What are Uterine fibroids?
Types of uterine fibroids
- Intramural fibroids
- Subserosal fibroids
- Submucosal fibroids
- Pedunculated fibroids
Causes
- Excess consumption of red meat
Symptoms
- Lower back and abdominal pain
- Heaviness around the pelvic region
- Enlargement of the uterus
- Heavy and painful bleeding during periods
- Frequent spotting between periods
- Painful experience during sexual intercourse
- Discomfort and pain during urination
Diagnosis
Test
Blood test: You may be required to go for a blood test which will show your complete blood count in order to check for anemia, other blood disorders or thyroid issues.
Transvaginal Ultrasound: This is an imagery test that uses sound waves to produce images of the uterus. An ultrasound device called the transducer is placed inside the vagina to confirm the diagnosis and measure the fibroids.
Magnetic resonance imaging (MRI): This is another imagery test that can provide some detailed information regarding the size, location and type of the fibroid. Most often used in women with a larger uterus or in women approaching menopause, this test helps in determining the appropriate method of treatment.
Hysterosonography: Also known as saline infusion sonogram, this test uses sterile salt (saline) water to expand the uterine cavity, making it easier to get images of submucosal fibroids and the lining the uterus among women who experience heavy blood loss or in women who are attempting pregnancy.
Hysterosalpingography: This test uses a dye to make the uterine cavity and fallopian tubes easier to be viewed on an X-ray. Often recommended during concerns regarding infertility, this test helps the doctor to determine if your fallopian tubes are open or are blocked and can show the presence of submucosal fibroids.
Hysteroscopy: This test involves the insertion of a small telescope attached with a light into the uterus via the vagina and cervix. The doctor then injects saline into the uterus, expanding the uterine cavity, which allows them to examine the walls of your uterus and the openings of your fallopian tubes.
Self-diagnosis
Fibroids in some women might not have any signs and symptoms and they would not even know that they have the condition. While, in certain conditions, these fibroids can cause severe symptoms that may include heavy menstrual cycles, heavy bleeding during periods, frequent spotting during periods, discomfort during urination and heaviness around the pelvic region. If you are going through some of the above mentioned symptoms, there might be a possibility that you are suffering from fibroids and consulting a doctor would be the right decision to make.
Diagnosis by doctor
If you are suffering from any of the signs and symptoms of uterine fibroids and visit a gynaecologist, the doctor will carry out a pelvic examination, which would allow them to feel the size and shape of the uterus. The gynaecologist will check if your uterus is enlarged or shaped abnormally which would confirm the presence of fibroids. If the doctor finds out about the presence of fibroids after the examination, they might recommend you to go through several tests such as ultrasound, blood test, hysteroscopy and MRI in order to confirm the diagnosis and identify the options for treatment.
Severity
- Grade 1 –
This is the initial stage where the fibroids are entirely within the uterine cavity. In this grade, the fibroids might cause certain symptoms but are easily removable.
- Grade 2 –
This is the stage where the fibroids are 50-90% between and within the uterine cavity. The fibroids in this stage might cause certain problems but are mostly easily removable.
- Grade 3 –
This is the stage where the leiomyomas are a bit complicated, making it the most difficult to be removed. In this stage, the fibroids are between 0 and 49% within the uterine cavity. The superficial blood vessels that fibroids contain often rupture at the time of menses and the resulting bleeding can be severe enough to require hospitalization and even blood transfusions in this grade.
Risks & Complications - Uterine Fibroids Treatment
During the surgery:
In general, a fibroid removal surgery does not involve any serious problems. However, depending on the severity of their condition and the type of surgery that the patient choses, there might be a number of complications that include:
- Allergic or other reactions to the anaesthesia
- Heavy bleeding
- Damage to the uterus or surrounding organs
- Blood loss, that may require a blood transfusion
- Urinary tract injury
After the Uterine Fibroids Surgery:
- Discomfort during bowel or urinary movements
- Issues with fertility
- Complications related to pregnancy
- Formation of bands of scar tissue, causing the internal organs to be stuck together
- Recurring fibroids that may require a repetitive treatment
If left untreated:
If fibroids are left untreated, they can continue to grow, both in size and number. Gradually, these fibroids will take over the uterus and the symptoms will keep on getting worse, causing severe pain, heavy bleeding and cramping. They can put additional pressure on the bladder resulting in incontinence or frequent urination, ultimately leading to infertility.
