Fibroids affect at least 20% of all women at sometime 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.
What is a Fibroid?
Fibroid is a 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.
Types of Fibroid
There are four types of Fibroid:
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).
Causes of Fibroid
A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumor cell and starts to grow and multiply. Heredity may be a factor. It is thought that a muscle cell in the uterus may be "programmed" from birth to develop into a fibroid sometime perhaps many years after puberty (the start of menstrual periods). After puberty, the ovaries produce more hormones, especially estrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.
Symptoms of Fibroid
The symptoms of fibroids may include:
Heavy Vaginal Bleeding: Excessively heavy or prolonged menstrual bleeding is a common symptom. Women describe soaking through sanitary protection in less than an hour, passing blood clots and being unable to leave the house during the heaviest day of flow.
Pelvic Discomfort: Women with large fibroids may feel heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague discomfort rather than a sharp pain. Sometimes, the enlarged uterus makes it difficult to lie face down, bend over or exercise without discomfort.
Pelvic Pain: A less common symptom is acute, severe pain. This occurs when a fibroid goes through a process called degeneration. Usually, the pain is localized to a specific spot and improves on its own within two to four weeks. Using a pain reliever, such as ibuprofen, can decrease the pain significantly.
Bladder Problems: The most common bladder symptom needs to urinate frequently. A woman may wake up several times during the night to empty her bladder. Occasionally, women are unable to urinate despite a full bladder.
Low Back Pain: Rarely, fibroids press against the muscles and nerves of the lower back and cause back pain. A large fibroid on the back surface of the uterus is more likely to cause back pain than a small fibroid within the uterine wall. Because back pain is so common, it is important to look for other causes of the pain before attributing it to fibroids.
Rectal Pressure: Fibroids also can press against the rectum and cause a sensation of rectal fullness, difficulty having a bowel movement or pain with bowel movements. Sometimes, fibroids can lead to the development of a hemorrhoid.
Discomfort or Pain with Sexual Intercourse: Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue. If your doctor doesn't ask you about this symptom, make sure you mention it.
Diagnosis for Fibroid
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. The following are the tests conducted for the diagnosis of fibroids.
Ultrasound: 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.
Preparing for Fibroid Surgery
Your doctor/health practitioner should check whether you are pregnant, before he/she gives any treatment for fibroids. The fact that you have fibroids does not mean you are infertile; many women have had successful pregnancies with fibroids in their womb. Sometimes they are only diagnosed on for the first time during an ultrasound during pregnancy. Surgery, of any kind, can cause a disruption of the normal functioning of the body's systems. The following measures should promote general good health, thereby helping the body to be in the best shape possible for surgery. When planning for surgery, whether or not it requires a stay in the hospital, several steps can be taken to prepare both you and those around you for what is to come. Preparation can summed up in the following ways:
Doing things to promote health and eliminate unhealthy habits, such as cigarette smoking, recreational use of drugs, or excessive drinking of alcoholic beverages.
Providing your doctor with a full personal and family health history,
Deciding whether or not to donate some of your own blood for use during surgery,
Preparing your home to be as convenient as possible for your recovery,
Having some laboratory tests done, and
Doing some immediate preparation before surgery
Eat a well balanced diet, which includes plenty of fresh foods and vitamins and minerals. Vitamin C, in particular, is thought to play an important role in healing.
Provide the Doctor with information about all prescription and over-the-counter medications you have recently taken or are currently taking.
Ask friends or family to help out when you get home from the hospital. Check with your doctor about what you should or shouldn't eat before surgery
Some people choose to donate some of their own blood before surgery, which can be used to replace any blood lost during the procedure.
Fibroid Surgery Procedures
When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
Hysterectomy: Hysterectomy is the surgical removal of the uterus (and usually of the cervix as well). It is the most common treatment for fibroids. Three out of every 10 hysterectomies in the United States are performed because of fibroids. Currently, hysterectomy is the only permanent cure for fibroids. However, a woman cannot become pregnant or carry a baby after having a hysterectomy. Hysterectomy is often considered when the uterus reaches the size it would be at 12 weeks of pregnancy. In the past, many doctors recommended a hysterectomy because they feared that such large fibroids could hide the presence of cancer of the uterus. A hysterectomy is usually performed through an incision in the abdomen. Sometimes the ovaries are removed in addition to the uterus and cervix. The decision to remove the ovaries depends on the woman's age and on whether the ovaries are diseased. Sometimes, for smaller fibroids, the uterus can be removed through the vagina. This is known as a vaginal hysterectomy. After a vaginal hysterectomy, the only stitches are inside the vagina. The body absorbs the stitches in four to six weeks.
