What are fibroids?
Fibroids are benign tumors of the uterus that are believed to arise from a single muscular fiber. They are present in 80% of menstruating women but only about 10% of them cause adverse symptoms.
Why does one get fibroids?
The exact causes of fibroid progression are unknown; Estrogen and Progesterone play a vital part in the growth of fibroids. Most fibroids degenerate or regress after menopause.
Do I have fibroids?
It is likely you have fibroids if you have any of the below symptoms
• heavy bleeding during menstruation
• pain during menstruation
• feeling a lump in your abdomen
What are the types of fibroids?
Depending from where they arise from the uterus, they are classified as
Can fibroids be medically managed?
Many medications (like OCPs and GnRh analogs) have been tried but they have accompanying side effects and can effectively only shrink the fibroid up to an extent. Once the medication is stopped, the fibroid usually regrows.
What about HIFU ?
High Intensity Focused Ultrasound has been tried for curing fibroids, but has quickly lost popularity because of its negative impact on fertility and loss of ovarian function.
When is surgical intervention required?
If having fibroids is causing adverse symptoms (described above) it is advised to get the fibroids removed surgically. It is advisable to remove fibroids larger than 8 cm in size.
So what surgery should I undergo?
If the fibroid is located inside the cavity of the uterus (intracavity or submucous) then hysteroscopic myomectomy is needed. When the fibroid is intramural (within the layers of the uterus), subserous (protruding into the abdominal cavity) or pedunculated (attached with a pedicle to the uterus), then laparoscopic myomectomy is warranted. If you have already completed your family life and want a definitive cure from fibroids, then laparoscopichysterectomy will be the best option.
How is laparoscopic myomectomy performed?
This procedure requires 4- 5 small sized incisions on the abdomen. Using laparoscopic energy devices like the harmonic scalpel, the fibroid is removed from the uterus and the cut uterus is sutured back using specialized sutures. This procedure requires a lot of skill and differentiates good surgeons from the rest. The fibroid is removed from the body using a morcellator. Power morcellation effectively cuts the fibroid into small pieces. (see below for more details)
What is power morcellation?
Most fibroids are larger than the small incisions we make on the abdomen,hence we
use power morcellation to retrieve the specimen. Morcellation is the process of removing a fibroid from the abdomen in a piecemeal fashion (in small pieces). If you have a family history of cancer, then we use an endo-bag to retrieve the fibroids and make a mini-lap incision of 3 cm (well below the bikini line) to avoid spill(of the fibroid tissue) inside the abdomen.
The FDA in America stated that the information about the pros and cons of power morcellation be shared with the patients when considering surgery with these devices.
What are the chances of Fibroids becoming malignant?
Leomyosarcomas are very rare and occur only in 2-3% of all uterine sarcomas (other uterine sarcomas are rare occurrences by themselves).