Fibroid (Uterine Myoma)

Fibroid is excessive growth of uterine musculature which forms a localized swelling in the uterus.

Depending on the location, size and site the fibroids are classified as:

1.      Subserous fibroid: The location of the fibroid is on the surface of the uterus.

2.      Submucous fibroid: The fibroid is situated within the uterine cavity.

3.      Intramyometrial fibroid: The fibroid is within the body of the uterus.

Rarely, fibroids of the above mentioned variant may coexist.

Epidemiology:  Fibroid is seen in 50% of the reproductive age group of women. It is one of the common causes for infertility in women. The incidence is on the rise due to early menarche, late marriage, poor breast feeding. There is association of genetic inheritance in fibroids.

Symptoms

• Abdominal pain and lump in tummy
• Menstrual irregularities: heavy painful bleeding, prolonged cycles, clots.
• Nausea, vomiting, bowel obstruction symptoms
• Urinary complaints: Large fibroids cause pressure symptoms giving rise to frequent urination, retention of urine, descent of reproductive organ.
• Dyspareunia (painful intercourse)
• Infertility

 A large population of women with fibroids is asymptomatic and need no treatment.

Occasionally as the size of fibroid enlarges, it may give rise to severe abdominal pain and surgical diagnostic dilemma.

Investigations

• Abdominal sonography is a very reliable tool for the diagnosis of fibroids.
• CT scan and MRI are performed in cases where there is diagnostic dilemma.

Treatment

Medical managementfor fibroids is a non-definitive treatment modality and should be exercised only in selective cases.

Surgical management:

• The right approach depends on the size, site, and location of fibroid.
• When reproductive function is to be preserved, Laparoscopic Myomectomy is performed in subserous and partially intramyometrial  fibroid.
• Hysteroscopic Myomectomy is performed in submucous fibroid.
• In cases of infertility, Diagnostic Hysteroscopy and Laparoscopy both have to be performed and accordingly the fibroid is removed.
• Laparoscopic Hysterectomy is performed for multiple fibroids and in whom reproductive function is not desired.