- Fibroids are non-cancerous (benign) tumors that grow from the muscle layers of the uterus (womb).
- They are also known as uterine fibroids, myomas, or fibromyomas.
- The singular of uterine fibroids is Uterine Fibroma.
- Fibroids are growths of smooth muscle and fibrous tissue. Fibroids can vary in size, from that of a bean to as large as a melon.
- Nowadays a number of women suffer from formation of fibroids in uterus.
- Fibroids affect at least 20% of all women at some time during their life. Women aged between 30 and 50 are the most likely to develop fibroids.
- Overweight and obese women are at significantly higher risk of developing fibroids, compared to women of normal weight.
- Malignant (cancerous) growths on the smooth muscles inside the womb can develop, called leiomyosarcoma of the womb. However, this is extremely rare.
- Fibroids can vary in size, shape, position and number, some causing symptoms of pressure and uterine enlargement, while others are small and discrete.
- Uterine fibroids are composed of dense muscular fibers arranged in circular layers, and encapsulated in a layer of smooth muscle.
Types of Fibroids
There are four types of fibroids and these are:
- Intramural: These are located in the wall of the uterus. These are the most common types of fibroids.
- Subserosal fibroids: These are located outside the wall of the uterus. They can develop into pedunculated fibroids (stalks). Subserosal fibroids can become quite large.
- Submucosal fibroids: These are located in the muscle beneath the lining of the uterus wall.
- Cervical fibroids: These are located in the neck of the womb (the cervix).
- Fibroids may be located within the uterus (intrauterine), in the wall of the uterus (myometrial), or outside of the uterus (extra uterine).
- Intrauterine fibroids can inhibit fertility by interfering with implantation.
- Myometrial fibroids can place pressure on adjacent organs, and in some cases, can affect renal function by placing pressure upon the ureters.
- Extrauterine fibroids are located under the serous membrane of the uterus, and can be on or near the fallopian tubes and can affect fertility.
Causes of Fibroids
- We cannot come to a common consensus about why fibroids occur.
- During a woman’s reproductive years her estrogen and progesterone levels are high. When estrogen levels are high, especially during pregnancy, fibroids tend to swell. When estrogen levels are low fibroids may shrink, e.g. during a woman’s menopause.
- Heredity may also be a factor. Women whose mothers and/or sisters have/had fibroids have a higher risk of developing them too.
- Insufficient exercise, excess food intake, low thyroid function all may contribute to fibroid formations. Stress and sadness associated with issues of maternity and conception is also considered to be responsible for fibroid formations.
Symptoms of uterine fibroids
Most women have no symptoms. That is why most patients with fibroids do not know they have them. When symptoms do develop, they may include:
- Menorrhagia, sensation of abdominal pressure and pelvic congestion, abdominal enlargement Pelvic Pain, lower back pain, and dysmenorrhea.
- Anemia (as a result of heavy periods), Backache
- Discomfort in the lower abdomen (especially if fibroids are large)
- Frequent urination, Heavy painful periods
- Pain in the legs, Painful sex
- Swelling in the lower abdomen (especially if fibroids are large)
Other possible symptoms of uterine fibroids include:
- Labor problems, Pregnancy problems
- Fertility problems, Repeated miscarriages
- Abnormal Vaginal Bleeding
- Reproductive Dysfunction – Infertility
The most prominent symptoms of uterine fibroids are the primary risk factors for fibroids include the regular consumption of coffee and obesity, with a slight risk associated with oral contraceptive use. The risk of fibroids declines with repeated pregnancies.
Diagnosis of fibroids
In most cases, the symptoms of fibroids are rarely felt and the patient does not know she has them. They are usually discovered during a vaginal examination
- Ultrasound: If the doctor thinks fibroids may be present he/she may use an ultrasound scan to find out. Ultrasound can also eliminate other possible conditions which may have similar symptoms. Ultrasound scans are often used when the patient has heavy periods and blood tests have revealed nothing conclusive.
- Trans-vaginal scan: A small scanner is inserted into the patient’s vagina so that the uterus can be viewed close up.
- Hysteroscopy: This is a small telescope that examines the inside of the uterus. During this procedure, if necessary, a biopsy can be taken of the lining of the uterus (womb).
- Laparoscopy: A laparoscope is a small device that looks at the outside of the uterus – where the doctor examines its size and shape. A laparoscope is a small flexible tube. During this procedure, if necessary, a biopsy can be taken of the outer layer of the uterus.
- Biopsy: A small sample of the lining of the uterus is taken and then examined under a microscope.
- GnRHA (gonadotropin released hormone agonist), administered by injection. GnRHA stops the woman’s menstrual cycle.
- Side-effects – menopause-like symptoms, a tendency to sweat more, and vaginal dryness. Although thinning of the bones (osteoporosis) is also a possible side-effect.
