How to Remove Uterine Fibroids?

What Are Uterine Fibroids?

Uterine Fibroids are non-cancerous tumors growing in or around the uterus. They usually occur during reproductive years. Usually composed of fibrous and muscle tissue from the uterine wall, they are highly common and have no recognisable symptoms. The growth and size of the fibroids is highly influenced by female reproductive hormones progesterone and oestrogen. They primarily develop during reproductive years and often shrink after menopause, once the hormone levels drop in the body. Highly common and asymptomatic in most women, they can lead to heavy bleeding during the menstrual cycle, pelvic pain and sometimes can pose problems in conceiving.

What Are The Different Types Of Fibroids?

Fibroids are usually classified depending on their location in or around the uterus. They can be classified as follows:

• Intramural Fibroids- They are the most common kind of fibroids. These fibroids grow inside the muscular wall of the uterus. They may develop singly or in clusters of multiple. Since they grow within the thick uterine muscle, they may cause the uterus to enlarge, which may interfere with uterine wall contractions during menstruation, leading to heavier bleeding and a more painful cycle.
• Submucosal Fibroids- These fibroids grow just below the inner lining of the uterus and can invade the uterine cavity. Because they can protrude into the uterine cavity, they can cause hindrance during embryo implantation causing fertility issues. They are not as common but can have severe symptoms.
• Subserosal Fibroids- These fibroids can grow under the outer lining of the uterine wall. They are on the outer surface of the uterus and if they grow big, can extend into the pelvic cavity. These fibroids can cause pelvic pressure and pain.
• Pedunculated Fibroids- These fibroids are attached to the uterus with a stalk or a stem. These are the least common types of fibroids.
• Cervical Fibroids- Extremely rare, these fibroids form in the cervix. Since they are extremely close to the vagina they can cause pain during intercourse and can lead to infertility. They can also interfere with the menstrual cycle and pregnancy.

Causes And Symptoms Of Uterine Fibroids

While professionals do not have an exact cause, research has shown hormonal changes, biological factors and lifestyle choices affecting the formation and growth of fibroids.

Medical professionals believe uterine fibroids may originate from a stem cell in the smooth muscle tissue of the uterus. A single cell can divide repeatedly and form into a solid rubbery mass over time. This mass is different from the surrounding tissue. They can remain the same, grow slowly or grow rapidly in size.

Fibroids that develop during pregnancy can disappear or reduce once the uterus returns to its actual size.

• Hormonal Imbalance- Fibroids are largely influenced by hormones like progesterone and oestrogen. These hormones can lead the tissues forming the uterine lining to thicken during the menstrual cycle and promote the growth of fibroids as well. During reproductive years, when the hormones are high in the body, the fibroids can enlarge and shrink after menopause once the level of hormones drops.
• Genetic Factors- Genetic changes in the cells of the uterine muscle wall can be a cause for abnormal cell growth and the formation of fibroids. They could also be hereditary in some cases, which means women with a family history of uterine fibroids are more likely to develop them.
• Growth Factors- Some bodily substances can stimulate or encourage the growth of smooth muscle cells in the uterus. Insulin-like growth factors can encourage fibroid development.
• Extracellular Matrix- It is the fibrous material that gives cells structural support. It is particularly common in fibroids, and its excessive accumulation can cause them to become hard and dense, leading to tumour development.
• Lifestyle/Outside Factors- Consuming alcohol, excess bodyweight, early menstrual onset, high red meat consumption, low consumption of fruits and vegetables, chronic stress, Vitamin D deficiency.

Symptoms

Most women may not experience chronic symptoms of fibroids. Symptoms also may vary depending on the size, type, location and number of fibroids.

• Heavy Period Flow: Fibroids can cause painful and unusually long menstrual cycles. In rare cases, it can cause anaemia due to excessive blood loss.
• Pressure in the Pelvis: Fibroids larger in size can create pressure, a feeling of fullness in the pelvic area that can also lead to chronic pain.
• Constant Urination: Large fibroids around the uterus can put pressure on the organs around it, like the urinary bladder. This can reduce bladder capacity due to pressure, causing you to urinate more often.
• Painful Sexual Intercourse: Depending on where the fibroid is located, some women may experience pain during sex.
• Constipation: Large fibroids can also put pressure on the intestines, interfering with bowel movements and leading to constipation.
• Pain in lower back or legs: Larger fibroids can also compress the surrounding nerves, causing pain in the lower back or legs.
• Fertility Issues: Fibroids can sometimes cause problems in reproduction and become a factor in miscarriages or other pregnancy issues.

