A Family Doctor's Tale - FIBROID

DOC I HAVE A FIBROID

All women have fibroids some small some bigger. In fact fibroid is very common especially after menopause. The fibroid is believed to be thickened muscle tissue in the uterus or womb. Most of the patient with fibroid do not show any symptoms but those with complications may have severe bleeding or pain. Always send the patient with heavy menstrual bleeding for a comprehensive gynecological examination.


Uterine Fibroids are benign tumors(non-cancerous) of the smooth muscles of the uterine cavity.
They are the commonest tumor found in women(25%) especially after the age of 35.


They are classified according to their location.

1.intramurally(inside the cavity of the uterus(70%)
2.extramurally(outside the cavity of the uterus) on the external wall(20%)
3.Submucous (in the lining of the uterus) 10%
4.subserous(below the lining of the uterus)
5.pendunculated subserous(like a polyp inside the uterus)
6.cervical(at the cervix or beginning of the uterus)


The cause of Uterine Fibroids is still not known.
Generally it is believed that during the thickening and shedding of the endometrium of the menstrual cycle, some uterine muscles and connective tissues overgrow and form a swelling in the wall of the uterus without encapsulation.
Fibroids are generally relatively avascular and may degenerate forming cysts and becoming calcified.


Most women with fibroid are asymptomatic.
Symptoms and signs varies with the size and location of the fibroid.


Common symptoms include:

Heavy menstrual flow sometimes with blood clots
Irregular menstrual periods
Painful menses
Backache
Pain with exercise
Painful and frequent urination
Bloating
Constipation
Fatigue


Signs:
Enlarged uterine mass on abdominal palpation
Anaemia and pallor due to blood loss


Pelvic examination may show enlarged uterine swellings
Ultrasound scan showed presence of fibroid.
Colposcopy may show the location of the fibroid.


Complications are:
sarcoma formation (a type of cancer)
degeneration
necrobiosis
cystic degeneration
torsion of pendunculated fibroid(fibroid on a stem)


If small no treatment is required.
If larger,then treatment depends on the size, extent of the lesions, age of the patient and the desire for pregnancy.


Myomectomy(removal of the fibroid only)
hysterectomy(removal of the womb)
special treatment during pregnancy
correction of anemia