A 50-year-old lady walked into my clinic with the belly of a 7-month pregnancy. She seemed quite pregnant and distressed. She told me that when she did not get her period, she presumed she was menopausal, and stopped using contraceptives.
But as the months went by, her abdomen grew larger and larger, and she started feeling pressure on her bladder and rectum leading to frequent urination and constipation.
She felt terribly embarrassed about being pregnant at that age and came to me fearing the pregnancy. What would she tell her teenagers at home!
When I saw her, my first thought was that she was pregnant. But when I examined her, I was proved completely wrong. She was not pregnant, she had large fibroids in her uterus.
Fibroids are non-cancerous tumors of the uterus, which may occur as a single tumour or may exist in large numbers within the uterus, in its muscle, its cavity or on the surface. And depending on their location, they give rise to various symptoms such as painful and heavy periods, infertility, abdominal enlargement, bladder and rectal symptoms. Sometimes, when they press on nerves and blood vessels, they may cause pain down the legs and swollen feet as well.
Almost one out of every four women above the age of 40 has fibroids, and it is one of the common diagnosis when women visit their gynaecologists at that age.
What Causes Fibroids? What Is the Treatment?
The cause of fibroids is not known, hence one cannot prevent them. If you remove fibroids today, many more fibroids can grow and they continue to reappear as long as you continue to menstruate, because it is your estrogen hormone which makes them grow.
Once you attain menopause and the estrogen levels drop, no new fibroids will grow and the old ones shrink by 30 percent.
Earlier, women with fibroids either underwent myomectomy (removal of fibroids) if they were interested in further childbearing, or underwent hysterectomy (removal of uterus) if she didn’t want to have kids anymore.
Today, there are many new developments in the management of fibroids. Besides open surgery, there are various types of minimally-invasive surgeries as well.
Most of these procedures are meant to save the uterus, but it’s yet to be determined whether fertility and pregnancy remain unaffected following these procedures. However, fertility after laparoscopic and hysteroscopic removal surgeries has been well established and they are deemed safe for future pregnancy.
If a woman has no symptoms and her fibroids are small, then they do not require any intervention, but need to be kept under observation for rapid growth.
Many women come to me to get the tumours removed because they are concerned about them becoming cancerous. Cancerous change is very rare in these fibroids and I have seen only two malignancies in fibroids in the last 39 years of my experience as a gyneacologist!
Medically there is no method to make fibroids disappear, but there are medications to shrink the fibroids temporarily till the treatment is continued.
My only message to all of you is not to be scared of fibroids and not to jump into a surgery before exploring all modalities.
After all the uterus is a part of your body and there is no need to get rid of it just because it is not useful to you for childbirth.
(Dr Duru Shah is the Director, Gynaecworld, Center for Assisted Reproduction and Women’s Health. The views expressed above are the author’s own. FIT neither endorses nor is responsible for the same.)
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