Dr Dimple Doshi

Dr Dimple Doshi

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Uterine Fibroids

Uterine fibroids are the most commonly occurring benign tumors in women. The incidence of fibroid is 25% in all women and 30-40% of women above 40 yrs of age.

Many women with  fibroids have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bladder causing a frequent need to urinate. They may also cause pain during sex or lower back pain. A woman can have one uterine fibroid or many. Sometimes uterine leiomyomas may make it difficult for a woman to become pregnant or miscarry often.

Uterine-Fibroids

 

The symptoms caused by  uterine leiomyomas can be severe enough to affect a woman s quality of life. Heavy periods due to uterine fibroids can cause lowering of the hemoglobin levels and subsequent weakness, lack of concentration, hair fall, and easy susceptibility to infections. Many times, women think that the problems will disappear once menopause comes; but it is not always necessary. For some women attaining menopause is delayed due to the presence of  uterine leiomyomas. And they end up getting weak with extremely low, dangerous hemoglobin levels.

Dr. Dimple Doshi has expertise in treating uterine fibroids. Her main focus in treatment is to save the uterus.  At NABH certified Vardaan Hospital; she suggests the conservative line of treatment by alleviating the problems with the modern medicines and if surgery is required, she offers the minimally invasive option.

Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.

  1. Hormones: Estrogen and pprogesterone hormones which are produced by the ovaries;may stimulate the growth of your fibroids. Same way, the uterine fibroids may increase in pregnancy due to these hormones in pregnancy.
  2. Family history: Fibroids may run in the family. If your mother, sister or grandmother has fibroids. Your chances of having uterine fibroids are high.
  3. It is unclear that deficiency of vitamin D, diet deficient in fibres, fruits and vegetables may encourage growth or development of new fibroids.
  1. Your gynecologist will examine you to assess the size ,of the fibroid and its location.
  2. Ultrasonography wil determine the exact size, and location of uterine fibroids
  3. MRI may be required prior to surgery to exactly map the fibroid

Intramural Fibroids

Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.

Subserosal fibroids

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.

Pedunculated fibroids

Subserosal fibroids can develop a stem, a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.

Submucosal fibroids

These types of fibroids develop in the middle muscle layer, or myometrium, of your uterus. Submucosal are notorious in giving symptoms like heavy bleeding, pain, infertility or recurrent miscrriages

  1. Heavy periods
  2. Pain during or after periods
  3. Constipation
  4. Low hemoglobin levels or anemia
  5. Difficulty getting pregnant
  6. Miscarriages
  7. Frequency of urination in case of a uterine fibroid which is placed ahead of the uterus.
  1. CONSERVATIVE:
    • Small, asymptomatic fibroids may not require any medicines or surgical treatment; but you will be asked to keep a close watch on the size of fibroids by doing sonography at regular intervals.
    • Medications are used to shrink the fibroids like leuprolide, ulipristal,misoprostol. Your gynecologist will judge which will suit you the best and whether you will be benefitted or not and how much useful they will be.
    •  Medications like trenaxamic acid are also used to control the symptoms like heavy bleeding and pain
    • HIFU: High intensity focused ultrasound is the new method of shrinking the uterine fibroid by ultrasound waves
  2. SURGERY:
Uterine fibroid treatment in the form of  surgery  is indicated if:
  • The uterine fibroids are symptomatic
  • Uterine fibroids increase in size
  • Fibroids are causing infertility.
  • Fibroids are causing recurrent pregnancy loss.
Uterine fibroid treatment in the form of surgery is of two types:
  • Uterus sparing surgery like Myomectomy
Myomectomy is indicated for the women who want to preserve their uterus either because  she wants children or because she does not want to remove the uterus
  • Uterus removal surgery or Hysterectomy .
Hysterectomy is indicated for the women who have copleed their family and the uterine fibroid(s) are causing severe symptoms.

Preventing uterine fibroids may not be possible, but only a small percentage of these fibroids require treatment. But, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, you may be able to decrease your  uterine fibroid risk by either reducing the severity of symptoms or the appearance of new fibroids.

Dietary Advice:

Foods to eat:

 Eating brightly colored fruits and vegetables is good for your general health. Consuming a variety of red, yellow, and orange foods will provide rich antioxidants. Dark greens are also nutrient dense and will provide healthful benefits. These nutrients may help protect you from diseases and uterine fibroids.

  1. Fibre rich foods like raw and cooked vegetables, fruits, oats, beans, lentils, whole grain
  2. Foods which can supplement Vitamin D like; fortified milk, dairy products, cheese,  fortified cereals, egg-yolk, mushrooms, cod liver oil, fatty fish like salmon, tuna
  3. Green tea which contains antioxidants which help reduces the growth or appearance of new uterine fibroid.
  4. Potassium rich foods like bananas, avocado, potatoes, tomatoes, oats, dates, collard green, lentils etc.

