Definition

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. Fibroid location, size and number influence signs and symptoms:

TYPES

 	Submucosal fibroids: Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are more likely to cause prolonged, heavy menstrual bleeding and are sometimes a problem for women attempting pregnancy.
 	Subserosal fibroids: Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing a pressure sensation, or on your spinal nerves, causing backache.
 	Intramural fibroids: Some fibroids grow within the muscular uterine wall (intramural fibroids). If large enough, they can distort the shape of the uterus and cause prolonged, heavy periods, as well as pain and pressure.

Symptoms

In women who have symptoms, the most common symptoms of uterine fibroids include:

 	Heavy menstrual bleeding
 	Prolonged menstrual periods - seven days or more of menstrual bleeding
 	Pelvic pressure or pain
 	Frequent urination
 	Difficulty emptying your bladder
 	Constipation
 	Backache or leg pains

 	Abnormal menstrual bleeding, such as:
o	Heavier, prolonged periods that can cause anemia
o	Painful periods.
o	Spotting before or after periods.
o	Bleeding between periods.

 	Pelvic pain and pressure, such as:
o	Pain in the,abdomen pelvis, or low back.
o	Pain during sexual intercourse.
o	bloating and feelings of abdominal pressure.

 	Urinary problems, such as:
o Frequent urination
o	Leakage of urine (urinary incontinence).
o	kidney blockage following ureter blockage (rare).

 	Other symptoms, such as:
o	Difficulty or pain with bowel movements.
o	infertility. Sometimes, fibroids make it difficult to become pregnant.
o	Problems with pregnancy, such as placental abruption and premature labor.
o	miscarriage.

Tests and diagnosis

Ultrasound
Magnetic resonance imaging
Hysterosonography
Hysterosalpingography
Hysteroscopy

Uterine Fibroids - All You Should Know!

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?

The uterus is set up inside the pelvis with different muscles, tissue, and tendons. Due to pregnancy, labour or complicated delivery, in a few ladies, these muscles tend to weaken. Additionally, as a woman ages and with a loss of the hormone oestrogen, her uterus can drop into the vaginal canal, bringing about the condition known as a uterine prolapse.

The following conditions can bring about a prolapsed uterus:

Pregnancy with complicated or even ordinary delivery through the vagina.
Weakness in the pelvic muscles with the increase in age.
Weakening and loss of tissue after menopause and loss of normal oestrogen.
Conditions leading to increased weight in the abdomen, for example, constant coughing (with bronchitis and asthma), straining along with constipation, pelvic tumours (uncommon), or clogging of liquid in the abdomen.
Being overweight puts extra strain on pelvic muscles.
Previous surgery in the pelvic region leading to loss of outer support
Smoking
However, this condition can be treated effectively:

Self care at Home: You can strengthen your pelvic muscles by performing Kegel workouts. You do these by contracting your pelvic muscles, as though attempting to stop the stream of urine. This exercise makes the pelvic muscle strong and gives some support. Have your specialist train you on the best possible approaches to exercise your muscles.
Medications: Oestrogen (a hormone) cream or suppository ovules or rings embedded into the vagina help in strength and endurance building of the tissues in the vagina. However, oestrogen is just for use in some of the postmenopausal ladies.
Surgery: Based on your age and whether you wish to conceive a child naturally, surgery can repair the uterus or remove it. The uterus as in many cases can be expelled with a hysterectomy. During the surgery, the specialist can repair the hanging or saggy vaginal dividers, urethra, bladder, or rectum. The surgery might be performed by an open abdomen procedure, through the vagina, or through little cuts in the abdomen or vagina with particular instruments.
Other Therapy: In case that you do not need surgery or have a poor possibility for surgery, you may choose to wear a steady gadget, called a pessary. It is worn in the vaginal tract to strengthen the falling uterus. It can be utilised briefly or can be long-lasting. They come in different shapes and sizes and should be fitted according to the person. In case that the prolapse is extreme, a pessary may not work. Prolapse surgery is always preferred by vaginal route. Likewise, pessaries can disturb the insides of the vagina and may bring about a noxious release.
It can be prevented in the following manner:

Decrease your weight.
Try to avoid constipation by consuming a high-fiber diet.
Do Kegel exercises to strengthen the pelvic muscles.
Stay away from heavy lifting or straining.

Prolapsed Uterus -  7 Conditions That Can Cause It!

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

Uterine cancer of cancer of the uterus is a fairly common type of cancer. In fact, this is the fourth most common type of cancer to affect women. This type of cancer is usually diagnosed in its early stages and hence can be easily treated. However, did you know that this type of cancer can be prevented? This is primarily because most cases of uterine cancer are caused by an increased amount of estrogen as compared to progestin. Here are a few tips to keep in mind.

Birth control pills: The regular use of birth control pills for at least a year is believed to reduce the risk of uterine cancer by at least 50%. The longer these contraceptives are used for, the more effective they are. The protection provided by them lasts for 15 years after their use has been discontinued.
Reduce weight: Being overweight not only increases the risk of lifestyle diseases such as diabetes and high blood pressure but can also increase a woman s risk of suffering from uterine cancer. This is because fat cells produce estrogen that further dis-balances the estrogen to progestin ratio. Reducing weight can thus help lower the estrogen levels in the body and prevent cancer. To lose weight, one must keep a strict control over portion sizes, eat nutritious food and exercise regularly.
Use an IUD: Some methods of contraception not only prevent unwanted pregnancy but also reduce the risk of uterine cancer. Many IUDs or Intrauterine Devices contain progestin. This helps balance the estrogen and progestin levels in the body. Additionally, it also reduces the risk of hyperplasia. This is a condition marked by the abnormal thickening of the lining of the uterus. In many cases, this condition is a precursor to uterine cancer.
Question Your Family: Genetics can also influence the risk of developing uterine cancer. For example, people carrying the gene responsible for Lynch Syndrome or hereditary nonpolyposis colorectal cancer have a much higher risk of uterine cancer as compared to others. Thus, if you know of family members who have suffered or are suffering from uterine or colon cancer, it is a good idea to undergo genetic testing.
Broccoli - A super food: Some foods can also help strengthen the immune system and reduce the risk of uterine cancer. Broccoli is one such vegetable. This is known as a super food that can prevent cancer. The best way to eat broccoli is by steaming it. This has the higher amounts of glucosinolate as compared to fried or boiled broccoli.

Uterine Cancer - 5 Tips To Help You Keep It At Bay!

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