Uterine leiomyomas, often called fibroids, are benign growths in the uterine muscular wall. Many women with fibroids may not show any symptoms at all, while others may have severe menstrual bleeding, pelvic discomfort, and other issues that seriously lower their quality of life. Thankfully, there are several therapy options available to manage fibroids and reduce related symptoms. Dr. Kiranjeet Kaur provides comprehensive fibroid management services, including minimally invasive surgeries, UFE, hormonal therapies, fertility-sparing options, collaborative care, patient education, compassionate support, and advanced technology.

Signs and symptoms

• Heavy menstrual bleeding or menorrhagia.
• Anaemia (caused by excessive bleeding).
• Pelvic pressure and pain.
• Frequent urination or difficulty in emptying the bladder.
• Bloating or expansion of the abdomen.
• Constipation.
• Leg discomfort or a low backache.
• Problems during pregnancy may be a cause of infertility.

Medical Management

Medications are commonly used to alleviate symptoms and diminish fibroid size in managing fibroids medically. Hormonal therapies, often prescribed, aim to regulate the menstrual cycle and reduce fibroid growth by inhibiting estrogen production. These may comprise:

• Tranexamic acid and Mefenamic acid: Medicine to reduce bleeding during heavy period days and pain.
• Birth Control Pills: Oral contraceptives containing estrogen and progestin can assist in regulating menstrual cycles and decreasing bleeding associated with fibroids
• Progestin-Releasing Intrauterine Devices (IUDs): IUDs releasing progestin can alleviate heavy menstrual bleeding linked to fibroids by thinning the uterine lining.
• Gonadotropin-releasing hormone (GnRH) Antagonists: They suppress ovarian activity, resulting in reduced estrogen levels and eventual shrinkage of fibroids.

Surgical Interventions

Surgical procedures are required when fibroids become large, numerous, or produce severe symptoms that significantly affect a person's quality of life. The two main surgical treatments for fibroids are myomectomy and hysterectomy. Myomectomy is the removal of fibroids and can be performed through laparoscopic, hysteroscopic, abdominal or vaginal route. Hysterectomy is a surgical removal of the uterus. The type of surgery offered usually depends on the size, number, and location of the fibroids, the age of the woman, and her desire to retain fertility.

Preparation for the surgery involves a comprehensive evaluation, which may include physical examinations, blood tests, and imaging examinations such as MRI or ultrasound. Patients may also need to discontinue certain medications, such as blood thinners, in the days leading up to the surgery. The procedure itself is performed under general anesthesia to ensure the patient's comfort and pain-free experience.

Let’s examine each procedure, taking into account factors and characteristics of recovery:

1. Myomectomy: Surgical removal of fibroids.

2. Laparoscopic Myomectomy: This minimally invasive surgery involves making tiny abdominal incisions through which a laparoscope or telescope and specialized tools are introduced into the tummy to visualize and remove uterine fibroids. It is suitable for people who want to preserve their fertility yet have little to moderately big fibroids.

3. Hysteroscopic Myomectomy: This procedure uses a hysteroscope that is passed into the uterus through the vaginal route and cervix to visualize the uterine cavity. The fibroids that extend into the uterine cavity, known as submucosal fibroids, are subsequently removed using specialized tools without requiring abdominal incisions.

Abdominal Myomectomy

During an abdominal myomectomy, an incision is made in the lower belly to access and remove fibroids from the uterus while ensuring the preservation of the uterus itself. This surgical option is often recommended for individuals who wish to preserve their fertility and have large or multiple fibroids.

While preserving the uterus allows for fertility preservation with an abdominal myomectomy, it is important to discuss potential risks and considerations with your healthcare provider beforehand. These may include the risk of fibroid recurrence, heavy bleeding, infection, and adhesions or scar tissue formation. Following the procedure, patients typically stay in the hospital for one to two days, depending on the duration of the surgery and individual circumstances. This allows for monitoring and post-operative care to ensure a smooth recovery process.

Hysterectomy: Surgical removal of the uterus

Individuals with symptomatic fibroids who have not responded to conservative treatments such as medication or hormonal therapy are often recommended for uterus removal surgery. Symptoms indicating the need for a hysterectomy may include heavy menstrual bleeding, pelvic pain, pressure, or abdominal enlargement. During hysterectomy, the entire uterus, along with any fibroids present, is removed, ensuring complete resolution of fibroid-related symptoms and eliminating the risk of fibroid recurrence.

Total Laparoscopic Hysterectomy

Total Laparoscopic Hysterectomy (TLH) plays a significant role in treating fibroids, particularly for individuals experiencing severe symptoms necessitating surgical intervention. TLH offers a minimally invasive approach, where the uterus is entirely removed through small incisions in the abdomen, aided by a laparoscope—a thin, lighted tube with a camera and specialized tools. The method presents several advantages over traditional open surgery, including shorter recovery times, reduced post-operative pain, and less noticeable scars.

Many patients experience a faster return to normal activities compared to traditional open surgery. This option is best suited for those who have completed childbearing or do not desire future pregnancies; TLH offers a definitive solution for symptomatic fibroids. Overall, TLH is crucial in managing symptomatic fibroids, offering a safe and effective treatment option with minimal recovery time and excellent outcomes for eligible patients.

Abdominal hysterectomy: Also known as open hysterectomy, it is preferred in women with very large fibroids, which may be difficult to remove through minimally invasive techniques, and who have symptoms of fibroids and do not desire future childbearing. In this, an incision is made in the lower belly, and the complete uterus is removed.

Nonsurgical procedure

Compared to traditional surgery, less invasive techniques frequently have shorter recovery periods and fewer complications. The goal of these operations is to preserve the uterus while reducing or eliminating uterine fibroids. Non surgical options for treatment of fibroids consist of:

• Uterine Artery Embolisation (UAE): Tiny particles are injected into the uterine arteries to impede blood supply to the fibroids, causing them to contract and deteriorate progressively. This treatment is usually carried out under local anesthesia and is typically performed by interventional radiologists.
• Focused Ultrasound Surgery: Focused Ultrasound Surgery, guided by Magnetic Resonance Imaging (MRgFUS), employs high-intensity ultrasound pulses to target and eliminate fibroid tissue while preserving surrounding healthy tissue. Real-time Magnetic Resonance Imaging (MRI) facilitates accurate guidance and observation throughout the procedure.

Ready to take control of your fibroid symptoms? Schedule a consultation with Dr. Kiranjeet Kaur, the best Obstetrician & Gynecologist in Delhi, today to discuss different options for fibroid management. Explore effective treatment options with minimal recovery time and excellent outcomes. Make an informed decision tailored to your needs and treatment goals.