- Tranexamic acid
- Anti-inflammatory drugs
- The contraceptive pill
- LNG-IUS (Levonorgestrel intrauterine system)
- This is a plastic device which is placed inside the uterus. LNH-IUS releases levonorgestrel (progestogen hormone). This hormone stops the lining of the uterus from growing too fast, which effectively reduces bleeding. One of the side-effects of this treatment is irregular bleeding for up to six months, headaches, breast tenderness, and acne. In very rare cases it can stop the woman’s periods.
Surgery to treat fibroids
When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
- Hysterectomy – removing the uterus. This is only ever considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes considered as an option to stop recurrences of fibroids (stop them coming back). Hysterectomies have two possible side-effects:
- Reduced libido
- Early menopause.
- Myomectomy: The fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant (as opposed to a hysterectomy). Women with large fibroids, as well as those whose fibroids are located in particular parts of the uterus may not be able to benefit from this procedure.
- Endometrial ablation: this involves removing the lining of the uterus. This procedure may be used if the patient’s fibroids are near the inner surface of the uterus. This procedure is considered as an effective alternative to a hysterectomy.
- UAE (Uterine Artery Embolization): This treatment stops the fibroid from getting its blood supply. UAE is generally used for women with large fibroids. UAEs effectively shrink the fibroid. A chemical is injected through a catheter into a blood vessel in the leg – it is guided by X-ray scans.
- Magnetic-resonance- guided percutaneous laser ablation: An MRI (magnetic resonance imaging) scan is used to locate the fibroids. Then very fine needles are inserted through the patient’s skin and pushed until they reach the targeted fibroids. A fiber-optic cable is inserted through the needles. A laser light goes through the fiber-optic cable, hits the fibroids and shrinks them.
- Magnetic-resonance- guided focused ultrasound surgery: An MRI (magnetic resonance imaging) scan locates the fibroids, and then sound waves are aimed at them. This procedure also shrinks the fibroids.
Ayurvedic view on Uterine Fibroid:
- According to ayurveda, fibroid is growth in mamsadhatu of uterus.
- According to ancient texts, Mamsarbuda means growth in muscles and connective tissue. Fibroid often manifests itself as excessive bleeding and hence this should be treated as ‘Yoni-vyapad’ (group of disorders related to female reproductive system).
- Uterine fibroids are considered mostly a kapha-accumulation disorder, but often involve pitta and vata displacements also,
- In which case the patient may be considered as pre-cancerous. Therefore, treatment must be deep-acting to balance the tri-dosha and must be sufficiently sustained over time to eradicated slow-moving kapha. The fibroids can be dissolved by diet, lifestyle changes and Yoga.
- Diet for the patient of uterine fibroids should be kapha-soothing and perhaps also pitta-pacifying, depending upon the bleeding patterns. Bitter, pungent and astringent foods are favored to support the metabolism in reducing its tendency to form fibrotic cellular changes from kapha and ama.
- Dietary changes should reflect an increase in whole foods and fiber, and a decrease in saturated fats and alcohol consumption.
Lifestyle should be aimed to reduce kapha, one should be active before sunrise. The earlier the rising time, the quicker kapha can metabolize itself. Self-massage with a minimal quantity of a light oil such as sunflower oil can helps to invigorate the body. Exercise, beginning gradually and becoming more vigorous over a few months is advocated.
- Give emphasis to yoga Asanas that focus on the first and second chakras. Poses such as the Bhujangasana (Cobra), Dhanurasana (Bow), Mahamudra and Gentle Spinal Twists are helpful.
- Postures that focus on the cardio-pulmonary chakra, such as Gomukhasana (Cow), Singhasana (Lion) helps remove the psycho-emotional root causes of uterine fibroids.
- Suryanamaskar (Sun salutations) bring positive activity to all chakras and may be useful if pitta is not elevated.
Ayurvedic Herbs useful in Uterine Fibroid
- Plant like Kumari, Shud Guggulu, Neem, Ashok, Manjistha are useful,
- Uttara basti (douche) with a decoction of 2 heaping tsps. Each of Ashok and Neem can be cooked for 5 minutes, covered, cooled and strained.
- To administer, add 1/3 cup aloe gel. Warm castor oil packs applied to the lower abdomen will help to ‘melt’ the fibroids and retract the kapha via apana vayu.
- Massage Pure, Cold-Pressed Castor Oil daily to lower abdomen around naval area in a circular motion is also helpful.
Ayurvedic Herbal preparations useful in Uterine Fibroid
- Kanchanar guggul
- Ashok ghana vati
- Kumari Asav
- Pushyanug churna
- Vradhivadhika Vati
- Punarnavadi Churn
- Varun Churn
- Nagkeshar Churn
- Bol Badh Ras
- Shiva Gutika etc. same as PCOS