Author Name: Dr. Archana Verma || Mentor Name: Dr. Shubhdeep Bhattacharya on April 24, 2020

FIBROIDS,often called uterine myomas are benign smooth muscle neoplasm that typically originate from the myometrium. Its incidence is 20-30% of women over 30 years of age.

Based on location fibroids can be classified as – Submucous, Intramural, Subserous and Cervical. According to FIGO classification it has been classified as Type 0 – pedunculated intracavity

Type1 -< 50% Intramural
Type2 – > 50% Intramural
Type 3 – 100% Intramural& endometrial contact
Type 4 – 100% Intramural
Type 5 –Subserosal&>=50%Intramural
Type 6 – Subserosal&< 50% Intramural
Type 7 – Subserosal pedunculated

Whereas, ADENOMYOSIS is characterized by uterine enlargement caused by ectopic nests of endometrium located deep within the myometrium. It can be either Diffuse adenomyosis; when nests scattered throughout the myometrium or, Focal Adenomyosis ; when present as localized nodular collection.

On the basis of SYMPTOMS-
FIBROIDS can be asymptomatic or can present with bleeding, pelvic pain, pressure symptoms,or infertility( fibroids can diminish fertility but only 1-3 % cases are solely due to fibroids).On pelvic examination, uterine enlargement, irregular contour or both can be present.

Whereas ADENOMYOSIS presents with menorrhagia, dysmenorrhea, metrorrhagia, chronic pelvic pain and dyspareunia.Infertility is occasionally reported but its incidence increases with increasing age.On pelvic examination, diffusely enlarged, tender, “boggy” uterus is suggestive of adenomyosis. Severe endometriosis might present as a fixed, tender uterus, with palpable nodules within the posterior cul-de-sac and/or lining the uterosacral ligaments and rectovaginal septum.

For diagnosis of Fibroids,
USG is the imaging modality of choice. Uterine fibroids mostly appear as concentric, solidhypo- to hyper echoic depending on the ratio of smooth muscle to connective tissue and whether there is degeneration. Calcifications appear hyperechoic which either rim the tumor or scattered throughout the mass. They may have anechoic components resulting from necrosis. If they are small and isoechoic relative to the uterus, the only ultrasonographic sign may be a bulge in the uterine contour.On Doppler study, a peripheral circumferential rim of vascularity from which a few vessels arise to penetrate into the centre of the tumor is seen. MRI has an important role in assessing disease in patients in whom ultrasound findings are confusing. It allows more accurate assessment of the size, number, and location of leiomyomas, which may help identify appropriate candidates for hysterectomy alternatives such as myomectomy or UAE. Fibroids appear as areas of low to intermediate signal intensity with sharp margins on T1- and T2-weighted MRI scans.

Whereas for ADENOMYOSIS,MRI has been reported to be the most reliable diagnostic method with a reported sensitivity between 70-100% and a specificity of 86-93%. However, ultrasonography is mostly preferred because it is more widely available and significantly more cost-effective for patients.On transvaginal ultrasonography, common features include anterior or posterior myometrial wall appearing thicker than its counterpart, myometrial texture heterogeneity, small myometrial hypoechoic cysts.

Other feature includes striated projections extending from endometrium into the myometrium, ill-defined endometrial echo and a globally enlarged uterus. On Doppler studies diffuse vascularity may be seen in affected myometrium.On T2-weighted MRI, the junctional zone is more easily visualized as a low signal intensity zone adjacent to the endometrium. On T2- weighted MRI, usually a junctional zone thickness greater than 12mm is considered diagnostic for adenomyosis. Additionally, heterotopic endometrial tissue appears as small foci of increased high signal intensity within the junctional zone.

In case of FIBROIDS, in asymtomatic cases, watchful waiting is the best option. Symptomatic cases can be treated medically or surgically.

For Medical management following drugs are used
• NSAIDS decreases dysmenorrhoea
• COCcauses decreased menstrual bleeding and 17% decrease in the risk of leiomyoma growth.
• Progestogens decreases menstrual bleeding in up to 70% cases, inducing amenorrhea in up to 30%,and may decrease uterine volume in up to 50%.
• LNG IUS reduces bleeding in 99% cases, and decreases uterine volume in about 40% .
• GnRH-analog causes uterine volume reduction in up to 50%.
• SPRM decreases bleeding in up to 98% cases, decreases fibroid volume in up to 53%.

(NSAID: Non steroid anti inflammatory drugs,COC: Combined oral contraceptive, LNG IUS: Levonorgestrel releasing intrauterine system, , GnRH a: Gonadotropin releasing hormone analog, SPRM: Selective progesterone receptor modulators)

Radiologic interventions for management of fibroid include-
• Uterine artery embolization- for women having significant symptoms despite medical management and who might otherwise be considered a candidate for hysterectomy or myomectomy, and
• Magnetic Resonance –guided Focused ultrasound (MRgFUS)
Surgical management includes,
• Myomectomy, which is fertility preserving surgery, and can be performed hysteroscopically, laparoscopically,or via laparotomy.
• Hysterectomy.

