It is very common for women to have heavy and painful periods or have a feeling of fullness in the lower abdomen. Although, it may not sound very alarming these could be the symptoms of uterine fibroids. These are the most common types of benign tumours found in women. The fibroids are basically some tissues and muscle cells that grow within the uterus, outside the uterus, or along the wall of the uterus. The fibroids are usually benign and asymptomatic and do not require any treatment unless they cause problems. 

Know the causes 

Though the exact cause of fibroid formation is not known, it is believed that the female hormones estrogen and progesterone have a role to play in their formation. Fibroids are formed only when a woman is producing these hormones and they are not seen in women in non-reproductive age i.e. before starting of menses or after stoppage of menses (menopause). If fibroids are persisting even after menopause or especially if increasing in size then it is an alarming sign. Such a fibroid needs to be taken care of immediately. 

What are the symptoms? 

Fibroids often remain quiet for long periods of time. They cause nonspecific symptoms in the pelvis and abdomen including: 

Fullness in the abdomen 
Low back pain 
Irregular menstruation 
Cramping with menstruation 
Painful sex 
Increased urgency to urinate 
Anemia, leading to tiredness and weakness 
Infertility Diagnosing the fibroids 
When these symptoms are recurrent, it is good to confirm the diagnosis. This can happen with a pelvic exam followed by ultrasound scanning to confirm the size and location of the fibroids. A blood test also may be done to confirm anemia, which is common due to heavy periods.

Treatment Options 

Management of fibroids can range from doing nothing to periodic monitoring to surgical removal. 

If pain and heavy bleeding are the only symptoms, then pain killers like ibuprofen should suffice for symptomatic relief. Anemia, if severe, may require iron supplementation. 
Embolization is an option which shrinks the fibroid, at the same time preserving the uterus. The blood flow to the fibroid is cut off, thereby preventing its further growth. It takes about 1 to 3 hours and requires some bed rest after the procedure. There could be some pelvic pain and vaginal bleeding, which will gradually subside. The fibroids may grow back, but the benefits of keeping the uterus are definitely there. This is suitable in case of single fibroid with specific blood supply. 
The next surgical option is myomectomy, where the portion of the uterus which contains the fibroid alone is removed. This is done in women who still wish to get pregnant and in women who would like to retain the uterus. This can also be achieved laparoscopically( key hole surgery). In such cases, fibroids are cut into small pieces and then removed from the body. This procedure should be done by a doctor specialised in advanced gynecological endoscopy as all this cutting should be done in a bag to avoid any spillage of cells inside the abdominal cavity. This procedure is known as Laparoscopic Myomectomy with In-bag Moecellation. 
In women who have crossed their pregnancy phase, hysterectomy or complete removal of the uterus is advised. In these women, the bleeding and pain may not have subsided even after years of treatment with hormones. The growing fibroids could be pressing on the adjacent organs, causing pressure. This is the only definitive treatment and should be done in women have completed their family and don t desire to be pregnant. 
Myomectomy and hysterectomy may be done laparoscopically or with an open method depending on the overall health, the size and location of the fibroids in the uterus.

Uterine Fibroid - How Removing Them Will Help You?

The uterus or womb, is a muscular structure and is held in place by ligaments and pelvic muscles. If these muscles or tendons become weak, they cause prolapse and are no longer able to hold the uterus in its place.

Uterine prolapse happens when the uterus falls or slips from its ordinary position and into the vagina or birth waterway. It could be complete prolapse or even incomplete at times. A fragmented prolapse happens when the uterus is just hanging into the vagina. A complete prolapse depicts a circumstance in which the uterus falls so far down that some tissue rests outside of the vagina. Likewise, as a lady ages and with a loss of the hormone estrogen, her uterus can drop into the vaginal canal. This condition is known as a prolapsed uterus.

Risks: The risks of this condition are many and have been enumerated as follows:

    Complicated delivery during pregnancy
    Weak pelvic muscle
    Loss of tissue after menopause and loss of common estrogen
    Expanded weight in the stomach area, for example, endless cough, constipation, pelvic tumors or accumulation of liquid in the guts
    Being overweight
    Obesity causing extra strain on the muscles
    Real surgery in the pelvic zone
    Smoking

Symptoms: Some of the most common symptoms of prolapse involve:

    Feeling of sitting on a ball
    Abnormal vaginal bleeding
    Increase in discharge
    Problems while performing sexual intercourse
    Seeing the uterus coming out of the vagina
    A pulling or full feeling in the pelvis
    Constipation
    Bladder infections

Nonsurgical medications include:

    Losing weight and getting in shape to take stress off of pelvic structures
    Maintaining a distance from truly difficult work
    Doing Kegel workouts, which are pelvic floor practices that strengthen the vaginal muscles. This can be done at any time, even while sitting down at a desk.
    Taking estrogen treatment especially during menopause
    Wearing a pessary, which is a gadget embedded into the vagina that fits under the cervix and pushes up to settle the uterus and cervix
    Indulging in normal physical activity

Some specialists use the following methods to diagnose the problem:

    The specialist will examine you in standing position keeping in mind you are resting and request that you to cough or strain to build the weight in your abdomen.
    Particular conditions, for example, ureteral block because of complete prolapse, may require an intravenous pyelogram (IVP) or renal sonography. Color is infused into your vein, and an X-ray is used to view the flow of color through your urinary bladder.
    An ultrasound might be utilised to rule out any other existing pelvic issues. In this test, a wand is used on your stomach area or embedded into your vagina to create images of the internal organ with sound waves.

