Tammy has been seeing her gynaecologist annually for the past five years. She has a large fibroid. Her gynaecologist has reassured her that no treatment is required since she has no symptoms. Tulsi, on the other hand, wants to have a child and has been investigated for the last two years to figure out why she has not conceived. She has a fibroid growing into the uterine cavity. She has been advised to have the fibroid removed.
The treatment options for uterine fibroids are varied. To decide what is best for a particular woman, certain questions need to be answered.
· What are the symptoms and how do they affect the quality of your life?
· Do you plan to have children in the future?
· Are there risks associated with the treatment chosen?
· What are the costs involved?
There are various situations that may be present in women with fibroids. Each scenario requires a different approach.
For women with no bothersome symptoms and who are not planning to become pregnant
These women can be watched expectantly. No intervention is required. Depending on the size of the fibroid, these women can see their gynaecologist every 6-12 months. As long as a woman is reassured that the large size of the fibroid is not going to interfere with her health, she will more often that not, choose to watch and wait.
For women with heavy bleeding but who are not planning a pregnancy
In these women, there are several options. Oral contraceptive pills may be used to control the flow as well as provide contraception. Women, who have fibroids and a normal size uterine cavity, may get relief from heavy bleeding by using a progestin-releasing intra-uterine device (IUD). The hormone in the IUD thins the uterine lining. The menstrual flow will progressively decrease and within 6 months there will be negligible bleeding during the periods. One scientific study showed that by 3-6 months, 85 per cent of women returned to normal bleeding.
For women with heavy bleeding but who are interested in future fertility
In these women, there are several options depending on the position of the fibroid.
Tranexamic acid tablets taken during menstruation may help control the bleeding. In case the fibroid is distorting the uterine cavity, a myomectomy may be done to remove the fibroid alone.
What is a myomectomy?
A myomectomy is a surgery where the fibroid or fibroids are removed and the uterus is preserved. This allows the woman to go ahead with a pregnancy in the future. It is also done in younger women who want to continue to have periods and are not emotionally prepared to undergo a hysterectomy.
There are three types of myomectomy. The more conventional method is to surgically open the abdomen and remove the fibroid. The next method is laparoscopic myomectomy . In this case, a thin, lighted scope is introduced through a small opening in the abdomen and special surgical instruments are used to excise the fibroid. The third method is called hysteroscopic myomectomy . Submucous fibroids can often be removed with a hysteroscope, which is a telescope placed through the cervix and into the uterus. A hysteroscopic myomectomy does not require any cuts to be made since the instrument is introduced through the cervix. Only fibroids less than 5 cm in size can be removed by hysteroscopy.
Are there medications to shrink fibroids?
This is one of the most frequently asked questions. Unfortunately, there are no medications currently available that either prevent the formation of fibroids or permanently shrink them once they occur.
Medicines are sometimes used to shrink the fibroid so that it can be removed with greater ease, either laparoscopically or through the hysteroscope. The effect is however temporary. Leuperolide injection is an expensive medication that needs to be given every month for 3 months, to cause a 35 per cent decrease in the size of the fibroid. It acts by suppressing the hormones estrogen and progesterone. Due to this, women may face severe menopause-like symptoms. Unfortunately, once the effect of the medication wears off, the fibroids will grow back to their original size .
Fibroids are benign tumours of the uterus and up to 75 per cent of them do not require any treatment. Fibroids do not automatically mean a hysterectomy!
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.
