Fibroids: Types, Diagnosis & Treatment

Types of Fibroids: Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus (intracavitary myomas) will usually cause bleeding between periods (metrorrhagia) and often cause severe cramping. Fortunately, these fibroids can usually be easily removed by a method called "hysteroscopic resection," which can be done through the cervix without the need for an incision. Submucous myomas are partially in the cavity and partially in the wall of the uterus. They too can cause heavy menstrual periods (menorrhagia), well as bleeding between periods. Some of these can also be removed by hysteroscopic resection. Intramural myomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. Many of these do not cause problems unless they become quite large. There are a number of alternatives for treating these, but often they do not need any treatment at all. Subserous myomas are on the outside wall of the uterus. A fibroid may even be connected to the uterus by a stalk (pedunculated myoma.) These do not need usually treatment unless they grow large, but they can twist and cause pain. This type of fibroid is the easiest to remove by laparoscopy.


Diagnosis

Fibroids may be felt during a pelvic exam, but many times myomas that are causing symptoms can be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit(saline enhanced sonography or sonohysterogram). While this will often provide additional information to the regular ultrasound, I usually learn much more by looking inside the uterus with a little telescope. This exam, called hysteroscopy, is usually done in my office, and allows me to directly look inside the uterus. when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination. Vaginal probe ultrasound only takes a few minutes to do, is not uncomfortable, and rapidly provides invaluable information if the examiner is experienced in looking at uterine abnormalities. It is possible to fill the uterus with a liquid during the ultrasound

Adenomyosis confused with fibroids:

One of the most common conditions confused with fibroids is adenomyosis. This can be a serious error, as the treatment may be quite different. In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. This can cause severe pain, and heavy bleeding.

On ultrasound examination adenomyosis will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border. Adenomyosis is usually a diffuse process, and rarely can be removed without taking out the uterus. Since fibroids can be removed by myomectomy, it is essential to differentiate between the two conditions before planning treatment. It is also common to have adenomyosis and fibroids in the same uterus.

Which fibroids can be removed laparoscopically?

Fibroids that are attached to the outside of the uterus by a stalk (pedunculated myomas) are the easiest to remove laparoscopically. Many subserous myomas (close to the outer surface) can also be removed through the laparoscope.

Fibroids that are deep in the wall of the uterus, or submucous are most difficult to remove laparoscopically. Although there have been successful pregnancies after laparoscopic removal of deep or multiple myomas, the real question is whether or not the uterus can be repaired as well through the laparoscope as can be done through an abdominal myomectomy.

What are the advantages and disadvantages of laparoscopic myomectomy?

The advantage of a laparoscopic myomectomy over an abdominal myomectomy is that several small incisions are used rather than one larger incision. It is important to understand that even a laparoscopic myomectomy is real surgery, and often requires several weeks of recovery. Another major factor in recovery time is motivation; I have found motivation can be just as important in recovery as the type of surgery.

One concern when there are multiple fibroids is of leaving smaller myomas behind. Often it is necessary to feel the uterus to find the smaller myomas; these likely would be left behind during a laparoscopic myomectomy. To summarize, I think laparoscopic myomectomy is best for pedunculated and superficial myomas. When there are deep myomas and a large number of myomas, I think that it is possible to repair the uterus better by doing an abdominal myomectomy.

Infertility; Is it a Woman's Problem?

It is a saga that infertility is considered always a "woman's problem." No it’s not the case. About one-third of couples facing infertility are due to problems with the man (male factors), and one-third are due to problems with the woman (female factors). The rest of the cases are due to a combination of both the male and female factors and other unknown causes.

What are the causes of Infertility in Men?

In men, the problems are mainly with the making of sperm or with getting the sperm to reach the egg. These problems with sperm may be present by birth or it could develop later in life due to lifestyle changes, illness or injuries. Few men produce no sperm or produce very few sperm. As per research lifestyle can influence the number and quality of a man's sperm dramatically. Alcohol and drugs can provisionally reduce the sperm quality. Other environmental toxin, that includes pesticides and lead, can also cause infertility in men.

What Causes Infertility in Women?

Problems with ovulation account for most infertility in women. Without ovulation, eggs are not available to be fertilized. Signs of problems with ovulation include irregular menstrual periods or no periods. Simple lifestyle factors – including stress, diet or athletic training – can affect a woman's hormonal balance. Much less often, a hormonal imbalance from a serious medical problem such as a pituitary gland tumor can cause ovulation problems.

Aging is also an important factor in female infertility. The ability of a woman's ovaries to produce eggs declines with age, especially after age 35. About one-third of couples where the woman is over 35 will have problems with fertility. By the time she reaches menopause, when her monthly periods stop for good, a woman can no longer produce eggs or become pregnant.

Other problems can also lead to infertility in women. If the fallopian tubes are blocked at one or both ends, the egg can't travel through the tubes into the uterus and thus pregnancy can't be achieved. Blocked tubes may result from pelvic inflammatory disease, endometriosis or surgery for an ectopic pregnancy.

PREGNANCY RATES FOR AVERAGE COUPLES

It often takes a number of perfectly timed cycles before pregnancy is achieved. The chances of getting pregnant each cycle varies a bit with age. If you are 20-25, your chance per cycle are about 25%. From there they begin to fall off. At 25-30 your chances are about 20%. At 30-35 they are about 15%. After 35 they may be about 10% per ovulatory cycle, and the chances continue the downward trend.

This means that the average woman under 30 will get pregnant within 6 cycles. Women in their early 30s get pregnant on average by the end of 9 cycles. Mid-30s would be a year. At any age you are considered infertile if you have been having regular unprotected intercourse for a year without conception; however, women over 35 should seek treatment after 6 months

For more information about Infertility and solutions, please visit motherababy.com