Myomectomy: Myomectomy is the removal of fibroids without removing the uterus. This operation preserves a woman's ability to bear children. However, a successful pregnancy is not guaranteed. Only 4 or 5 out of 10 women become pregnant and give birth after a myomectomy. Heavy bleeding can occur when the fibroids are removed. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy. She is also at higher risk for problems such as infection and blood clots in the legs. Fibroids may grow back after a myomectomy, and another operation may be needed later to remove them. The risk of re-growth is related to the number, not the size, of fibroids removed. If more than three fibroids are removed, the risk of re-growth is about 50-50. Like a hysterectomy, a myomectomy is usually performed through an incision in the abdomen. The risks and recovery time are about the same as for a hysterectomy. Sometimes a myomectomy can be performed with the assistance of a laparoscope or hysteroscope.
UFE (Uterine Fibroid Embolization): Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus. The procedure is also sometimes referred to as Uterine Artery Embolization (UAE), but this term is less specific and, as will be discussed below; UAE is used for conditions other than fibroids. Fibroid tumors, also known as myomas, are benign tumors that arise from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, and pressure on the bladder or bowel. In a UFE procedure, physicians use an x-ray camera called a fluoroscope to guide the delivery of small particles to the uterus and fibroids. The small particles are injected through a thin, flexible tube called a catheter. These block the arteries that provide blood flow, causing the fibroids to shrink. Nearly 90 percent of women with fibroids experience relief of their symptoms. Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the operation to remove the uterus.
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. The entire lining of the uterus (the endometrium) is removed or destroyed. The standard endometrial ablation and resection techniques are equally effective in reducing bleeding. In general, either one reduces bleeding by about half. At least 90% of women find either procedure acceptable and about three-quarters are totally or generally satisfied with the treatment. Only about 15% of women require a hysterectomy later on. Since no procedure has any particular advantage, a woman's best option may be to select the procedure based on their surgeon's skill and experience with it.
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: Is an MRI (magnetic resonance imaging) scan locates the fibroids, and then sound waves are aimed at them. This procedure also shrinks the fibroids. Most experts say Magnetic-resonance-guided percutaneous laser ablation and Magnetic-resonance-guided focused ultrasound surgery are both effective - however, there is some uncertainty regarding their benefits vs. risks.
Post Operative Care after Fibroid Surgery
Full recover will take about 2-4 weeks. When you return home, do the following to help ensure a smooth recovery:
Be sure to follow your doctor's instructions.
Wear sanitary pads or napkins to absorb blood. The first menstruation after the procedure may be heavier than normal.
Try to walk often. This will decrease the risk of blood clots.
Take medicines as prescribed by your doctor. If you had to stop medicines before the procedure, ask your doctor when you can start again.
Bathe or shower as normal. Gently wash the incision area with mild soap.
Ask your doctor when you will be able to:
Return to work and drive
Resume sexual activity
Resume strenuous activity (You may need to wait 2-6 weeks.)
Recovering after Fibroid Surgery
The recovery from fibroid removal may require a hospital inpatient stay of a few days and recovery can take several weeks. The following are the recovery for Hysterectomy and Myomectomy
Recovery from Hysterectomy: An abdominal hysterectomy involves a large incision and has a recovery time of 4 to 6 weeks. Laparoscopic and vaginal hysterectomies utilize small incisions reducing recovery time to 3 to 4 weeks. All hysterectomies require 2 to 3 day hospital stays, painkillers, potentially a catheter to assist with the passage for urine, and moving around to prevent blood clots.
Recovery from Myomectomy: Recovery time after a single, large incision myomectomy lasts about 4 to 6 weeks. Laparoscopic and vaginal myomectomies have shorter recovery times of 1 to 3 weeks. All mymectomies require 2 to 3 day hospital stays, painkillers, and moving around as quickly as possible to prevent blood clots.