Prevention
By far, there is no proven way to prevent the occurrence of fibroids. However, you might be able to lower the chances of attaining uterine fibroids by exercising regularly, eating fresh fruits and cruciferous vegetables like arugula, broccoli, cabbage, cauliflower, collard greens, and turnip greens. Including high amounts of fiber in your diet, and avoiding foods that are high in sugar can also help you lower the risk of the occurrence of fibroids to a higher extent.
When to consult a doctor?
Uterine fibroids are extremely common among women. In certain cases, these fibroids may not cause any symptoms or complications and can be left untreated. However, in some cases, they might cause problems such as irregular periods, heavy menstrual bleeding, persistent pelvic pain or pressure, and discomfort during urinary or bowel movements. If you experience any of these symptoms, you should consider seeking medical assistance and consult a doctor in order to prevent the condition from escalating into a severe medical complication.
Questions to ask your doctor.
Q1. How many fibroids do I have?
Q2. What is/are the size of the fibroid/fibroids?
Q3. Are the fibroids located on the inside or outside of my uterus?
Q4. What are the treatment options available to me?
Q5. Do I have any alternative treatment options other than a surgery?
Q6. Will I need any medications before or after the treatment?
Q7. What are the chances of my fibroids returning back after surgery?
Q8. What are the side effects I can expect from the use of medications?
Q9. Will the fibroids affect my ability to get pregnant?
Q10. Can the treatment improve my fertility?
Uterine Fibroids Treatment Options & Cost
Non-surgical
Depending upon the severity of your condition, the gynaecologist may prescribe certain medications that may help in shrinking the fibroids. However, these medications may not necessarily eliminate them. The medications include:
- Gonadotropin-releasing hormone agonists (GnRH): These medications treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. As a result of which, the menstruation stops, the fibroids shrink, and anemia often improves. However, these medications cannot be used for more than a period of three to six months as long-term use of such medications can result in the loss of bone.
- Progestin-releasing intrauterine device (IUD): A progestin-releasing IUD can help in getting temporary relief from heavy bleeding caused by fibroids. However, neither does it shrink the fibroids or make them disappear. This type of medication can result in the prevention of pregnancy.
- Tranexamic acid: This type of medications include lysteda or cyklokapron that can help in the prevention of heavy menstruation and should be taken only during the days concerning heavy blood loss.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Although these are not hormonal medications, they may be quite effective in relieving the pain, but do not help in the reduction of bleeding caused by the fibroids.
Additionally, the doctor might prescribe certain iron and vitamin medicines in case of heavy menstrual bleeding and anemia.
There are certain non-invasive or minimally invasive procedures that can destroy uterine fibroids without actually removing them through surgery. The methods of Uterine fibroids treatment include the following:
- Uterine artery embolization: This is a procedure in which embolic agents are injected into the arteries in order to cut off the blood supply to the uterus, ultimately causing them to shrink and gradually decline. Although complications may arise if the blood supply to the ovaries or other organs are compromised, the rate of these such complications is similar to that of a surgical fibroid treatment, except for the fact that the risk of transfusion is substantially reduced in this procedure.
- Radio-frequency ablation: This is a minimally invasive procedure that uses heat to target the fibroids and reduce their size significantly by shrinking the blood vessels that feed them. This procedure works best in patients whose fibroids are not too large, while the uterus is located below the naval and has not had complex abdominal surgeries in the past. Although this procedure reduces the size of fibroids, it does not eliminate them. There is a slight possibility that the fibroids may regrow and new fibroids can develop after the procedure.
- Hysteroscopic myomectomy: This procedure is used to remove submucous fibroids that are found in the uterine cavity. The fibroids in this procedure are removed by using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal and the fibroids are removed using an electrosurgical wire loop.
- Endometrial ablation: This is an effective procedure that can put an end to heavy and abnormal bleeding. It is performed by inserting an instrument through the uterus that uses heat, microwave energy, hot water, or electric current to destroy the linings of the uterus. Endometrial ablation is not recommended if you are pregnant or are planning for a pregnancy in the future.
- Myolysis and Cryomyolysis: Myolysis is a procedure that is carried out on fibroids of certain sizes near the surface of the uterus. This procedure is carried out by making small incisions. Guided by a laparoscope, surgical devices are inserted through the incisions that direct the source of heat using electrical current or lasers, in order to close the supply of blood to the fibroids. The fibroids remain intact and are not surgically removed. However, without blood supply, they gradually shrink over the due course of time.
