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Fibroids – Do’s and don’ts

What Are Fibroids?

Fibroids, or leiomyomata (myomas), are common noncancerous growths that usually occur in or on the muscle walls of the uterus. One cell divides repeatedly and grows into a firm, rubbery mass separate from the rest of the uterine wall. Almost half of women older than 50 have these growths. They’re more common in African American women than in Caucasian women. They can grow as a single mass or more often as a number of masses of different sizes.

What Causes Fibroids?

The cause isn’t clear. Several factors probably work together to produce fibroids. These factors may be hormones such as estrogen, genetics (runs in families), and environmental. Being overweight, never having had a child, and getting periods before age 10 also may have an effect. The fibroids usually, but not always, shrink after menopause (change of life).

What Are the Symptoms of Fibroids?

Most fibroids (30% to 50%) cause no symptoms. Problems, when they occur, are related to the size and location of the fibroids. Fibroids may grow to be quite large so that a woman may look pregnant and have symptoms of pregnancy: pressure in the pelvic area (lower belly), heaviness, and need to go to the bathroom often to urinate. Fibroids in the uterine wall or in the cavity of the uterus may cause bleeding between periods or heavier and more painful periods. Constipation, backache, pain during sex, and lower belly pains may occur. Rarely, fibroids cause sudden pain or bleeding.

How Are Fibroids Diagnosed?

The health care provider will do an examination of the pelvic area. Ultrasound or x-rays may be used but aren’t always needed for diagnosis. The doctor may do a special procedure (hysteroscopy) for women with bleeding symptoms. This simple procedure lets the doctor look into the uterus to find the cause of the bleeding or to plan or carry out therapy.

How Are Fibroids Treated?

Most fibroids need no treatment and only regular checks to be sure that they’re not growing too large or causing problems. Medicines including hormones and drugs that act against hormones can be tried. If fibroids continue to be a problem, hysterectomy (surgery to remove the uterus) is an option. Sometimes, fibroids alone may be surgically removed (myomectomy), which saves the uterus if children are wanted. Another newer method is uterine artery embolization. In this method, arteries to the uterus are blocked so they don’t feed the fibroids. Myolysis (electric current destroys fibroids and shrinks blood vessels feeding them) and cryomyolysis (liquid nitrogen is used instead of electric current) are other methods. However, fibroids can return and mean more surgery later. Newer medicines may shrink fibroids, but this change is only temporary.

DOs and DON’Ts in Managing Fibroids:

• DO get regular health care provider checkups.
• DO tell your health care provider your concerns and describe your symptoms.
• DON’T delay having children just because you have fibroids. They usually won’t get in the way of pregnancy. If you do need treatment for fibroids, some treatments can temporarily or permanently prevent you from becoming pregnant.
• DON’T worry about getting cancer from fibroids. Typical fibroids are not cancerous.

Surgery for uterine fibroids

• Medication to treat fibroid symptoms usually only works while you are taking it. Many women who have severe pain and heavy menstrual bleeding end up considering surgery as an option. There are a number of different types of surgical treatments, each with its own pros and cons.

• Surgery is done in the hope that it can permanently stop the symptoms of uterine fibroids. Some women do, in fact, experience long-term relief. But surgery always carries risks too. Whether or not surgery is an option – and, if so, what kind of surgery – will depend on how the woman feels about the different advantages and disadvantages. The size, number and location of the fibroids will also influence the choice of treatment. Not all types of surgery are suitable for women who still want to have children.

• Your doctor may recommend taking hormones such as GnRH analogues several weeks before having surgery. These kinds of artificial hormones are used to shrink the fibroids. Doctors can then make smaller cuts during surgery, allowing the womb (uterus) to recover more quickly. The drug ulipristal acetate is sometimes used for this purpose too.

• But removing individual fibroids isn’t a good idea if it might cause too much scarring in the womb, or if the risk of bleeding during or after surgery is too high. Plus, it isn’t always absolutely certain that the symptoms will improve after surgery. Hysterectomy (surgical removal of the womb) is then an option – or possibly another non-surgical treatment approach such as uterine artery embolization (UAE, sometimes also called uterine artery embolization, or UFE). Uterine artery embolization cuts off the blood supply to the fibroid.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years experience in handling all kinds of Gynecological conditions including Fibroids.

