occurred.

CLASSIFICATION OF FIBROIDS:

Fibroids can be classified as per their growth in the uterine wall. There are four types of uterine fibroids. They are:

• Sub-mucosal fibroids: Sub-mucosal fibroids are the rarest type of fibroids. They grow in sub-mucosal layer i.e., beneath the thin layer of the tissue in the uterus. These fibroids can invade into the uterine cavity.

• Intramural fibroids: Intramural fibroids are the most common type in fibroids. They grow in between the muscles of the uterus.

• Sub-serosa fibroids: Sub-serosa fibroids are the most common type of fibroids. Fibroids can push out of the uterus to the pelvis.

• Pedunculated fibroids: These fibroids are differed from other by a stalk like structure called peduncle. These fibroids can grow both interior & exterior to the uterus.

SYMPTOMS:

Generally uterine fibroids are asymptomatic in nature, in some rare cases patient may experience mild to severe symptoms such as:

• Unusual pain or heavy bleeding.

• Painful periods.

• Painful sex.

• Frequent urination.

• Complications during pregnancy/labor.

• Frequent urination.

DIAGNOSIS:

Uterine fibroids are generally diagnosed through a routine pelvic exam. Physician may feel some irregularities in shape of uterus. If symptoms are seen, other tests may be prescribed.

• Ultrasound: Sound waves are used to get a picture of the uterus to confirmation and to measure the fibroid size.

• Lab tests: during severe menstrual bleeding, lab tests may be prescribed. Lab tests may include complete blood count (CBC) to determine anemia due to severe blood loss and also other blood tests to detect blood disorders and thyroid problems.

      Other imaging tests:

           If ultrasound and lab tests aren’t given satisfactory results then the physician prescribes other imaging tests.

• Hysterosonography: It can also be called as saline infused sonogram. For detecting fibroids sterile saline is used for expanding uterine cavity and to get images of sub-mucosal fibroids. The test is mainly prescribed for women with chronic bleeding and pregnancy.

• Hysterosalpingography: Physician prescribes hysterosalpingography in cases of infertility. For detection dyes can be used to highlight the uterine cavity and fallopian tubes on x-ray film.

• Hysteroscopy: For the detection of fibroids, the technician inserts a small telescope through cervix. And then injects saline into uterus hence the cavity gets expanded and helps the technician to examine the walls of the uterus.

TREATMENT:

Uterine fibroids don’t have a single medication for cure. Researchers are still working on the treatment medications. Oral contraceptives and NSAIDs are prescribed which helps to treat pain and bleeding but doesn’t cure fibroids.

MEDICATIONS: Medications mainly target hormones which regulate the menstrual cycle, chronic bleeding. Medications don’t cure fibroids but helps in reducing the size of fibroids.

• Gonadotropin-releasing hormone agonists: Gnrh agonist such as Gasorelin, Leuprolide, Triptorelin acts by inhibiting the release of estrogen and progesterone, which eventually results in stoppage of menstrual cycle hence the fibroids get shrinked and often improves anemia.

Gnrh agonists may results in with-drawl symptoms. And long term usage causes loss of bone.

• Progestin-releasing intra uterine devices: IUDs help in relieving chronic bleeding caused by chronic bleeding. IUDs doesn’t shrink fibroids.

• Tranexamic acid: It is a non-hormonal medication administered to control chronic bleeding.

NON-INVASIVE PROCEDURES:

Non-invasive treatments are performed with a high-energy ultra-sound transducer. Images show exact location of the fibroid hence the transducer targets on the sound waves and degrades the fibroids in the uterine cavity.

MINIMALLY INVASIVE PROCEDURES:

• Radio frequency ablation: radio frequency energies destroy the fibroids & shrink the blood vessels feeding fibroids. Physician makes two smaller incisions in the abdomen for inserting a laproscope having a camera on its tip which helps to locate the fibroid. A specialized device will be used to deploy small needles into fibroid. Fibroids temperature gets increased by needles & immediately destroys the fibroids. Shrinkage of fibroids occurs in next 3-12months.

• Laproscopic myomectomy: This type of procedure takes place in cases of small number of fibroids present. Slender instruments are inserted through smaller incisions in the abdomen to remove fibroids.

Larger fibroids can also be removed by breaking the fibroids to smaller pieces.

• Endometrial ablation: A specialized instrument will be inserted into uterus, microwave energy, heat or electric current can be used to destroy uterine lining either to control menstrual bleeding or stoppage of menstruation.

TRADITIONAL SURGICAL PROCEDURES:

• Abdominal myomectomy: In case of multiple fibroids, large fibroids or deep fibroids, physician prefers an open abdominal surgical procedure to remove fibroids.

• Hysterectomy: It includes removal of uterus, which is the only solution for uterine fibroids. It is a major surgery mainly done during menopause.

MORCELLATION DURING REMOVAL: It is a process of breaking fibroids into smaller pieces which results in increased risk of cancer if any undiagnosed cancerous mass undergo morcellation during myomectomy. There are several ways to reduce the risk of cancer by evaluating risk factors before surgery.

BENEFITS OF MORCELLATION:

Allows removal of a large fibroid tissue through smaller cuts on abdomen or through vagina.

• Less painful after surgery.

• Reduced risk of infection.

• Reduced risk of blood clots in legs and lungs.

• A shorter hospital stay.

• Quick recovery.

RISK OF MORCELLATION:

• A small piece of non-cancerous tissue could leave inside abdomen during the surgery.

• Morcellation of fibroid that could contain unexpected cancer i.e., uterine sarcoma.

CONCLUSION:

Uterine fibroids are the common concern in women at fertile age causes chronic bleeding and menstrual pain. It shows a negative impact on different aspects in life.

REFERENCES:

1. https://pubmed.ncbi.nlm.nih.gov/11345000/#:~:text=Abdominal%20myomectomy%20and%20hysterectomy%20remain,and%20delineated%20avoid%20unnecessary%20intervention.

2. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/diagnosis-treatment/drc-20354294

3. https://www.med.unc.edu/obgyn/migs/our-services/types-of-surgeries-performed/

T.Jahnavi, (b.pharm)

Student at Clinosol.

Reference id: 069/0421.