- Cryomyolysis follows a similar procedure like that of myolysis, except that rather than using heat and electric current, this procedure uses liquid nitrogen to freeze the fibroids before they shrink and disappear with time.
- MRI guided focused ultrasound surgery (FUS): In this procedure, you will be placed inside an MRI scanner and your uterus, along with the other organs inside your abdomen will be clearly viewed by the doctor. Once the doctor detects the precise location of the fibroids, a transducer will be used to generate focused sound waves into the fibroid in order to heat up the fibroids before completely destroying them, leaving your uterus intact.
Surgical
- Abdominal myomectomy: Also known as open myomectomy, this is the traditional surgical procedure of treating uterine fibroids. An abdominal myomectomy involves an open surgical cut in the abdomen to access the uterus and remove the fibroids. After the fibroids are removed, the abdominal wall and skin are closed with sutures or stitches. This type of myomectomy is preferred for multiple or deeply rooted fibroids.
- Laparoscopic myomectomy: In this procedure, small incisions are made around the abdomen and the fibroid is visualized using a laparoscope, (a thin, lighted scope with a camera attached at the end) which is inserted through one of the incisions. The doctor then uses surgical instruments through the small incisions in the abdomen in order to remove the fibroids in your uterus.
- Robotic myomectomy: A robotic myomectomy uses the same method of treatment like that of a laparoscopic myomectomy and only differs in the fact that in this procedure,, the surgeon sits at a console away from the patient in order to control the surgical instruments.
- Abdominal Hysterectomy: This is the traditional procedure of surgically removing a part or all of the uterus, depending upon the severity of the condition. Sometimes, the fallopian tubes, cervix, ovaries or any other part of the uterus that is affected by the fibroids are also removed. Since this method of surgery results in infertility, it is usually carried out as the last resort of treatment when all the other procedures have been ineffective.
- Laparoscopic hysterectomy: This is a minimally invasive procedure to surgically remove the uterus. This is one of the most commonly preferred procedures as it involves less blood loss, less scars, postoperative complications are reduced to a greater extent, and recovery time is much faster than that of traditional hysterectomy. During the procedure, the surgeon makes several tiny incisions in the lower abdomen. Through one of the incisions, a laparoscope, which is a thin-lighted tube attached with a camera is inserted in order to have a distinctive view of the fibroids, the uterus, and the other organs. After that, the surgeon inserts certain surgical instruments through the other incisions. Then, the uterus or cervix are removed with or without both the ovaries and fallopian tubes through the incisions.
There are a number of ways of performing a laparoscopic hysterectomy, which are as follows :
- Total laparoscopic hysterectomy: In this procedure, the uterus is detached from inside the body. It is then removed in small pieces through the incisions or the pieces are passed out of the body through the vagina.
- Laparoscopically assisted vaginal hysterectomy: This is a procedure where the uterus is separated by detaching the fallopian tubes, ovaries and other pelvic structures. At the end of the process, all the organs are removed through the vagina.
- Laparoscopic supracervical hysterectomy: In this procedure, only the uterus is removed and the cervix is left in place.
- Robot-assisted laparoscopic hysterectomy: Also known as robotic hysterectomy, the procedure is very similar to that of a laparoscopic hysterectomy as this process also uses the same method of treatment. This procedure differs from the laparoscopic method of treatment only in the part that, in this process, the surgeon uses control devices to direct the surgical instruments that remove your uterus.
Surgery preparation
- Depending upon your condition, the doctor may prescribe medications before going for a surgical procedure, to reduce the size of your fibroids, which would make them easier to be removed.
- Before the surgery, the doctor might ask you to go for a number of medical evaluations that may include blood tests, MRI scans, pelvic ultrasound and electrocardiogram in order to make sure that you are healthy enough to undergo a surgery.
- You will be required to stop taking certain medications before going for a surgery. Therefore, prior to a few weeks before the surgery, you should inform your doctor about any over-the-counter or prescribed medications you are taking.
- You will have to avoid and completely stop smoking from six to eight weeks before the surgery as it can increase the risk of cardiovascular events during the surgery and can also slow down the healing process after the surgery.
- You will be required to refrain from consuming any food or liquids for atleast 8 hours before the surgery.
