Image Courtesy of Centers for Disease Control and Prevention (NIH), some rights reserved.
Fibroid or Fibromyoma is a benign tumor of the uterus. The fibroid is also known by leiomyoma or myoma. The fibroid is a very common tumor in women. It remains undiagnosed for maximum time as the majority of tumor patients are asymptomatic. Myoma is more common between the ages group of 35 – 45 years.
RISK FACTOR OF FIBROID
Obesity is a major risk factor for fibroid. Nulliparity (women with no childbirth) is also another risk factor. Sometimes a positive family history of fibroid is also found.
SIGNS AND SYMPTOMS OF FIBROID
The majority of fibroid uterus patients are asymptomatic. Symptoms are seen according to the size and origin of the tumor.
- MENORRHAGIA – Menorrhagia or heavy menstrual bleeding is often found in large fibroid or submucous fibroid
- METRORRHAGIA – Metrorrhagia or irregular bleeding may be seen in fibromyoma patients.
- DYSMENORRHOEA – Dysmenorrhoea or painful menstruation is usually seen in the submucous fibroid.
- INFERTILITY – Infertility can occur in a fibroid uterus. This is due to a change in the shape or size of the uterus or due to low uterine contraction.
- ABDOMINAL LUMP – The patient may feel a lump within the lower abdomen due to large fibroid uterus.
- RECURRENT MISCARRIAGE – Recurrent miscarriage also happens in fibroid uterus as the uterine cavity becomes smaller due to the fibroid.
TYPES OF FIBROID
Three major types of fibroid are seen in uterus -Intramural, Subserosal and Submucosal fibroid.
INTRAMURAL FIBROID – All fibroid tumors are intramural or interstitial by origin, almost 75% of uterine fibroids are intramural.
SUBSEROSAL FIBROID – Subserosal fibroids are covered by peritoneum partially or completely. In fact, intramural fibroids grow outward and form subserous fibroid.
SUBMUCOUS FIBROID – Submucous fibroid lies below the mucosal layer of the uterus. It is formed by the inward growth of the interstitial fibroid. This type of fibroid causes symptoms like dysmenorrhoea and menorrhagia.
Another type of fibroid is found named as cervical fibroid. The cervical fibroid is found in the cervix of the uterus and this is a rare variety.
COMPLICATIONS OF FIBROID
A uterine fibroid may be complicated by various secondary changes.
- DEGENERATION – Variety types of degeneration are seen in myoma like hyaline degeneration, cystic degeneration, fatty degeneration, calcific degeneration, and red degeneration. Fatty generation is found after menopause. Red degeneration occurs during the second trimester of pregnancy. Red degeneration is also called carneous degeneration.
- ATROPHY – Atrophy means shrinking of size. After menopause fibroid may go into atrophy due to lack of estrogen support.
- NECROSIS – Sometimes the center of submucous fibroid may undergo necrosis due to a lack of blood supply.
- INFECTION – Infection can occur within the fibroid tumor.
INVESTIGATIONS FOR FIBROID
For diagnosing uterine fibroid many investigation procedures are available nowadays.
- ULTRASONOGRAPHY – Abdominal ultrasound or transvaginal ultrasound is done to detect uterine myoma. TVS(Trans Vaginal Sonography) gives more accurate information about fibroid location, shape and size. The submucous fibroid is better seen by SIS ( Saline Infusion Sonography)
- MRI – Magnetic Resonance Imaging or MRI is a costly investigation but gives more accurate results.
- LAPAROSCOPY – Laparoscopy is a small surgical procedure where an abdominal cavity is observed through a small hole with fibro optic wire. It helps to diagnosis a small size fibroid tumor.
- HYSTEROSCOPY – Hysteroscopy helps indirect visualization of the uterine cavity. It is useful for the diagnosis of submucous fibroid uterus.
TREATMENT OF FIBROID UTERUS
According to the symptoms, tumor size and complications treatments are given. Two types of management options are available – Medical treatment and surgical treatment. Asymptomatic fibroid uterus with <12 weeks size needs regular supervision only but >12 weeks size and all symptomatic fibroids need treatment.
- MEDICAL TREATMENT – Medical treatment is given to reduce symptoms like heavy bleeding or pain or to reduce tumor size. For metrorrhagia. Tranexamic acid with iron supplements given. Mifepristone, an anti-progesterone drug is very useful to treat menorrhagia. Mifepristone also reduces fibroid tumor size. Danazol is an anti-androgen drug that reduces blood loss and causes a mild reduction of tumor size. GnRH agonist drugs like Goserelin, Buserelin, Nafarelinare also used to treat fibroid uterus. GnRH antagonist drugs like Cetrorelix or Ganirelix are also beneficial for myoma.
- SURGICAL TREATMENT – When medical management of fibroid uterus fails or tumor size large, then surgical treatment is given,
- MYOMECTOMY – Myomectomy is the removal of myomata from the uterus. It preserves the reproductive function of the uterus. It is useful for patients willing to be pregnant.
- MYOLYSIS – Myolyis can be done by using a laser or bipolar diathermy.
- HYSTERECTOMY – Hysterectomy means complete removal of the uterus. It is suitable for elderly patients or post-menopausal patients.