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Fibroids surgery -laparoscopy / key hole surgery versus open myomectomy

Uterine fibroids are noncancerous growths that grow in the wall of the uterus. When fibroids cause heavy bleeding or painful symptoms, and other treatments are ineffective, a doctor may recommend surgery.

Fibroids are common, but it is challenging for doctors to determine what percentage of people have them, as not everyone experiences symptoms. According to various estimates, fibroids may affect between 20% and 80% of the female population under the age of 50 years.

Although fibroids can sometimes grow to the size of a grapefruit or even larger, they are often very small. Many people with fibroids are unaware that they have them. People with asymptomatic fibroids do not require surgery or other treatments.

However, other people experience abdominal pain, pressure, bloating, pain during sex, frequent urination, and heavy or painful periods. These individuals may require surgery.

In this article, learn more about surgery for fibroids, including the types, risks, and what to expect.

There are several different surgical approaches to treating fibroids. The types of surgery that a person can have will depend on the location of the fibroid.

A doctor will usually recommend more conservative options, such as medication, before considering surgery.

In cases where medication and other treatments do not work, surgical options include the following:

Myomectomy

Myomectomy is a surgical procedure that removes fibroids. Depending on the location of these growths, a surgeon may also have to remove other tissue in the process. Surgeons offer different myomectomy techniques.

The traditional technique is quite invasive as it uses a relatively large cut. This incision may go from the bellybutton to the bikini line or run horizontally along the bikini line. Some surgeons also perform laparoscopic surgeries, which use smaller incisions but require more skill.

Although a myomectomy preserves the uterus, women who wish to become pregnant should speak to a doctor about the possible complications. Those with very large or deeply embedded fibroids may only be able to have cesarean deliveries after this procedure.

New fibroids may develop after a myomectomy, which means that it is not a permanent solution for everyone.

Radiofrequency ablation procedure

Radiofrequency ablation destroys fibroids using either an electric current, a laser, cold therapy, or ultrasound. It requires only a small incision.

However, it can cause dangerous pregnancy complications, such as scarring and infection, so doctors do not recommend it for those who are planning future pregnancies.

Radiofrequency ablation may be a good option for people considering a hysterectomy who want a less invasive procedure.

Endometrial ablation

Endometrial ablation does not remove fibroids, but it can help relieve heavy bleeding.

During endometrial ablation, a surgeon uses a range of techniques — which may include heat, electric current, freezing, lasers, or wire — to destroy the lining of the uterus. These techniques reduce or stop heavy bleeding.

This procedure is less invasive than some other surgical options. Sometimes, doctors can even perform it on an outpatient basis in their office.

This procedure may prevent women from being able to get pregnant in the future, so it is not a good option for those who would still like to have children.

Hysterectomy

A hysterectomy is a surgery to remove the uterus and, sometimes, the ovaries. A hysterectomy permanently eliminates uterine fibroids.

This procedure is not an option for anyone planning a future pregnancy, as it removes the womb. Some people opt to leave the ovaries in place so that they continue producing estrogen.

A surgeon may be able to perform a laparoscopic hysterectomy, which uses several small incisions and a tiny camera to help the surgeon see inside the abdomen. An open hysterectomy requires a large incision between the bellybutton and the bikini line.

Another option is a vaginal hysterectomy, which is the approach that most people prefer. In this procedure, a surgeon will remove the uterus through the vagina.

A vaginal hysterectomy may not be possible if the uterus or fibroid is too large to fit through the vagina.

Individuals who undergo an open hysterectomy may have a longer recovery time. Doctors usually recommend a hysterectomy only for those whose fibroids are very large or significantly interfere with their quality of life.
People who have other reproductive health issues, such as endometriosis, may find that a hysterectomy provides significant relief from fibroids and other symptoms.