Uterine Prolapse: Risks, Symptoms and Diagnosis

Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.


Know All About Gynae Laparoscopy Surgery

Ultra sound is commonly known as sonography. It is a process of reproducing ultrasound images of soft tissues of a particular body part and other organs on the computer screen with the help of the echoes of the sound waves produced by the transducer, a high-frequency generating instrument.
Ultra sound is commonly used during the different stages of pregnancy to denote the foetal health, the foetal sex, date of delivery, birth defects etc. However, in recent times, the ultra sound has also been associated with the diagnosis of other body parts such as the eyes, heart, gall bladder, liver, ovary, uterus, kidney, uterus, testicles, and ovaries. Ultra sound has also been useful in conducting biopsies for suspecting cancer patients, although not all of the cancers are detected by this imaging process. 3D & 4D ultrasound imaging are useful for looking at a particular body portion with much more precision and in slow motion respectively.

The advantages of ultra sound are:
1. The process of ultrasound imaging is a painless and a fast one. It does not require any insertion of needles or similar objects to denote the problems of the concerned body part.
2. The process is more convenient as compared to other similar imaging processes like MRI, mammogram and x-rays as they can capture images of the soft tissues, blood flow & cysts more clearly than the other processes.
3. The process is free of any harmful effects as there are no chances of exposure to radiation as compared to similar processes such as CT scans or X-rays.

Ultrasound - How it is Beneficial over Other Imaging Techniques?

Uterine fibroids are referred to as benign, abnormal growths which tend to develop in the uterine walls of a woman. The size of such growths can range from a few centimeters to even excess of a few inches. As such, they can cause the uterus to increase to the size of a five month pregnancy. Although, the symptoms of fibroids are not always apparent, they often cause heavy bleeding and pain in women. A recent research concluded that around 60 to 75 percent women contract such fibroids by the age of 50, at least once in their life.

Depending on the site of formation, uterine fibroids are distinguished into different types. Intramural fibroids in the lining of the uterus and subserosal fibroids which develop outside the uterus are the most commonly observed fibroids.

What causes Uterine Fibroids?
Although, the exact reason for the formation of fibroids are obscure, medical professionals have determined certain factors that may affect their formation. Some of them are:
1) Hormones: Progesterone and estrogen, produced by the ovaries regenerate the uterine lining during each menstrual cycle and trigger the growth of fibroids.
2) Family history: If you have had a family history of uterine fibroids, then you&#x2019;re likely to develop the condition yourself as well.
3) Pregnancy: The production of progesterone and estrogen increases during pregnancy which increases the likelihood of fibroids.

What are the signs of the condition?
Depending on the location and size of the tumors, symptoms of such fibroids include:
1) Heavy bleeding and blood clots during periods
2) Pain in the pelvis
3) Frequent menstrual cramps
4) Pressure and pain in the lower abdomen
5) Swelling in the abdomen
6) Pain while intercourse

What is the procedure of the treatment?
Ultrasound and pelvic MRI are common diagnostic procedures to check for uterine fibroids. After diagnosis, depending on your age, size of the fibroid and your comprehensive health, the doctor would prescribe you with appropriate medications. Only after medications prove futile, doctors opt for minimally invasive surgeries.


Causes and Symptoms of Uterine Fibroids

Fibroid tumour is the abnormal cell growth in the uterus and they are mostly benign. Fibroids usually affect women in the age bracket of 30 - 40. Fibroid tumours are of three types, depending on their location:

Submucosal fibroids: The tumour develops under the lining of the uterus
Intramural fibroids: The growth is found amongst the muscles in the wall of the uterus
Subserosal fibroids: The growth develops on the wall of the uterus right in the pelvic cavity
Causes behind it
The exact cause of fibroids in not known clearly. But certain factors have been discovered that might influence their formation. These factors include:

Hormones: Progesterone and estrogen are the hormones responsible for recreating the uterine lining during every menstrual cycle. These hormones might trigger the formation of tumour.
Family history: If any member in your family; your mother, grandmother or sister has/had fibroids in their uterus, you may also develop it.
Pregnancy: Your body produces excessive progesterone and estrogen when you are pregnant, which may cause an increase in the size of a pre-existing small fibroid. Myomectomy can be done by giving incision on the abdomen or by laparoscopy depending on the size and location of the fibroids.
Signs You are suffering from it

Heavy bleeding along with blood clots during or between your periods
Lower back or pelvic pain
Elevated menstrual cramping
Frequent urination
Pain during sex
Longer than normal periods
Bloating or pressure in lower abdomen
Enlargement or swelling of the abdomen
How it can be treated?
Your doctor will formulate the right treatment depending on your age, the mass of the fibroids and your overall health. Your doctor may choose a combination of treatment to cure your fibroids, and they include:

Medication: Gonadotropin releasing hormones (GnRH) agonists, birth control pills and ibuprofen (anti-inflammatory medicine) are prescribed. GnRH agonists reduce the level of progesterone and estrogen in your uterus.
Surgery: Myomectomy and hysterectomy are two common surgical procedures to treat fibroids. Myomectomy is performed by removing the fibroids only by making an incision on the abdomen. But hysterectomy completely removes the uterus. The latter is reserved for serious cases.
Non-invasive surgery: Forced ultrasound surgery, myolysis (shrinking fibroids with laser or electric current), cryomyolysis (fibroids are frozen) and endometrial ablation (an instrument uses heat, hot water, microwaves or electric current to destroy fibroids) are some non-invasive surgical procedures.

Fibroid Tumours - 8 Signs You are Suffering From it

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