Fibroids & Polyps

Uterine fibroids are benign lumps in the muscle layer of the uterus. Fibroids are composed of muscle cells and other tissues.  Uterine fibroids are usually round and Fibroids are found in 30-50% of all women.

Types of Fibroids

Based on their location within the uterus, uterine fibroids can be classified as:

  • Subserosal fibroids: found beneath the serosa (the outer surface of the uterus)

  • Submucosal fibroids: found in the uterine cavity

  • Intramural: found in the muscle wall of the uterus

  • Pedunculated fibroids: Develop on a stalk attached to the outer wall (serosa) of the uterus

Causes for Fibroids

The exact cause for the development of fibroids remains unknown, but some of the proposed causes include:

  • Genetic abnormalities

  • Alterations in expression of growth factor (protein involved in rate and extent of cell proliferation)

  • Abnormalities in the vascular system

  • Tissue response to injury

  • Family history of fibroids

Symptoms of Fibroids

The majority of women with uterine fibroids may be asymptomatic. However, the basic symptoms associated with fibroids include:

  • Heavy menstrual bleeding

  • Prolonged menstrual periods

  • Pelvic pressure or pain, awareness of a pelvic or abdominal mass

  • Frequent urination, difficulty passing urine

  • Constipation

  • Backache or leg pain

  • bleeding between periods,

  • pelvic pain, pain during intercourse

  • Infertility and recurrent miscarriages

  • anaemia due to heavy menstrual bleeding

  • Some women do not have any symptoms (smaller fibroids)

Diagnosis of Fibroids

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. MRI can provide very detailed information on size, and location of fibroids.

Treatments of Fibroids

Different methods are used for managing uterine fibroids. Surgery is considered the best modality of treatment. The common surgeries performed for the management of fibroids include:

  • Hysteroscopic myomectomy - the removal of fibroid growing in the cavity of the uterus

    • Laparoscopic myomectomy - removal of fibroid in the muscle of the uterus via keyhole surgery. The defect in the uterus is closed with laparoscopic sutures

    • Open multiple myomectomy - removal of 4 or more fibroids followed by reconstruction od the uterus. This is performed as an open (laparotomy) procedure.  

  • Hysterectomy - removal of the uterus

  • Destructive techniques that involve boring holes into the fibroids with a laser or freezing probes (cryosurgery) - not widely used

  • Other techniques employed are uterine artery embolisation (UAE) and uterine artery occlusion (UAO)

Risks during pregnancy

The presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as first trimester bleeding, breech presentation, placental abruption, increased chance of Caesarean section and problems during labor.

Uterine Polyps

Uterine polyps are tissue overgrowths of endometrium, a tissue in the inner lining of the uterus, that extend into the uterus cavity. They are rarely cancerous.

Causes of Uterine Polyps

Uterine Polyps may occur spontaneously or because of higher levels of oestrogen hormone stimulating an isolated area of the uterine lining.

Although most of the polyps are noncancerous, the polyps that developed in women during or after menopause may turn out to be cancerous.

Uterine polyps are more common in women aged between 40 and 50 years. However, occasionally may be seen in younger women of 20 years or less. Obesity, uncontrolled hypertension and certain drugs used to treat breast cancer may increase the risk of uterine polyps.

Symptoms of Uterine Polyps

The most common symptom of uterine polyps is irregular menstrual periods.  Menorrhagia or abnormal heavy menstrual bleeding, prolonged periods, bleeding between periods and bleeding even after menopause or during sexual intercourse are some of the other symptoms of uterine polyps. Infertility may also be an indication of the presence of uterine polyps.

Diagnosis of Uterine Polyps

Uterine polyps are diagnosed based on the medical history and symptoms. Also, other diagnostic tests such as transvaginal ultrasound, sonohysterography, hysteroscopy and curettage may be performed.

Treatments for Uterine Polyps

Smaller polyps that do not cause any problem need not be removed but should be assessed every 6 months to check their progression. However, if uterine polyps cause heavy menstrual bleeding, or infertility or if there is previous history of miscarriage, then removal of uterine polyps (polypectomy) may be considered.

Usually, polypectomy may be performed using hysteroscopy during which a long, thin rod with a video camera and light (hysteroscope) is inserted through the vagina and cervical opening. Then the polyp is held and cut with a small pair of scissors.

Larger polyps need to be operated in a hospital set-up under general anaesthesia.