Morcellation

Morcellation is a procedure that reduces the size of fibroids so that a surgeon can remove them through a tiny incision in the abdomen. A doctor may use morcellation during a myomectomy, hysterectomy, or other surgery.
However, the Food and Drug Administration (FDA) caution that morcellation carries significant risks.

While fibroids are not cancerous, uterine cancer is more common in people having fibroid surgery than experts previously thought.

It can also be difficult to tell the difference between a fibroid and a type of cancer that looks the same. According to the FDA, morcellation may inadvertently spread cancer that resembles a fibroid.

Benefits

The benefits of surgery depend on the type of surgery and can vary from person to person. For example, there is no chance that the fibroids will grow back after a hysterectomy. However, they may regrow following other procedures.

Some potential benefits include:

• reduced bleeding
• relief from pain or pressure
• removal of fibroids
• the potential that fibroids will either not grow as large or not regrow at all

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 13 years experience in handling all kinds of fibroids.

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Post menopausal bleeding – what can it possibly be?

What is postmenopausal bleeding?

Postmenopausal bleeding is any bleeding that occurs in a woman’s vagina after she has undergone menopause. Once a woman has gone 12 months without a period, she’s considered to be menopausal.

In order to rule out serious medical problems, women with postmenopausal bleeding should always see a gynecologist.

What is vaginal bleeding?

Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or assault
  • cervical cancer
  • infections, including urinary tract infections
  • Polyps
  • Endometrial hyperplasia
  • Fibroids

If you’re experiencing vaginal bleeding and are postmenopausal, your Gynecologist will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.

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Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a gynecologist immediately .

What causes postmenopausal bleeding?

Bleeding can occur in postmenopausal women for several pathological reasons. For example, women who take hormone replacement therapy for menopause may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur.

There are a variety of other conditions that can cause postmenopausal bleeding such as polyps, endometrial hyperplasia, and endometrial atrophy.

Uterine polyps

Uterine polyps are noncancerous growths. Though benign, some polyps may eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding.

Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.

Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated.

Endometrial cancer

Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.

This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat cancer in many cases. Less than 10% of women who have postmenopausal bleeding have endometrial cancer.

Endometrial atrophy

This condition results in the endometrial lining becoming too thin. It can occur in postmenopausal women. As the lining thins, bleeding may occur.

Cervical cancer

Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Gynecologists can sometimes identify these cells during a regular exam.

Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring for abnormal Pap smears.

Other symptoms of cervical cancer can include pain during sex or abnormal vaginal discharge, including in women who are postmenopausal.

Symptoms of postmenopausal bleeding

Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.

Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

Symptoms postmenopausal women may experience include:

  • vaginal dryness
  • decreased libido
  • insomnia
  • stress incontinence
  • increased urinary tract infections
  • weight gain

Why Dr. Ruchi Tandon is the best choice?

Dr. Ruchi Tandon is a gynecologist with over 13 years of experience in clinical menopause and is a trained Hysteroscopy surgeon, practicing in leading hospitals of South Delhi such as Max smart super specialty hospital, Saket, Apollo Cradle Royale, Nehru Place. She specializes in hormone replacement therapy and recommended the management of menopausal symptoms.

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Ovarian cyst – laparoscopy is treatment of choice

Ovarian cysts are fluid-filled sacs or pockets in the ovary or on its surface. Women have two ovaries — each about the size and shape of an almond, 2-3cm in size— on each side of the uterus. Eggs, which develop and mature in the ovaries, are released in monthly cycles during the childbearing years.

Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — can cause serious symptoms. To protect your health, get regular pelvic exams and know the symptoms that can signal a potentially serious problem.

Symptoms of ovarian cyst

Most cysts don’t cause symptoms and go away on their own spontaneously. However, a large ovarian cyst can cause:

  • Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
  • Fullness or heaviness in your abdomen
  • Bloating

Complications of ovarian cyst

An ovarian cyst often causes no problems, but sometimes it can lead to complications.

  • Torsion: The stem of an ovary can become twisted if the cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
  • Burst cyst: If a cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding. Symptoms may resemble those of appendicitis.
  • Cancer:less than 10 % of ovarian cysts can become malignant or cancerous.

