Fibroid Treatment

• Laparoscopy
• Hysteroscopy
• Fibroid
• Endometriosis
• PCOS
• Tubal Pathology
• Adhesiolysis
• Laparoscopic key hole Hysterectomy
• Ectopic pregnancy
• Urinary Incontinence
• Ovarian cyst
• Post menopausal bleeding

Uterine Fibroid Treatment

Uterine fibroids are a common kind of growth that can grow in and on your uterus. They are not cancerous. These are growths made of muscle and tissue that form in or on the wall of your uterus. They are also known as leiomyomas. These growths are most often benign (not dangerous) and are the most common benign tumor in women.

Uterine fibroids can cause a lot of different signs, such as pain and heavy, irregular bleeding in the uterus. People with fibroids don't always know they have them because they don't have any signs. How you are treated for fibroids usually depends on how bad your symptoms are.

Uterine fibroids are classified into several categories based on their location and attachment method. There are several forms of uterine fibroids, including:

• Intramural fibroids: These fibroids are lodged in the muscular wall of your uterus. They are the most prevalent type.
• Submucosal fibroids: Submucosal fibroids develop beneath the inner lining of your uterus. Subserosal fibroids: This form of fibroid develops beneath the outer surface of your uterus. They can get extremely big and grow into your pelvis.
• Pedunculated fibroids: Pedunculated fibroids are the least frequent form, and they adhere to your uterus via a stalk or stem. They're typically referred to as mushroom-like because they have a stalk and a broader top.

Symptoms of Uterine Fibroids

A lot of people who have uterine fibroids don't even know they have them. The signs and symptoms can be changed by where, how big, and how many fibroids a person has.

These are the most frequent signs of uterine fibroids:

• A painful period or a lot of blood during your period.
• Either longer or more often.
• Pressure or pain in the pelvis.
• peeing a lot or having trouble peeing.
• Improving abdominal area
• Digestive problems
• Shoulder or lower back pain, or pain while having sex.
• When a fibroid gets too big for its blood supply and starts to die, it can sometimes cause sudden, severe pain.

Often, fibroids are put into groups based on where they are. Inside the muscle wall of the uterus, intramural fibroids grow. Fibroids under the mucosa push into the uterine region. Those that are subserosal form on the outside of the uterus.

Causes of Uterine Fibroids

It's not clear what causes uterine tumours. But these things may play a part:

• Genes can change: A lot of fibroids have changes in their genes that are not found in normal uterine muscle cells.
• Hormones: During each period, oestrogen and progesterone, two hormones, make the tissue that lines the inside of the uterus thicken. This makes the body ready for birth. They also seem to help fibroids get bigger.
  There are more cells that oestrogen and progesterone bind to in fibroids than in normal uterine muscle cells. Because hormone levels drop during menopause, fibroids tend to get smaller.
• Growth of other things: Insulin-like growth factors and other substances that help the body keep its tissues may slow or stop the growth of fibroid.
• Extracellular matrix, or ECM: Cells stick together with this stuff, like cement between bricks. Fibroids have more ECM, which makes them rubbery. The extracellular matrix (ECM) also stores growth factors and changes the way cells work.

Medics think that uterine fibroids might start in a stem cell in the uterus's smooth muscle tissue. Cells split over and over again. Over time, it changes into a firm, rubbery mass that is different from the flesh around it.

Uterine tumours grow in a number of different ways. They could grow quickly or slowly. They could also stay the same size. Some fibroids get bigger, and some get smaller on their own.

When a woman gives birth, her uterus shrinks and is back to its normal size. This can cause fibroids to shrink or go away.

Risk factors for Uterine Fibroids

There are various risk factors that can influence your chances of acquiring fibroids. These may include:

• Obesity and elevated body mass index (BMI).
• There is a family history of fibroids.
• Not having children.
• Menstruation begins early (you receive your period when you're young).
• Menopause occurs at a later age.

