Uterine Fibroids & Hysteroscopy

Uterine Fibroids – Symptoms

Fibroids are muscular tumors which differ in regards to their shape, size and placement in the uterus. They are generally noncancerous and sometimes don’t even cause problems for a lot of women and show no symptoms. The symptoms generally appear due to their size, number or placement. The most common are:-

1. Painful, extended or uncharacteristically heavy bleeding
2. Pain in the pelvic area

• Less control of the bladder

1. Constipation
2. Pain in the lower back area

Certain signs and symptoms may indicate that you have serious complications. These include –

• Persistent pain in the pelvic area
• Inability to control urinary bladder
• Extremely heavy and painful bleeding in periods

• Lump or mass visible in abdominal area

Please get immediate medical attention in case of uncontrollable vaginal bleeding and/or sudden sharp pelvic pain

Uterine Fibroids – Causes

• Female hormones – estrogen and progesterone are hormones produced by the ovaries which most likely cause uterine fibroids to grow.
• Genetic predisposition among certain women has been known to be a factor leading to growth of fibroids inside the uterus.
• Pregnancy produces higher levels of estrogen and progesterone which also lead to fibroid growth in certain women.

Uterine Fibroids – Diagnosis

Fibroids may generally be discovered during a routine pelvic examination. The doctor examines the shape of the uterus and determines if there are any irregularities in it. The following tests may be required:

• Abdominal or Vaginal Ultrasound is used to get a picture of the uterus to confirm the diagnosis.
• Magnetic resonance imaging (MRI) may need to be conducted to show detailed images of the fibroids.

In some cases, other slightly invasive tests like Hysterosonography, Hysterosalpingography or Hysteroscopy maybe needed

Uterine Fibroids – Treatment

If you don’t show symptoms of Fibroids, you will generally not need any treatment. However, your doctor may ask you to look out for symptoms getting more pronounced.

In case you develop symptoms, your treatment options may include –

• Medications targeting hormones which generally do not eliminate fibroids but may shrink them
• Uterine artery embolization is a non-invasive procedure which can be opted in some cases
• Surgery is the best option when the medications are unable to control the symptoms or in case the fibroids are already too large or have a very rapid growth. The various options depend on the patient status

1. Laparoscopic or robotic Myomectomy – When the uterus needs to be preserved, a keyhole surgery through abdomen can be done
2. Hysteroscopic myomectomy – In this, the removal of the fibroid is done through instruments using a hysteroscope inserted through the vagina and cervix

Hysterectomy

In severe cases of fibroids, the uterus is removed through a surgical process called Hysterectomy. Hysterectomies have become routine treatments for pre-menopausal women who have been suffering from uterine fibroids for some time.

A doctor may perform partial or complete hysterectomy depending on the severity of the symptoms and the extent of fibroid growth.

• Partial hysterectomy involves removal of the upper part of the uterus but leaves the cervix and fallopian tubes intact
• In a complete hysterectomy, the uterus and the cervix are both removed
• A doctor may even take out the fallopian tubes and ovaries along with the uterus and cervix if the case so demands

There are several ways in which hysterectomies can be performed and the doctor may perform any one of those depending on what is possible on the day of the surgery.

1. Abdominal Hysterectomy – In this method the uterus is removed by making a cut in the abdomen. It allows the most flexibility to the doctor to perform a partial or a total hysterectomy.
2. Vaginal Hysterectomy – In this method the uterus is removed by surgery done through the vagina. It can only be total and not partial.

• Laparoscopic Hysterectomy – In this method, the uterus is removed by making 3-4 small holes through the abdomen. It is a minimally invasive procedure and may or may not be combined with the removal of ovaries and fallopian tubes.

Robotic Hysterectomy – In this method, the surgeon uses laparoscopic tools to perform the procedure through a computer. It can be used to remove an area of endometriosis or tumors without removing the entire uterus.

Hysterectomy – Risks & Complications

Hysterectomies have become routine and the risks associated with them have also reduced significantly over the years due to more advanced medical technology. Some of the risks may include:

• Adverse reaction to anesthesia
• Blood clots
• Infection of the wound
• Excessive bleeding
• Damage to peripheral organs while removing the uterus, cervix which may need further treatment
• Early onset of menopause

Hysterectomy – Pre Op Care

Here are some of the things you will have to keep in mind before going in for an Appendectomy –

• Inform your doctor about any other medical conditions that you are having
• Inform your doctor about all the medications and supplements you are taking
• Inform your doctor about any allergies you might have
• Make sure all other conditions are well controlled
• Discuss all options for the type of procedure that can be performed depending on your condition

Hysterectomy – Post Op Care

• Allow your body to heal by giving it proper rest
• Limit heavy lifting or any form of strenuous physical activity for 4 to 6 weeks
• Take your antibiotics regularly and as prescribed to prevent post-surgery infection
• Take pain relieving medicines as required and prescribed by your doctor
• Keep your incision area clean to avoid infection
• Watch out for warning signs including swelling & redness around the incision, fever & chills, stomach cramps, vomiting, loss of appetite, and diarrhea or constipation for more than 2 consecutive days
• Assess for signs of hemorrhage