Laparoscopy in ovarian cyst

A small incision will be made just below the navel. Next, a laparoscope will be inserted. This is a thin tube with a camera on the end. To allow the doctor to better view the organs, carbon dioxide gas will be pumped into the abdomen. The laparoscope will be used to locate the cyst. When it is found, 1 or 2 more incisions will be made. Surgical instruments will be inserted to remove the cyst. Tissue may be removed for testing. If cancer is found, both ovaries may need to be removed. After the cyst is removed, the instruments will be removed. The incision area will be closed with stitches or staples.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?

There will be pain after the surgery. You will be given pain medication.

Average Hospital Stay

You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Why Dr. Ruchi Tandon?

Dr. Ruchi Tandon is a trained laparoscopic Gynecological surgeon, practicing in best hospitals in South Delhi such as Max smart super speciality hospital, saket, Apollo Cradle Royale, Apollo Spectra Hospitals, Delhi. She has over 14 years of experience in the field of operative Gynecology and endoscopic procedures.

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Why you should choose a specialized Laparoscopic Surgeon and Cosmetic Gynecologist?

Laparoscopy is a skilled profession that demands a high level of expertise and well-versed training. Gynecological Laparoscopy involves procedures such as

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy and Hysteroscopy for Infertility
  • Hysteroscopic Polypectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Gynecological expertise is of paramount importance in all of these procedures.

Reasons for gynecologic laparoscopy

Laparoscopy can be used for diagnosis, treatment, or both of them. A diagnostic procedure can sometimes very commonly turn into a treatment.

Some reasons for diagnostic laparoscopy are:

  • unexplained pelvic pain
  • unexplained infertility history of pelvic infection

Conditions that might be diagnosed using laparoscopy include:

  • Endometriosis
  • Uterine fibroids
  • Ovarian cysts or tumors
  • Ectopic pregnancy
  • Pelvic adhesions
  • Pelvic inflammatory disease

Some types of laparoscopic treatment include:

  • Hysterectomy or removal of the uterus
  • Removal of ovaries
  • removal of ovarian cysts
  • removal of fibroids
  • blocking blood flow to fibroids
  • adhesion removal
  • reversal of a contraceptive surgery called tubal ligation
  • Burch procedure for incontinence
  • vault suspension to treat a prolapsed uterus

Preparing for gynecologic laparoscopy

Preparation depends on the type of surgery. You may need imaging tests, or your doctor might order fasting or an enema.

Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.

Ask a friend to come to pick you up after the surgery or schedule a car service. You will not be allowed to drive yourself.

Cosmetic Gynaecology

Cosmetic Gynaecology is one of the emerging areas of Gynecology and includes :

  • Non-surgical vaginal tightening
  • Surgical vaginoplasty
  • Hymenoplasty or restoration of virginity
  • Ovarian rejuvenation
  • Reversing menopause
  • Labiaplasty
  • Non-surgical treatments for painful intercourse

Dr. Ruchi Tandon, is a specialized gynecologist practicing in Greater Kailash, South Delhi with over 13 years of experience in operative laparoscopy, cosmetic Gynecology, and high-risk pregnancy cases.

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FIBROIDS WHEN YOU ARE 40

What are fibroids?

Fibroids are non – cancerous or benign growths arising out of the uterus or its musculature

And are usually restricted to female reproductive organs.

What are the different types of fibroids?

The type of fibroid a woman develops depends on its location.

Intramural fibroids

Intramural fibroids are the most common type of fibroid, which appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.

Subserosal fibroids

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side than the other.

Pedunculated fibroids

Subserosal tumors can develop a long stem and a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.

Submucosal fibroids

These types of tumors develop in the inner and middle muscle layer, or endometrium, of your uterus. Submucosal tumors aren’t as common as the other types.

What causes fibroids?

It’s unclear why fibroids develop, but several factors may influence their formation.

Hormones

Estrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.

Family history

Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.

Pregnancy

Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly during pregnancy.

What are the symptoms of fibroids?

