Fibroids are common tumours of the uterus found in over 20 per cent of young women. These are firm, ball-like and may vary in size. Fibroids are diagnosed by the history, gynaecological examination and sonography. They are named according to their position in the womb and the symptoms and problems that they cause depends on their location. Their management depends upon the size and location, patient's age, symptoms and the patient's desire for children in the future.
Different types
Subserosal fibroids grow on the outer side of the uterus. These usually cause no problems unless they grow very big and patient experiences difficulty in passing urine or stools. The fibroids may start showing as a bulge in the lower part of the stomach if they are large and have to be removed. Regular surgery requires longer hospitalisation and rest and recovery period is also longer. There is also a tendency to develop adhesions (intestines getting stuck to each other and the womb) and this can cause long-term pain and sometimes infertility.
Nowadays, most fibroids can be removed by the keyhole or buttonhole (laparoscopic) surgery, which does not leave a large scar. Further the patient has to stay in hospital only for 2-3 days, has less pain and adhesions and can get back to an active life very soon.
Intramural fibroids lie in the middle of the womb and may cause pain during periods and sometimes problems during pregnancy if they are large. These fibroids may prevent a normal delivery or cause heavy bleeding or infection after delivery. They can be removed in the same way as serosal fibroids.
The fibroids that cause maximum problems are submucous ones. These grow on the inner side of the womb; where the baby grows or the part shed during menses. Even small submucous fibroids can cause pain, heavy and irregular menses, infertility, recurrent abortions and difficulty in normal delivery and need to be removed. This is achieved by hysteroscopic surgery. A thin telescope with a camera attached to it (hysteroscope) is introduced into the womb through the vagina and the fibroid is shaved off. This can be done using a machine called a resectoscope or the new technique using the versapoint. The versapoint is a laser like device with which the fibroid can be vaporised. This is a safe and efficient system.
Revolutionary method
Now, for the first time in Asia, there is a method to treat the common problem of fibroids, without surgery. With the introduction of the MRI guided focused ultrasound (MRgFUS) fibroids can be treated without surgery, hospitalisation and anaesthesia. The procedure is done under MRI guidance, takes 1 – 2 hours. This technique uses heat energy to stop the blood going to the fibroid and hence causes it to reduce in size. As the MRI is very accurate, the fibroid is properly localised and a fine beam of ultrasound waves is focused on it raising temperature within to cause necrosis. Continuous monitoring of the temperature within the fibroid is done to get best results.
The patient has no pain during or after the procedure. She can go home the same day and resume work the next day. Soon after the MRI, the patient's symptoms improve and gradually the fibroid reduces in size.
High risk patients and those scared of surgery can now breathe easy. The uterus is preserved and so is fertility; the patient can safely have children in the future if they want. The procedure has a very low risk of complications and is simple, safe and effective.
However, if the woman is older, has multiple fibroids and has completed her family, the entire uterus along with fibroids can be removed.
Since fibroids may be found in women of all ages from those in 20's to those in their 50's, it is good for all women to have regular gynaecological check ups even if they have no symptoms.
The writer is a Mumbai-based consultant gynaecologist.
