UTERINE FIBROIDS

Fibroids are noncancerous growth that develop in theuterus.

It is the commonest benign tumour in females. It can be single or multiple in number and vary in size from very small to large.

Medically it is termed as leiomyoma or myoma. Sometimes these tumours can become large in size and cause severe abdominal pain along with heavy periods.

In most cases they cause no signs or symptoms at all.  Histologically, they are composed of  smooth muscle  and fibrous connective tissue.

Uterine fibroids are usually  round. In most cases, fibroids do not cause pain or other symptoms. However if exceptionally large, fibroids may cause pressure on bladder or other organs leading to specific symptoms.

UTERINE SARCOMA(malignant uterinetumour):

It is very rare and is only found in two per thousand hysterectomies. It is formally known as leiomyosarcoma.97 per cent of sarcomas are slow growing.

INCIDENCE:

It is estimated that at the age of 30 or above around 20 per cent of female have got fibroid in their uterus.

The occurrence is highest in the age groups of 35-48 years. It is more common in nulliparous or in infertile women.

CLASSIFICATION OF FIBROIDS

Uterine fibroids are often classified based upon location within uterus.

  • Subserosal fibroids:- They are located beneath the serosa (lining membrane on outside of uterus). These often appear localized on the outside or may be attached to outside surface by

pedicle. Sometimes the pedicle may be torn through this fibroid is called wandering or parasitic fibroid.

  • Submucosal fibroids:- They are located inside the uterine cavity beneath inner lining of uterus. It can make uterine cavity irregular and distorted.
  • Intramural fibroids :- They are located within the muscular wall of uterus. Intially , fibroids are intramural in position.
  • Pedunculated fibroids :-They are grown on stalk of tissue known as pedicle, extending either inside the cavity of uterus or outside the uterus from its outer surface.

5)Cervicalfibroid: It is very rare.

AETIOLOGY OF FIBROIDS :-

Experts don’t know exactly why you get fibroids. Aetiology is unclear. Hormones and genetics play an important role as the causative factors.

  • Hormones:- Estrogen and progesterone are hormones that make the lining of uterus thickens every month during the periods. Menarche at young age are at greater risk of developing fibroids. Although taking these female hormones are also linked to fibroids . When hormone production slows down during menopause, fibroids usually shrink. It is predominantly an oestrogen dependent tumour.
  • Genetics :- A positive family history is present. Researhers have found genetic differences between fibroids and normal cells in the uterus. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells. Chromosomal abnormalities are seen in chromosome number six or seven.
  • Other growth factors:- Substance that helps the body to maintain tissues, such as insulin like growth factors, stimulate the growth of fibroid.
  • Extracellular matrix (ECM):- ECM is the material that makes cells stick together, like mortar between bricks. ECM is increased in fibroids and make them fibrous. ECM also stores growth factors and cause biological changes in the cells themselves.
  • Risk factors for Fibroids:-
  • a)Obesity
  • b)Infertility or nulliparous
  • c)Black women: Incoloured races incidence is higher
  • d)Excess secretion of oestrogen.

SYMPTOMS OF UTERINE FIBROIDS :-

Majority of the women around 75 per cent remain asymptomatic.

In other cases, symptoms can be influenced by location, size and number of fibroids. The site is more important than the size.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include.

  • Heavy menstrual bleeding (Menorrhagia)
  • Menstrual periods lasting more than week.
  • Irregular bleeding(Metrorrhagia)or spotting between periods.
  • Pelvic pressure or pain.
  • Difficulty emptying the bladder.
  • Frequent urination
  • Backache or leg pains.
  • Infertility: In 30 per cent cases it may be a major complaint.
  • Pregnancy related problems like abortion, preterm labour ,intrauterine growth restrictions are seen.

Diagnosis of uterine fibroid:-

Uterine fibroids are frequently found accidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids.

If you have symptom of uterine fibroids your doctor may order these tests.