- You should take a shower before the surgery as the doctor would ask you to keep the surgical area dry in order to eliminate the risk of any infections after the operation.
What to expect during the surgery?
- You will be put under the influence of general anesthesia which would help in easing the pain and discomfort during the surgery.
- One you are sedated by the anesthesia, the surgeon will make small incisions around your lower abdomen.
- The surgeon will then insert a laparoscope, (a thin-lighted scope with a camera attached to it) which would allow the surgeon to have a proper view of your internal organs.
- The doctor will then insert certain surgical instruments through the other small incisions in your abdomen in order to access the uterus and remove the uterus, cervix and any other parts of the reproductive system.
- Once the uterus is removed, the laparoscope and the other surgical instruments will be removed before closing the incisions with stitches or sutures, followed by skin glue or skin closure tapes.
After the surgery
- As soon as the surgery is complete, you will be placed under observation until the reaction of the anaesthesia wears off.
- After the surgery, a catheter may be placed in your bladder to allow the drainage of your urine, until you are easily able to walk to the toilet and empty your bladder.
- The doctors will closely monitor your vital signs such as breathing and heart rate in order to eliminate the risk of any further complications.
- Once the reactions of the anaesthesia wears off and your blood pressure, breathing, and pulse rate .stable, you will be moved to a cabin or hospital room.
- Depending on your overall physical condition and the procedure of the treatment you receive, you will be prepared for a discharge from the hospital.
- You will be advised to keep the surgical area dry for the next few days after the surgery, which will help you in ensuring a faster healing of the wound while preventing possible infections.
- During the first 24 hours after undergoing a surgery, there is a possibility that you might experience certain symptoms like severe pain, vaginal bleeding, nausea or vomiting, difficulty or discomfort during bowel movements. In such cases, you should notify the doctor immediately.
Cost of a uterine fibroids treatment in India with Pristyn Care
To get an estimated cost of a uterine fibroid removal treatment method, you can refer to the following:
- Uterine Fibroids Embolization Rs. 2,10,000- Rs. 2,60,000 approx
- Radiofrequency Ablation Rs. 1,26,000 to Rs. 2,60,000 approx.
- Laparoscopic Myomectomy Rs. 1,85,000- Rs. 2,97,000 approx.
- Laparoscopic Hysterectomy Rs. 1,00,000- Rs. 1,50,000 approx.
- Hysteroscopic Myomectomy Rs. 55,750 to Rs. 2,60,000 approx.
- Endometrial Ablation Rs. 50,000 to Rs. 5,00,000 approx.
- Abdominal Myomectomy Rs. 70,000 to Rs. 2,10,000 approx.
- Hysterectomy Rs. 1,00,000 to Rs. 2,50,000 approx.
The above mentioned approximate range of cost is subject to change depending on multiple factors such as:
- Severity of the condition [number and size of fibroids]
- Consulting and operating fee of the doctor
- Location and type of the hospital chosen to undergo the treatment
- Cost of medications before and after the surgery
- Amount to be paid for diagnostic tests
All the above mentioned factors are taken into consideration while calculating the final cost of the uterine fibroids treatment.
Before and after the surgery comparison
The results of a uterine fibroid treatment are immediate as the benign lumps that are located in the wall of the uterus will completely be removed. However, the recovery time
may vary from person to person, it usually takes upto a 6 weeks to completely recover from the treatment. Gradually, the symptoms like heavy menstrual bleeding, prolonged periods, pelvic pain and back pain will also be treated permanently.
Insurance coverage
Uterine fibroids can cause a lot of problems if they are large in size and continue to grow in numbers. They can lead to symptoms such as pelvic pain, anemia, heavy, painful and prolonged periods. Its treatment is considered a medical necessity since it concerns a woman’s health. Therefore, most of the insurance providers in India including Pristyn care cover the cost of a uterine fibroids treatment. To learn more about the insurance policy, its coverage, the different payment options and the claim process, you can get in touch with us.
Recovery rate
The usual recovery time of a laparoscopic hysterectomy depends on a number of factors, primarily concerning the general health of the patient. It might take about four to six weeks for a patient to recover completely and get back to performing daily activities. Whereas, in case of an open surgical procedure, it might take about six to eight weeks to recover fully. However, the rate of recovery varies from person to person, depending on the severity of the condition and the response of the patient’s body to the treatment and post-operative care also plays an important role in ensuring a proper and faster recovery.