Diagnosis and Tests

In many situations, a healthcare provider detects uterine fibroids during a pelvic exam. Quite often, excessive bleeding and other related symptoms may prompt your provider to consider fibroids as a component of the diagnosis. Fibroids can be confirmed and their size and location determined by tests. Tests may include:

• Ultrasonography: This noninvasive imaging exam uses sound waves to build a picture of your interior organs.
• MRI: This test uses magnets and radio waves to make detailed images of your interior organs.
• CT scan: A CT scan uses X-ray images to create a detailed view of your inside organs from multiple angles.
• Hysteroscopy: A scope (a thin, flexible tube with a camera) is used to view fibroids in the uterus. The scope goes into your cervix and vagina into your uterus.
• Hysterosalpingography (HSG): A thorough X-ray of your uterus after contrast material is injected.
• Sonohysterography: In this imaging test, your provider implants a tiny catheter in your vagina and then injects saline into your uterus. This fluid gives a sharper view of your uterus than a normal ultrasound.
• Laparoscopy: During this exam, your provider will create a small cut (incision) in your lower abdomen. A thin and flexible tube with a camera on the end will be inserted to examine attentively at your interior organs.

Uterine Fibroids Treatment

Treatment for uterine fibroids varies according to their size, quantity, and location, as well as the symptoms they cause. If you don't have any symptoms from your fibroids, you may not require treatment. Small fibroids can frequently be left alone. Some people have no symptoms or issues related to fibroids. In these circumstances, your doctor may advise you to get regular pelvic exams or ultrasounds to monitor your fibroids.

If you have fibroids-related symptoms, such as anemia from excessive bleeding, moderate to severe discomfort, or urinary tract and bowel difficulties, you will need to seek treatment. Your treatment strategy will be determined by several factors, including:

• How many fibroids do you have?
• the size of your fibroids.
• Where your fibroids are.
• What fibroids-related symptoms are you experiencing?
• You want to keep your uterus.

The most appropriate treatment option for you will also be determined by your future pregnancy goals. When discussing treatment choices with your doctor, talk about your fertility goals. Treatment options for uterine fibroids may include:

Mediation:

• Over-the-counter (OTC) pain medicines: Over-the-counter (OTC) pain medicines can alleviate pain and discomfort caused by fibroids. Acetaminophen and ibuprofen are both over-the-counter drugs.
• Iron supplements: If you have anemia due to excessive bleeding, your doctor may recommend that you take an iron supplement.
• Birth control: Birth control can also help with fibroids' symptoms, such as heavy bleeding during and between periods and menstrual cramps. You can use a range of birth control methods, including oral contraceptives, rings, injections, and intrauterine devices (IUDs).
• Gonadotropin-releasing hormone (GnRH) agonists: These drugs operate by shrinking the fibroids. They are occasionally used to reduce a fibroid before surgery so that it can be removed more easily. However, these treatments are just temporary, and if you stop taking them, the fibroids may grow back.
• Oral therapies: Elagolix is a novel oral medication for heavy uterine bleeding in persons who have not gone through menopause but have symptomatic uterine fibroids. It has a maximum duration of 24 months. Consult your provider about the benefits and drawbacks of this therapy. Tranexamic acid, another oral treatment, is used to treat heavy menstrual bleeding caused by uterine fibroids.

Any drug you take should be discussed with your healthcare professional. Always with your doctor before beginning a new medicine to discuss any potential concerns.

Fibroid surgery

When comparing the various methods of fibroid removal surgery, several aspects must be considered. Not only can the size, location, and number of fibroids influence the type of surgery, but your future pregnancy goals should also be considered when formulating a treatment strategy. Some surgical options keep your uterus intact and allow you to conceive in the future, while others damage or remove it.

Myomectomy is a surgery that allows your doctor to remove fibroids. There are numerous types of myomectomy. The optimal technique for you will be determined by the location, size, and number of fibroids you have. Myomectomy treatments to eliminate fibroids can include the following:

• Hysteroscopy: Hysteroscopy is a procedure in which your physician inserts a scope (a thin, flexible tube-like equipment) via your vagina and cervix into your uterus. Your provider uses a scope to cut away and remove the fibroids.
• Laparoscopy: During this treatment, your provider will remove the fibroids using a scope. Unlike hysteroscopy, this treatment requires making several small incisions in your belly. This is how the scope enters and exits your body.
• Laparotomy: During this treatment, your provider creates a single bigger incision in your abdomen and removes the fibroids using this cut.