Your symptoms will depend on the number of tumors you have as well as their location and size. For instance, submucosal fibroids may cause heavy menstrual bleeding and trouble in conceiving.

If your tumor is very small or you’re going through menopause, you may not have any symptoms. Fibroids may shrink during and after menopause. This is because women undergoing menopause are experiencing a drop in their levels of estrogen and progesterone, hormones that stimulate fibroid growth.

  • Symptoms of fibroids may include:
  • Heavy bleeding between and during periods that includes blood clots
  • pain in the pelvis and backache
  • increased menstrual cramping
  • Increased urination
  • Pain during intercourse
  • menstruation that lasts longer than usual
  • Fullness in the lower abdomen

How to diagnose fibroids?

Fibroids are diagnosed using Ultrasound and MRI. Transvaginal ultrasound is the most accurate method of locating and assessing the fibroid.

How to treat fibroids?

  • medical method – drugs like mifepristone, GnRH analogs are still experimental.
  • surgery – Myomectomy or removal of fibroids. This is done laparoscopically in advanced setups.
  • hysterectomy or removal of the uterus.

Fibroids Management by Laparoscopy in Greater Kailash

Laparoscopy is being done in all the leading hospitals in South Delhi. Dr. Ruchi Tandon has received extensive training in laparoscopy from the best hospitals in Delhi and Mumbai, such as moolchand hospital, leelavati hospital. Dr. Ruchi Tandon is one of the best gynecologists, based in greater Kailash and doing all sorts of daycare and operative laparoscopic procedures. Infertility surgeries, Myomectomy, hysterectomy, Hysteroscopy are some of the procedures to name a few. she is doing these procedures at Max smart super specialty hospital, Saket, Apollo Cradle Royale, and Apollo Spectra. In lieu of her experience and contribution to this field, she was conferred with the “best budding endoscopic surgeon “(National) award by the Economic Times at a grand event on 4th October, recently in Delhi.

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What do you mean by Laparoscopy?

Laparoscopy also called as keyhole surgery, is a specialized kind of surgery, using very fine instruments and through small incisions (0.3-1.2 cm). Originally started in Germany, it has evolved rapidly over the last 3 decades, superseding convention surgery and ultimately is the preferred mode of operation for all types of Gynecological procedures and surgeries. The various advantages of Gynecological laparoscopic procedures include less hospitalization duration, quicker patient recovery, lesser scaring, overall less operative time reducing

complications.  

Procedures done by Laparoscopy /Hysteroscopy:

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy & Hysteroscopy for Infertility
  • Laparoscopic Adhesiolysis
  • Hysteroscopic Polypectomy
  • Hysteroscopic Myomectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Advantages of laparoscopic surgery:

  • Faster healing
  • Lesser scarring
  • Better recovery
  • Lesser hospital stay
  • Lesser intra operative complications

Complications of laparoscopy:

Same as of any other conventional open surgery.

The use of energy devices has risk of thermal injury to visceral organs, namely bowel injury and ureter injuries.

What all you need to know before your laparoscopy?

It is important to understand the benefits and risks of your procedure before undergoing any surgery.

In cases of difficulty, Laparoscopy may need to be converted into open laparotomy. Huge fibroids, adhesions and difficultly in visualisation can make laparoscopy a challenge for operating surgeon.

Laparoscopy Treatment:

Laparoscopy is being done in all the leading hospitals in South Delhi. Dr Ruchi Tandon has received extensive training in laparoscopy from best hospitals in Delhi and Mumbai, such as moolchand hospital, leelavati hospital. Dr Ruchi Tandon is one of the best gynecologists, based in greater Kailash and doing all sorts of daycare and operative laparoscopic procedures. Infertility surgeries, Myomectomy, hysterectomy, Hysteroscopy are some of the procedures to name a few.

She is doing these procedures at Max smart super specialty hospital, Saket, Apollo Cradle Royale and Apollo Spectra. In lieu of her experience and contribution to this field, she was conferred with the “best budding endoscopic surgeon “(National) award by the Economic Times at a grand event on 4th October, recently in Delhi.