Fibroids are benign tumours of the uterus which are very common in women in childbearing years. They are noncancerous and cancerous change is very rare. They are slow growing usually. Sometimes may progress rapidly. Based on location may be subserous, intramural or submucous. They may be solitary or multiple sometimes 20 to 30. Maybe microscopic or reach large sizes. They may be asymptomatic or symptomatic based on their location, size and number of fibroids.

Symptoms:

1. Heavy menstrual bleeding
2. Menstrual periods lasting for more than a week
3. Pelvic pressure or pain
4. Urinary symptoms: Increased frequency, pain, recurrent UTI, incomplete emptying of bladder.
5. Constipation
6. Backache or leg pains
7. Infertility
8. Swelling of feet

The exact cause for fibroids is not known. Hormones estrogen is required for growth of fibroids. And fibroids usually stop growing after menopause

Treatment:

Treatment of fibroids depends on size, number, symptoms and age of the patient. Treatment includes medical management with hormonal, non hormonal treatment, myomectomy and hysterctomy.

• Asymptomatic patients with small asymptomatic fibroids do not need treatment.
• Before operation of infertility patients all other causes for infertility should be ruled out.
• It must be understood that fibroids can be recurring.
  Medical Management of fibroids:
  • GnRH analogues
  • OCP
  • Progestins
  • Levonorgestral containing intra uterine device commonly known as Mirena
  • GnRH antagonists
  • SPRMs or progesterone receptor modulating drugs: ulipristal
  • Mifepristone
  • SERMS: selective Estrogen receptor modulator Experimental stage
    Most of these drugs are used in small fibroids or to shrink the size of large fibroids.

Surgical Management:

Myomectomy: It is a conservative surgery where only the fibroids are removed. It is done in

women who want to preserve their uterus. It may be done laparoscopic or open.

Hysterectomy: In large fibroids or multiple fibroids in women who have completed the family

It may again be open or laparoscopic.

Interventional radiology: uterine artery embolization.  It is a procedure in which uterine

artery is blocked cutting off blood supply to the fibroid.