It is important to consult a medical professional if any of the above symptoms are prolonged.

How To Remove Or Treat Fibroids?

Treatment and measures of removal are suggested depending on the size, location and type of fibroid. Since fibroids are largely asymptomatic, immediate treatment can be avoided with watchful waiting. Fibroids can also shrink on their own if they occur during reproductive years. Small asymptomatic fibroids can be managed with pelvic examinations, MRI scans and ultrasound imaging.

Treatment options may also vary for patients looking to plan a pregnancy in future.

Medication/Drug-Based Treatment

• Over-the-counter pills: These medications help manage pain and discomfort caused by fibroids. Ibuprofen and paracetamol are some examples.
• Iron supplements: Doctors can suggest these if the patient develops anaemia due to excessive bleeding.
• Birth control: Menstrual cramps and excessive bleeding during and between periods are two symptoms of fibroids that birth control can help with. You can adopt a range of birth control methods, such as intrauterine devices (IUDs), oral contraceptive tablets, rings, and injections.
• Gonadotropin-releasing hormone (GnRH) agonists: These drugs reduce the size of fibroids. They are occasionally used to reduce the size of a fibroid prior to surgery, which facilitates its removal. But these drugs are just temporary, and the fibroids may return if you stop using them.

Surgical Treatment

Myomectomy is the procedure that removes fibroids while preserving the uterus. This procedure maintains fertility and removes symptomatic fibroids.

The following are some examples of myomectomy techniques used to remove fibroids:

• Hysteroscopy: A thin, flexible, tube-like instrument is inserted into your uterus through your cervix and vagina. Your provider uses the scope to slice away and remove the fibroids.
• Laparoscopy: The fibroids are removed using a scope during this surgery. In contrast to hysteroscopy, this treatment entails making a few tiny abdominal incisions. The scope will enter and exit your body in this manner.
• Laparotomy: In this treatment, your doctor makes a single, bigger incision in your abdomen to remove the fibroids.
• Hysterectomy: The uterus is removed during this procedure. It is the only permanent cure for fibroids. It is usually recommended for patients with large fibroids. It is suggested in cases of extreme symptoms. It is ideal for patients who are not planning any future pregnancies, as this eliminates any chance of that. Vaginal, laparoscopic, or robotic techniques are examples of minimally invasive hysterectomies.
• Uterine fibroid embolisation (UFE): The gynaecologist assists an interventional radiologist in carrying out this surgery. They insert a tiny catheter into your radial or uterine artery and inject tiny particles that obstruct the blood supply to the fibroids. The fibroids get smaller, and the symptoms get better when blood flow is reduced. It is not ideal for all cases.

Uterine fibroids can be safely and effectively treated with radiofrequency ablation (RFA), which uses microwave (RF) energy. For those who have not yet hit menopause, it is advised. Smaller fibroids are treated with it.

Risks and Post-treatment Care

Like any treatment or surgery, this one may carry some risks. It is important that you consult a healthcare professional before making any decision. All surgeries have the underlying risk of infection and internal bleeding. Also, for patients wanting future pregnancies, it is important to weigh all pros and cons before committing to a treatment. 

Recovery for any patient depends on the procedure they went through. Non-invasive measures or minimally invasive measures take only a few days. Whereas surgery can take anywhere between 2 to 4 weeks.

During this period, it is recommended that patients maintain a healthy diet, attend their follow-up appointments regularly, and avoid any strain or heavy lifting.

Conclusion

Uterine fibroids are amongst the most common benign tumours affecting women during their reproductive years. They are growths arising from the smooth muscle layer of the uterine wall. They are largely asymptomatic but can sometimes cause health complications like heavy bleeding, pelvic pain, etc. It can be treated surgically or non-surgically, depending on its size and location on the uterine wall. They can form due to various reasons like hormonal imbalance, genetic history and lifestyle habits. Overall, the majority of women with uterine fibroids may effectively manage their illness and retain a high quality of life with appropriate medical care and routine monitoring.