If you are not intending any further pregnancies, your healthcare professional may propose other options. These methods can be extremely helpful, but they usually prevent subsequent pregnancies. These may include:

• Hysterectomy: A hysterectomy is a surgical procedure in which your uterus is removed. Only a hysterectomy can treat fibroids. The fibroids will not return if your uterus is entirely removed, and your problems should be resolved. If your ovaries are left in place, you will not experience menopause following a hysterectomy. This operation may be considered if you are experiencing excessive bleeding from your fibroids or if you have huge fibroids. Minimally invasive hysterectomies can be performed vaginally, laparoscopically, or robotically.
• Uterine fibroid embolisation: Uterine fibroid embolisation is performed by an interventional radiologist under the supervision of your gynaecologist. They insert a tiny catheter into your uterine or radial artery and inject small particles, which obstruct the flow of blood from the artery to the fibroids. Reduced blood flow decreases the fibroids and improves your symptoms. This treatment may not be appropriate for everyone.
• Radiofrequency ablation (RFA): Radiofrequency ablation is a safe and effective treatment for uterine fibroids that involves the use of microwave (RF) energy. It is advised for those who have not entered menopause. It addresses smaller fibroids.

Risk Factor in Uterine Fibroids Treatment

Every treatment has some risks. Medicines can have side effects, and you might not be able to handle all of them. Before you start a new medication, you should tell your doctor about all the medicines you are already taking for other health problems and your full medical background. If you start taking a new drug and start to feel bad, call your doctor to talk about your choices.

Having surgery to remove fibroids also comes with some risks. You can get an infection or bleed during surgery, and there are also risks with anaesthesia. Another risk of surgery to remove a tumour is the chance of getting pregnant again. Some surgeries can stop women from getting pregnant again. A myomectomy only gets rid of the fibroids, so you can get pregnant again in the future. But people who have had a myomectomy might need a C-section to have another baby.

Prevention

Most of the time, you can't avoid getting fibroids. One way to lower your chance is to keep a healthy weight and get regular pelvic exams. Make a plan with your doctor to check on your small tumours if you have them.

Uterine fibroids are benign (i.e. non-cancerous) growths arising from the muscle of the uterus. Small fibroids of 1-2 cms generally do not cause any symptoms. A fibroid can cause infertility when it is very large i.e. > 5 cms in diameter, it protrudes in the endometrial canal, or it causes a mechanical obstruction of the fallopian tube or the cervical canal. There are no medicines to cause a permanent cure of fibroid. However, GnRH analogues either in the form of daily or monthly injections for 4-6 months or nasal spray are used in the treatment of fibroids. This treatment can be useful to decrease the size of the fibroids before they can be operated upon. The treatment decreases the size of fibroid by 30-60%. Majority of the cases of fibroid need surgical treatment either laparoscopically or by the traditional cut on the abdomen. Fibroids situated in the cavity of the uterus are best operated upon through the Hysteroscopy.

Depending on the skill of the laparoscopic surgeon, Fibroids of all sizes can be operated laparoscopically. A cut is made on the bulge on the uterus where the fibroid is located. The fibroid is separated or dissected out. The defect on the uterus is sutured or closed laparoscopically. The fibroid is then taken out of the abdomen by cutting it into strips with the help of a morcellator. We have operated on fibroids of 12-15 cms at our setup. The pregnancy rates either natural or with treatment improves after a fibroid surgery.

Hysteroscopy is useful to operate on fibroids that protrude into the cavity of uterus. The fibroid is cut into small strips with the help of energy source passed through resectoscope. The energy source could be either a bipolar or monopolar current. Bipolar current is safer. At our centre, we use a bipolar resectoscope for Hysteroscopic resection of the submucous fibroid.

We at Dr Sudha Tandon’s fertility, IVF, Gynec Endoscopy and Maternity center have all world class facilities for laparoscopic and hysteroscopic surgery for all pelvic pathologies and IUI /IVF and ICSI treatment for ART.