Foods to avoid:

  1. Avoid red meat diet
  2. Avoid estrogen increasing foods like soy milk, soya beans, flax seeds, tofu
  3. Excess sugar, refined sugar and carbs as found in white bread, pasta, fruit juices , chips , crackers, energy bars, sugary drinks, sweets

Lifestyle Advice:

  1. Keep your weight and blood pressure in control; as high blood pressure is said to increase the risk of fibroid development.  
  2. Limit your alcohol consumption.
  3. Quit smoking; active as well as passive
  4. Balance your estrogen which is an important hormone for healthy fertility but too much of it can increase your risk for fibroids.

This balancing in estrogen can be done by:

  • Losing weight
  • Avoid or limit coming into contact with hormone disrupting chemicals found in
  • fertilizers
  • pesticides
  • plastics such as BPA
  • nonstick coatings on cookware
  • fire retardants
  • dyes
  • paints
  • some personal care product

Lower your blood pressure by:

  • Avoiding added salt and flavoring your food with herbs and spices instead
  • Limit high-sodium processed and packaged foods
  • Check your blood pressure regularly
  • Exercise regularly
  • Quit smoking active or passive smoking.
  • Increase potassium by eating a majority of plants at each meal.
  • Lose weight.

Q: Why do Uterine Fibroids Occur?
A: Though the exact cause is not known; uterine fibroids may be linked to hormones like estrogen and progesterone; family history and diet and lifestyle deficient in fibers; fruits and vegetables and vitamin D.


Q: Why Do Uterine Fibroids Cause Bleeding?
A: Not all fibroids cause bleeding but those which put pressure against the uterine lining can cause heavy bleeding. Also due to fibroids, the uterus may not contract properly or they may stimulate the growth of blood vessels and contribute to heavy bleeding.

 

Q: Where Are Uterine Fibroids Located?
A: Uterine fibroids may be located on top of the uterus ( subserosal or pedunculated ); inside the wall of the uterus may or may not be pushing the cavity and totally inside the uterine cavity ( submucous )

 

Q: Will Uterine Fibroids Affect The Pregnancy?
A:Uterine fibroids may affect fertility, and may affect your ability to carry a pregnancy successfully. However; some women may not experience fertility problems or pregnancy complications as a result of fibroids if they are small or located at a safe place in the uterus

 

Q: Will Uterine Fibroids Go Away On Their Own?
A: Fibroids may go away if estrogen levels in the body decrease like in menopause or while taking medications like GnRH agonists or antagonists; as fibroids are hormone-dependent tumors.

 

Q: Will Uterine Fibroids Cause Weight Gain?
A: Larger fibroids may cause a woman to gain weight. Weight gain and bloating could be due to hormonal imbalance and the size of the fibroid.

 

Q: Can Uterine Fibroids Cause Back Pain?
A:Fibroid present on the back surface of the uterus may press against the muscles and nerves of the lower back and cause back pain.

Q: How Are Uterine Fibroids Diagnosed?
A: Uterine fibroids are diagnosed by physical examination by your gynecologist and by ultrasonography.

Q: Are Uterine Fibroids Common?
A:The incidence of uterine fibroids is 25% in all women and 30-40% in women above 40 yrs of age.


Q: How Often Are Uterine Fibroids Cancerous?
A: Uterine fibroids are benign tumors. Rarely less than 1 in 1000 patients will develop a condition called leiomyosarcoma. This does not arise from an existing fibroid and having a fibroid also does not increase the risk of developing leiomyosarcoma.


Q: When Should Uterine Fibroids Be Removed?
A: If the fibroids are multiple and growing fast; if there is a single fibroid that is also large; and if there is infertility; pain pregnancy wastage and heavy bleeding. These are the times when the fibroids should be removed.


Q: Why Do Uterine Fibroids Cause Pain?
A: Fibroids may press on your bladder, rectum, or spinal cord causing abdominal pressure and backache. Fibroids can also distort the shape of the uterus resulting in pressure and pain.

 

Q: How Do Uterine Fibroids Affect Your Health?

A: Uterine fibroids can lead to very heavy bleeding resulting in very low hemoglobin levels which can cause weakness; giddiness; work absenteeism; lack of concentration; hair fall and many other problems which can affect the day-to-day quality of life.

 

Q: When Are Uterine Fibroids Removed?
A:Inability to conceive; pregnancy wastage; pain and heavy bleeding are the indications for which the fibroids should be removed.

 

Q: What Is The Cost Of Uterine Fibroid Surgery?
A:The cost of fibroid surgery ranges from 45000 to 1.5 lacs depending upon the complexity of the case and the room which is selected.