  • Ultrasound :- If confirmation is needed, your doctor may order an ultrasound. It is useful tool to confirm the diagnosis of fibroid and to differentiate it from ovarian mass or pregnancy.. A doctor or technician moves the transducer over your abdomen or place it in your vagina(transvaginal) to get images of uterus.
  • Lab tests:- If you have abnormal menstrual bleeding your doctor may order other tests to investigate other causes. There might include complete blood count to determine if you have anemia because of chronic blood loss and other blood test to assess your hormones level.
  • MRI:- This imaging test shows more details regarding size and location of fibroids, identify different types of tumors. An MRI most often used in women with larger uterus or women approaching menopause.
  • Other test may include hysterosono graphs, hysterosalpingography, hysteroscopy.

MANAGEMENT OF UTERINE FIBROIDS :-

CORRECT ANAEMIA: The foremost approach must be to manage or improve cases of menorrhagia and to correct anemia.

The physician must work on to minimize the size and vascularity of tumor.

The patient must be advised to take diet rich in iron such as poultry ,meats ,fish, green leafy vegetables, legumes and cereals.

Depending upon symptoms doctor may prescribe iron supplements. In advanced cases of heavy bleeding where there is considerable loss of blood surgery is required.

Watchful waiting :-

Many women with uterine fibroids experience no signs or symptoms or only mildly annoying signs and symptoms that can live with.

If that’s the case for you, watchful waiting could be the best option.

Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly or not all and tend to shrink after menopause, when level of reproductive hormones drop.

In allopathic approach :

DRUGS:- Progestrones, Antifibrinolytics, Antiprogesterones, Danazol are frequently used to minimize bleeding and to reduce the size of fibroid.

UTERINE FIBROID EMBOLIZATION(UFE): In this procedure ,a catheter is placed into blood vessels that supply the uterus. By sparing the uterus it cuts off blood supply to the fibroids .Significantly, the fibroids decrease in size.

HYSTERECTOMY: Surgical removal of the uterus is done in situations of uterine prolapse, in cases of large fibroids which are causing much discomfort and heavy bleeding.

HOMOEOPATHIC  MANAGEMENT OF UTERINE FIBROIDS:-

  • Thlaspi bursa pastoris:- It is one of top grade medicines for treating uterine fibroids with prolonged menses. The menses continue for 10-15 days. Menses appear frequently as well. Menstrual bleeding is profuse with presence of large clots. Violent uterine colic during menses can occur.
  • Calcareacarbonica :- calcarea carb is very useful medicines for treating heavy periods from uterine fibroids. Menses continue for long and may even appear early. Menses are too early tooprofuse, too long. Vertigo during menses. Leucorrhea of thick, milky or yellow colour is another complaint.
  • Belladonna and sepia officinales:- Both remedies are well indicated for uterine fibroids where menses are painful. Belladonna is best prescribed where there is cramping pain in uterus during menses and menses are bright red in colour and profuse.

Sepia is recommended in case of gripping burning or bearing down pains during menses. Menses start early and are quiet copious. Fainting and chilliness during menses may attend. Sepia is also indicated in painful intercourse in uterine fibroid cases.

  • Ustilagomaydis:-It is highly recommended where menstrual bleeding is dark. Clots may also be present in menstrual blood and bleeding is stringy or ropy in nature. Metrorrhagia with cramps in uterus.
  • Sabina officinales:- Mostly recommended remedy where clots is present in menstrual flow. The slight motion increases pain. Pain from sacrum to pubis is another attending feature. The patient feels better when lying down on back. Uterine pain extends to thighs. Other symptoms include foul, acrid, corrosive yellow leucorrhea.
  • Fraxinus Americana:- It is also top grade medicine for uterine fibroids which is mostly recommended where the major indicated feature is bearing down sensation in the pelvis from uterine fibroids. There is enlargement of uterus due to fibrous growths.
  • Other homoeopathic remedies are Aurum murnat, trillium pendulum, kali carbonicum, erigeron candensis, china officinalis, ferrummetallicum, pulsatilla and many more according to indicated symptoms.

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