Uterine fibroids (or leiomyomas) are non-cancerous(benign) growths that can occur in or around the uterus. They are commonly found in women of reproductive age, and may occur as small, asymptomatic nodules or large masses that can cause discomfort.

 Causes for Uterine Fibroids

The exact cause is not known, but many factors can influence their growth –

  • Hormonal influence: Estrogen and progesterone stimulate fibroid growth, and hence it commonly develops during the reproductive age and may shrink during menopause.
  • Genetic factor: Fibroids often run in families, suggesting a hereditary component.
  • Age: Fibroids are commonly seen in women aged between 30 and 50 years.
  • Obesity: Higher body mass index (BMI) has been associated with increased risk for fibroids.
  • Early onset of menstruation: Those who have had their first period at an early age have a higher chance of fibroid development.
  • Lifestyle factors: A diet high in red meat and low in fruits, vegetables, and dairy products may contribute to fibroid growth.

The growth pattern of fibroids can vary widely from one woman to another.

Types of uterine fibroids and their symptoms

Uterine fibroids are classified based on their location inside or outside the uterus. The type and position of the fibroid often determine the symptoms a woman experiences and the treatment approach.

Intramural Fibroids 

They are the most common type and are located inside the muscular wall of the uterus. They can cause heavy menstrual bleeding, pelvic pain, or a feeling of fullness. Large intramural fibroids can enlarge the uterus and affect fertility or pregnancy outcomes.

Submucosal Fibroids

They grow just beneath the inner lining of the uterus and protrude into the uterine cavity. They are often associated with prolonged menstrual bleeding. It can interfere with implantation and fertility. Even small submucosal fibroids can cause significant symptoms.

Subserosal Fibroids

They develop on the outer surface of the uterus and may grow outward and put pressure on the surrounding organs. They commonly cause pelvic pressure, back pain, and urinary issues, and are less likely to affect menstrual bleeding directly.

Pedunculated Fibroids

They grow on a thin stalk either inside or outside the uterus and may twist on their stalk, leading to sudden and severe pain. They can mimic other acute abdominal conditions.

Cervical Fibroids (Less Common)

They are located in the cervix and may cause difficulty during childbirth or discomfort during intercourse. They can also have urinary or bowel issues.

Not all fibroids require treatment, but symptoms that affect daily life or those that show progressive growth often require medical evaluation.

Possible complications of fibroids

When fibroids are left untreated or become significantly large, they may cause the following complications:

  • Severe anaemia resulting from heavy bleeding
  • Persistent pelvic pain or pressure.
  • Urinary or bowel-related issues, such as difficulty emptying the bladder or constipation.
  • Fertility challenges
  • Increased risk of pregnancy related complications, including pre-term labour, abnormal fetal position, or higher likelihood of cesarean delivery
  • Fibroid degeneration, which can cause severe pain and inflammation.

Early diagnosis and treatment help prevent complications and support better long-term outcomes.

Treatment options for fibroids

Today’s fibroid treatment or care includes a wide range of options –  from medical therapy to advanced minimally invasive and non-invasive procedures. The choice depends on symptoms, fibroid size, patient age, any plan for future pregnancy, and overall health.

Medical management

For women with mild symptoms and those nearing menopause, the following treatments may be considered –

  • Hormonal medications to reduce bleeding and help shrink fibroids
  • GnRH analogues are used to temporarily induce a low estrogen state and shrink fibroids before surgery.
  • Medications for help control heavy menstrual bleeding.

These options can reduce symptoms but are not a definitive cure.

Minimally Invasive Surgical Options

These are often preferred for women who require fertility preservation, want to avoid large incisions, or require a quicker recovery.

Laparoscopic Myomectomy

  • Removal of fibroids via small abdominal incisions.
  • Benefits: less pain, shorter hospital stay, and faster recovery
  • Ideal for multiple or deeper fibroids.

Hysteroscopic Myomectomy

  • Fibroids inside the uterine cavity are removed through the vagina and cervix using a hysteroscope.
  • Benefits: No external incisions, rapid recovery.

Robot-assisted Myomectomy

  • Uses robotic technology for enhanced precision.
  • Benefits: 3D magnified view, excellent dexterity for complex fibroids, minimal.
  • Particularly useful for large fibroids or difficult locations.

Minimally Invasive Non-surgical Procedures

Advances in gynecology have introduced options that don’t require open surgery.

Uterine Artery Embolization (UAE)

  • It is a radiological procedure that blocks the blood supply to the fibroids, causing them to shrink
  • Benefits: quick recovery, avoids surgical insertion
  • Best sorted for symptomatic fibroids in women not seeking pregnancy.

MRI-guided focused ultrasound (MRgFUS)

  • Non-invasive Technology using focused ultrasound waves to destroy fibroid tissue under MRI Guidance.
  • Benefits: No incisions, minimal downtime

Hysterectomy (Definitive Treatment)

Hysterectomy or surgical removal of the uterus is a definitive option when:

  • symptoms are severe
  • other treatments are ineffective
  • childbearing is complete.

This eliminates fibroids permanently but ends fertility.

 

Success stories: Real Cases

Case 1: Large degenerated fibroid in a high-risk patient

A patient presented with severe pelvic pain due to a degenerated fibroid measuring 14 cm in a posterior uterine location. Surgery was technically challenging due to

  • obesity with a BMI of 45
  • difficult and anatomical access.

Despite this, the surgical team successfully removed the fibroid using advanced minimally invasive techniques, ensuring a safe recovery and significant symptom relief.

Case 2: 2 kg fibroid causing pressure symptoms

A 46 year old woman experienced increased urinary frequency and discomfort due to a large 2kg fibroid. As she had completed her family, a hysterectomy was chosen. The procedure was technically demanding due to the size and location of the fibroid, but the surgery was executed successfully, relieving symptoms and greatly improving her quality of life.

How do advanced techniques help in treating fibroids?

Modern and advanced technologies, such as robotic surgery, MgFUS, and uterine artery embolization, have helped in transforming fibroid care by

  • reducing incisions and surgical trauma
  • shortening hospital stays and faster recovery
  • minimising post-operative pain
  • potential for preserving fertility

These innovations provide tailored options, giving women more control over their health and treatment outcomes.

Conclusion

Fibroids can range from asymptomatic to significantly life-altering conditions.

With a personalized care plan and access to modern treatment modalities, most women can achieve excellent outcomes – whether through minimally invasive surgery or non-surgical therapies. For more details, kindly contact us.

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