A fifty year old lady walked into my clinic, with a belly of a 7 month pregnancy! She seemed quite pregnant and distressed! She told me that when she did not get her periods, she presumed she was menopausal, and stopped using contraceptives! But as the months went by, her abdomen grew larger and larger, till she started feeling pressure symptoms on her bladder and rectum leading to frequent urination and constipation. She felt terribly embarrassed about being pregnant at that age and came to me fearing that she was indeed pregnant! What would she tell her teenagers at home!
When I first saw her, my first thought was that she was pregnant. But when I examined her, my first thought proved completely wrong! She was not pregnant, she just had large fibroids in her uterus! Fibroids as we all know, are non-cancerous tumors of the uterus, which may occur as a single tumour or may exist in large numbers within the uterus, anywhere, within its muscle, its cavity or on the surface of the uterus. And depending on their location, they give rise to various symptoms such as painful periods, heavy periods, infertility, abdominal enlargement, bladder and rectal symptoms and sometimes, when they press on nerves and blood vessels, they may cause pain down the legs and swollen feet! Almost one out of every 4 women above the age of 40 yrs. has fibroids, and it is one of the common diagnosis when women visit their gynecologists at that age.
The cause of fibroids is not known, hence one cannot prevent them. If you remove fibroids today, many more fibroids can grow and they continue to reappear, till as long as you continue to menstruate, because it is your estrogen hormone which makes them grow. Once you attain menopause and estrogen levels drop, no new fibroids will grow whilst the old ones shrinks by 30%. Hence the decision whether to remove the uterus or save uterus depends on various factors such as your age, need for childbearing, number of fibroids, your health etc. In the past, every woman with fibroids underwent myomectomy (removal of fibroids) if she was interested in further childbearing, or underwent hysterectomy (removal of uterus) if she had completed her family!
Today there are many new developments in the management of fibroids. Besides open surgery, there is laparoscopic surgery, (telescope inserted through the abdomen but not inside the uterus) hysteroscopic surgery (telescope inserted into the uterus through the vagina) Uterine Artery Embolization (UAE) under radiological control and High Intensity Focused Ultrasound (HIFU) under MRI control.
Most of these procedures are minimally invasive and meant to save the uterus, but whether fertility and pregnancy are efficient following these procedures, is yet to be determined. But fertility after laparoscopic and hysteroscopic removal has been well established and safe for future pregnancy. If a woman has no symptoms and her fibroids are small, then they do not require any intervention, but need to be kept under observation for rapid growth. Many women come frightened to me that they have these tumors and want them taken out because they are concerned about them becoming cancerous. Cancerous change is very rare in these fibroids and I have seen only 2 malignancies in fibroids in the last 39 years of my experience as a gynecologist!
Medically there is no method to make fibroids disappear, but there are medications to shrink the fibroids temporarily till the medical therapy is continued. We do have medications to reduce the blood loss and pain during menstruation but again it is only to temporarily help a woman and it is not a cure. My only message to all of you, is not to be scared of fibroids and not to jump into a surgery before exploring all modalities, because after all the uterus is a part of your body, there is no need to get rid of it just because it is not useful to you for childbirth today. It is a well known fact that when hysterectomy (removal of uterus) is done before menopause, it hastens your aging process and I am sure you do not wish to age prematurely!