Have you ever struggled with heavy periods, constant fatigue, or unexplained abdominal discomfort? For many women, these symptoms are more than just monthly inconveniences; they could be signs of uterine fibroids. These non-cancerous growths can disrupt daily life, causing pain, excessive bleeding, and even impacting work and personal well-being. While surgery has long been the go-to treatment, medical advancements now offer less invasive options. We spoke to Dr Naveen Chandrashekhar, Consultant Intervention Radiologist, Gleneagles BGS Hospital, Kengeri, Bengaluru, who explained how intervention radiology is revolutionising fibroid treatment and helping women regain control over their health.
"Uterine fibroids are by far the most common cause of abnormal increased menstrual bleeding. Women complain of increased or heavy menstrual bleeding, lower abdominal pain, constipation, frequent urination and postcoital pain. This bleeding can indirectly affect the overall well-being and cause anaemia, easy fatigue, headaches, and body pain," said Dr Chandrashekhar.
More consequences of these uterine fibroids are on the quality of life where the affected individuals report suboptimal productivity at the workplace, frequent job changes and inability to represent themselves to their full potential.
What Are Uterine Fibroids?
Uterine fibroids are non-cancerous or benign growths developing either on the surface of the uterus or inside the uterus. They are classified into three types based on their location:
- Sub-Mucosal Fibroids: Grow inside the uterine cavity.
- Intramural Fibroids: Develop within the muscular wall of the uterus (most common).
- Subserosal Fibroids: Located on the outer surface of the uterus.
"As these fibroids are female hormone-driven, they are commonly seen in women aged 20-50. Fibroids may grow or develop during pregnancy, which is a high hormonal physiological status in reproductive age group women. This is why fibroids often shrink after menopause, when hormonal levels decline, and consequently, fibroid growth is rarely seen after menopause," added Dr Chandrashekhar.
Also Read: Uterine Fibroids: Here Are Some Symptoms To Know
Causes and Risk Factors
There are various causes and risk factors for the development of fibroids, including:
- Genetic predisposition: Fibroids can run in families.
- Hormonal imbalances: Oestrogen and progesterone promote fibroid growth.
- Lifestyle factors: Obesity, alcohol consumption, high intake of red meat and dairy products, and smoking are linked to fibroid development.
- Vitamin D deficiency: Research suggests a correlation between low vitamin D levels and fibroids.
Diagnosis of Uterine Fibroids
When a woman presents with symptoms of uterine fibroids, a thorough evaluation is conducted by an interventional radiologist. This includes:
Medical History and Physical Examination: A review of the patient's medical history, duration of symptoms, and a general physical examination, followed by a pelvic examination.
Imaging Tests:
- Ultrasound: A safe, non-invasive, and widely available diagnostic tool used to scan the abdomen and pelvis. This helps determine the size and location of the uterus and fibroids, as well as identify any abnormal features that may require further investigation to rule out cancer.
- MRI (Magnetic Resonance Imaging): An additional non-invasive diagnostic test used to further assess uterine fibroids, following an ultrasound scan.
Laboratory Tests: Routine investigations are conducted to evaluate:
- Haemoglobin levels
- Hormonal reserve markers
- Other relevant parameters
The comprehensive approach allows healthcare providers to diagnose uterine fibroids accurately and develop an effective treatment plan.
Treatment Options for Uterine Fibroids
According to the Gynecology and Obstetrics Clinical Medicine (GOCM), a personalised treatment plan is essential for women with fibroids, taking into account individual factors, such as age, reproductive goals, fibroid size, number, and location, symptom severity, and the range of available treatment options.
Treatment options include either medical management, surgical management or the most advanced minimally invasive techniques in intervention radiology. Dr Chandrashekar explains the treatment options as follows:
Medical Management
“Medical management can involve using oral contraceptive pills to regulate hormonal imbalances, hormone-based intrauterine devices like IUDs or Copper T, and GnRH agonists to help shrink fibroids alongside the supplementation or correction of anaemia,” said Dr Chandrashekhar.
Surgical Management
Surgical management of uterine fibroids involves two primary options: open surgery and laparoscopic surgery. Myomectomy is performed using these procedures, which involve either partial or complete fibroid removal. In some cases, however, a hysterectomy may be necessary, which involves the complete removal of the uterus.
Minimally Invasive Techniques For Uterine Fibroid Treatment
Most advanced, emergent and recent techniques used to treat uterine fibroids include uterine artery embolisation, uterine fibroid ablation and High-Intensity Focused Ultrasound (HIFU).
Uterine Artery Embolisation (UAE)
A UAE treatment for uterine fibroids is a minimally invasive technique performed by an interventional radiologist. The procedure involves:
- Angiography: It includes mapping the uterine arteries that supply blood to the fibroids using X-ray equipment and digital subtraction angiography.
- Blocking Blood Supply: Inserting thin catheters into the uterine arteries and blocking them with embolic agents, starving the fibroid of blood and hormonal drive.
- Monitoring and Recovery: Patients are monitored for a few hours and discharged. The fibroid begins to shrink, and bleeding is controlled within the first month.
Thermal Ablation
Another important and recent addition to uterine fibroid treatment includes thermal ablation. This treatment involves inserting a needle through the skin, under ultrasound guidance, to reach the uterine fibroid. The fibroid is then heated to a particular temperature to cause cell death and necrosis.
High-Intensity Focused Ultrasound (HIFU)
HIFU is a non-invasive treatment for uterine fibroids performed by an intervention radiologist. "In this procedure, a woman is placed in an MRI scanner, where ultrasound waves are precisely directed to heat and shrink the fibroid without surgery. Although this treatment is currently available in only a few parts of the country, it is gaining recognition and is expected to become more widely accessible shortly," concluded Dr Chandrashekhar.
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your professional if you are dealing with any health issue to avoid complications.]