Listen to this article
Fibroids are a common occurrence in the reproductive age group. Most often, they can be attributed to estrogen and progesterone hormones, and not many know, but they are rarely seen before puberty. Instead, their occurrence is most prominently seen during the reproductive years, and they regress after menopause.
Fibroids are classified as submucous fibroid, which means the fibroid is present inside the uterine cavity. Intramural fibroid is when it is in the body of the uterus, and subserosal fibroid is what forms on the outside of your uterus.
Here are some factors causing fibroids. To begin with, overall lifetime exposure to estrogen such as obesity, and early menarche is a big reason. The incidence of fibroids increases with age, and if the woman has a mono-twin. There is a 2.5% increased risk of developing fibroids, if a first-degree relative suffers from the same problem. The risk of fibroids increases with every 10 kilogram-increase in body weight or even body mass index (BMI).
Fibroids can cause various symptoms, but most of the time, 50 per cent of the patients are asymptomatic. The symptoms of fibroids depend on the site, size, as well as presence of the degeneration in the fibroid. Fibroids can cause abnormal uterine bleeding, dysmenorrhoea that is pain during menses, constant pelvic pain or backache, and sometimes pressure symptoms can be seen, if the fibroid increases in size.
If the fibroid presses on the urinary bladder, it might cause increased frequency of urination or hydronephrosis (the swelling of a kidney due to a build-up of urine). In case it presses on the bowel system, it can cause constipation. The patient can feel a lump in the abdomen and sometimes, it also leads to infertility in two to 10% of the patients.
Depending on the location and size of the fibroid, they might cause infertility as well. The causes of infertility due to fibroids are elongation and distortion of the canal, displacement of the cervix, occlusion of the fallopian tubes, stretching of the fallopian tubes, and disturbance of the tubal-ovarian relationship. It could also be endometrial thinning, if it is a submucous fibroid, and there is abnormal uterine contraction. All these factors can lead to infertility. The presence of submucous fibroids will decrease fertility rates, and if you remove these fibroids which are entering the uterine cavity, the fertility rate is increased.
Subserosal fibroids that are outside the uterus usually do not affect fertility rates. Intramural fibroids, which are inside the body of the uterus can slightly decrease fertility, especially if they are located near the endometrial lining. The location and size of the intramural fibroids do affect one’s decision of removing them or not.
It can be done through simple transvaginal sonography, which is the most readily available and least costly technique to differentiate fibroids from any other pelvic pathology. So, apart from sonography, an MRI and saline infusion sonography can be opted to diagnose the fibroids.
During these procedures, the size of the fibroids, the number of the fibroids, and the position of the fibroids are checked. Depending on these factors, the decision of medical management or surgery is taken. In the case of patients with infertility, medical therapy is given to them to see if a fibroid is decreasing in size. If the fibroids are not regressing then the removal of fibroids via myomectomy is suggested to the patient.
Both medical and surgical methods can be adopted. The surgery for removal of fibroids is known as myomectomy. If the patient has undergone removal of fibroids before planning the pregnancy, then the chances of C-section will be much higher. Check the size of the fibroid first and only then take the decision of removing it, after consulting the expert.