Fibroids

Fibroids are benign neoplasms, well circumscribed tumors arising from the wall of uterus.

Also known as Myomas, Fibromyomas, Leiomyomas.

Fibroids Causes

Uterine contractions causes stress points within myometrium, hence providing the stimulus for the growth of immature cells into a neoplasm.

Estrogens

    • Myomas are rarely found before puberty and tends to shrink post menopause
    • Myomas increases during pregnancy and treatment with oral contraceptives
    • Myomas are found frequently in women having granulosa cell tumors and PCOD
    • Presence of oestrogen receptors is higher in myomas

Human Placental Lactogen produce rapid enlargement of myomas in pregnancy

Fibroids type

Fibroids type
  • Intramural fibroids ( muscle wall of the uterus)
  • Sub serosal fibroids (grow outside the wall of the uterus into the pelvis)
  • Submucosal fibroids (develop in the muscle beneath the inner lining of the uterine wall and  grow into the middle of the uterus)
  • Pedunculated fibroids ( grow from the outside wall of the uterus and are attached to the uterine wall by a narrow stalk)
  • Cervical fibroids ( develop in the wall of the cervix)

Symptoms

Menstrual Disturbances

  • Menorrhagia (most often in Submucous and intra-mural myoma)
  • Polymenorrhoea (Occurs only when ovaries are hyperaemic and cystic)
  • Metrorrhagia (intermenstrual bleeding occurs often in submucous  and cervical myomas)

Pain  

  • Spasmodic dysmenorrhea occurs in intramural and submucous myoma
  • Congestive dysmenorrhea in vascular leiomyoma
  • Sudden onset of pain suggests sarcomatous changes
  • Severe pain is a sign of complications

Pressure symptoms

  • Cervical myoma causes difficulty in micturition and constipation
  • Posterior uterine wall myomas  causes first frequency and then acute retention of urine
  • Anterior wall myomas causes frequency of urine
  • Oedema of lower extremities is rare

Blood stained vaginal discharge

Infertility –due to

  • distortion of uterine cavity preventing sperm migration
  • cornual fibroid blocking fallopian tube
  • Infrequent ovulation

Mass in lower abdomen

  • Painless/slight pain
  • Growing slowly/not at all
  • Growing rapidly (may be malignant)

Anaemia

Ascites ( rare) caused by pedunculated sub serous myoma

Signs

  1. Distended abdomen below the umbilicus
  2. Firm, consistent abdominal swelling, usually movable from side to side
  3. Swelling dull on percussion
  4. On P/V
  • Cervix moves with swelling
  • Uterus is not felt separated from the mass
  • Firm swelling is low down and uterus is felt on the top of myoma in cervical myomas
  • Retroverted uterus in anterior and posterior wall myoma
  • Open cervix in myomatous polyp
  • Chronic inversion of uterus in submucous myomatous polyp

Investigations

  • Blood film, Hb, ABORh, Blood sugar
  • Ultrasonography
  • Hysterosalpingogram
  • Hysteroscopy
  • Diagnostic laparoscopy
  • CAT scan

Fibroids Treatment

Ayurveda Medicines under the guidance of Ayurveda doctor. Some of them are-

  • Chanderprabha vati
  • Kanchnar guggul
  • Medohar guggul
  • Variddhi vatika vati
  • Arogyavardhini vati
  • Punarnava Arishta
  • Dashmoola Arishta

Surgery   

  •  Myomectomy—indicated in young, infertile women. It may be done Abdominally or Vaginally according to the position and number of myomas
  • Videopelviscopic myomectomy is recommended for sub serous pedunculated fibroid
  • Hysterectomy—indicated in multiparous women with symptomatic myomas

Radiotherapy—Rarely employed

Complications

Degenerations

  • Atrophy
  • Hyaline
  • Cystic
  • Fatty
  • Calcareous
  • Red

Sarcomatous changes

Torsion

Inversion

Capsule rupture

Inflammations

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