For Treatment of Adenomyosis-
For improvement of symptoms, main objective of treatment is to relieve pain and bleeding.NSAIDS and COCS can be used for this. LNG-IUS is also effective for treatment of adenomyosis related bleeding. GnRH agonists are effective choice for women with adenomyosis related subfertility.Hysterectomy is definitive treatment.

You may also link with us on Facebook, Instagram, Twitter, Linkedin, Youtube & Pinterest

Talk to the best team of fertility experts in the country today for all your pregnancy and fertility-related queries.

Call now 18003092323

(Visited 328 times, 1 visits today)
Inline Feedbacks
View all comments



PCOS Awareness Month – Everything You Need to Know about PCOS and its Prevention

Polycystic ovary syndrome (PCOS or...
Read More

A Complete IVF Guide: All You Need to Know About IVF

1. When to consult for...
Read More

Is Covid-19 Vaccination dangerous for pregnant women? Know the Benefits and Risks

What do we know today...
Read More

The Impact of Covid-19 on Pregnant Women & their Babies

Pregnant women and those in...
Read More

IVF Treatment in Covid-19 Age: Yes or No?

IVF in Pandemic: Safety Measures...
Read More

Pregnancy in COVID-19: What are the Risks?

Is the infection more dangerous...
Read More

Diet Plan for Lactating Mothers: What to eat while breastfeeding?

You know breast milk is...
Read More

आईवीएफ में जुड़वा बच्चेः आईवीएफ गर्भावस्था और एकाधिक प्रेगनेंसी

सामान्य जुड़वा बच्चे बनाम आईवीएफ...
Read More

Right Time For IVF: Indications and Contraindications

The IVF procedure can be...
Read More
Female Infertility Hindi

बच्चेदानी में सूजन: लक्षण, कारण, निदान, एवं उपचार

एंडोमेट्रैटिस (Endometritis) अथवा बच्चेदानी में...
Read More
Hindi IVF

आईवीएफ के लिए ऋण: एक अवलोकन

संतान की चाह रखने वाले...
Read More
Hindi IVF

कैसे करें एक सही आईवीएफ सेंटर का चयन?

आईवीएफ एक सुप्रसिद्ध सहायक प्रजनन...
Read More

जानिए आप प्रेगनेंट हैं या नहीं

प्रेगनेंसी के 10 प्रमुख लक्षण...
Read More
Female Infertility

7 things you must discuss with your gynaecologist!

With female friends or people...
Read More

உங்கள் பிறக்காத குழந்தையைப் புரிந்துகொள்வோம்: கருவில் குழந்தை எப்படி வளர்கிறது!

கீழ்காணுமாறு ஒவ்வொரு வாரமும் கரு வளர்ச்சியடைவதை...
Read More

ನಿಮಗೆ ಹುಟ್ಟಲಿರುವ ಮಗುವನ್ನು ಅರ್ಥಮಾಡಿಕೊಳ್ಳುವುದು: ಗರ್ಭದಲ್ಲಿ ಮಗು ಹೇಗೆ ಬೆಳೆಯುತ್ತದೆ!

ವಾರದಿಂದ ವಾರಕ್ಕೆ ಭ್ರೂಣ ಅಭಿವೃದ್ಧಿಯಬಗ್ಗೆ ಎಲ್ಲವನ್ನೂ...
Read More

ಪಿಸಿಒಡಿ – ಕಾರಣಗಳು, ಲಕ್ಷಣಗಳು ಮತ್ತು ಚಿಕಿತ್ಸೆ

ಪಾಲಿಸಿಸ್ಟಿಕ್ ಅಂಡಾಶಯದ ಕಾಯಿಲೆ (ಪಿಸಿಒಡಿ)ಯು ಮಹಿಳೆಯರಲ್ಲಿ...
Read More

ಅಂಡಾಶಯದ ಸಿಸ್ಟ್ (ಅಂಡಾಶಯದಲ್ಲಿ ಗಡ್ಡೆ): ಲಕ್ಷಣಗಳು, ಕಾರಣಗಳು ಮತ್ತು ಚಿಕಿತ್ಸೆ

ಅಂಡಾಶಯದ ಸಿಸ್ಟ್ (ಅಂಡಾಶಯದ ಸಿಸ್ಟ್‌ಗಳು) ಸಾಮಾನ್ಯವಾಗಿ...
Read More

ಗರ್ಭಪಾತದ ಲಕ್ಷಣಗಳು, ಕಾರಣಗಳು ಮತ್ತು ರೋಗನಿರ್ಣಯವನ್ನು ತಿಳಿಯಿರಿ

ಗರ್ಭಪಾತವಾಗುವುದು ಅಪರೂಪದ ವಿದ್ಯಮಾನವಲ್ಲ. ಇದು 15...
Read More
Hindi PCOD

भ्रूण स्थानांतरण के बाद आहार

इन विट्रो फर्टिलाइजेशन (IVF) एक...
Read More
Request Call Back
IVF telephone
Book An Appointment