Advance Treatment Options for Fibroid Surgery
The following are newer treatment options for Fibroid Surgery:
Embolization: This procedure shrinks fibroids by cutting off their blood supply. Guided by an X-ray image, the doctor threads a small catheter (a thin flexible tube) through a tiny incision in the groin into the main arteries that supply blood to the uterus. He or she then injects particles of inert plastic through the catheter to block these blood vessels. The uterus itself is not damaged because smaller arteries continue to supply the nutrients and oxygen it needs. The procedure takes about an hour. It may be performed with local or general anesthesia. The woman must lie flat on her back for six hours afterward to stop bleeding from the incision in the groin. Cramps in the pelvis are common, and the doctor usually prescribes a pain medication for them.
Laparoscopic Surgery: Some procedures can be performed using a laparoscope, a pencil-thin surgical telescope similar to a hysteroscope. The surgeon inserts the laparoscope and tiny surgical instruments through one or more small incision in the abdomen. If the fibroids are small and easy to reach, the surgeon makes an incision in the uterus and removes them. This is called a laparoscopic myomectomy. It may require an overnight hospital stay. When the fibroids are larger or harder to reach, the surgeon may use a laser or an electric needle to destroy or shrink them. This procedure is known as laparoscopic myolysis. Women who have this procedure done can often go home the same day.
Hysteroscopic Resection: This procedure uses a hysteroscope, a thin telescope that is inserted through the cervix. It enables the surgeon to see inside the uterus. The surgeon may then remove the fibroids with a laser or an electrical knife, wire, or probe. No incision is made. The procedure may be done with local or general anesthesia. The woman may stay overnight in the hospital or be treated as an outpatient. Full recovery takes a week or two.
Fibroid Surgery in India
India has emerged as an option abroad for Fibroid Surgery and other medical treatments for the international patients looking for low cost solutions with high quality service. Surgeons performing Fibroid Surgery in India treat with best medical facilities and provide highest successful results to these patients.
India finds the infrastructure and technology at par with that in USA, UK and Europe. Fibroid Surgery is one the common treatments for global patients coming to India. The good facilities provided in India are certainly beneficial but also the skyrocketing medical costs and long waiting lists to get treated by the specialists in the western countries are helping Indian medical tourism industry.
India has highly trained doctors to appeal to the medical tourists with a large pool of professionally qualified doctors, nurses and paramedics. The world-class facilities and infrastructure is further supported by low cost airfare and other facilities related to their stay in India in the following cities:
Cost of Fibroid surgery in India
The cost of surgery less when it is compared with the other western countries, it is relatively cheap because that is the way the international economy runs. A cost comparison of various medical treatments can give you the exact idea about the difference:
Procedure Cost (US$)
Uterine Artery Embolization
Some of the common countries from which patients travel to India for surgery are:
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - A city quite unlike any other in the whole of India, Mumbai (previously named Bombay) is an island city, being located on Salsette Island, alongside the Arabian Sea. With an appealing coastline, many of Mumbai's top resorts and tourist attractions lie around its main beaches, which include both Juhu Beach and also Girgaum Chowpatty Beach, where evening funfairs provide plenty of atmosphere.
Hyderabad - Hyderabad city is the capital city of the Indian state of Andhra Pradesh, in the region of Telangana. Hyderabad city is known for its rich history, food and its multi-lingual culture, both geographically and culturally. Founded in the year 1591 by fifth Qutb Shahi Ruler Muhammad Quli Qutb Shah. Now known as the historic old city, home to the Charminar, Falaknuma Palace, Chowmallah Palace and Makkah Masjid, it lies on the southern bank of the river.
Goa – Goa, a small enclave on the West Coast of India is one of the best holiday destinations in the World. Famous for its long stretch of beaches dotted with shacks, it is a favorite destination for the European tourists who flock to Goa during the winter months. Swaying palms, white sands and sparkling waters: the three essential elements that attract 2 million visitors annually to Goa’s balmy shores are plentiful in this tiny, glorious slice of India
Bangalore - Bangalore, the capital of the Karnataka, is fifth largest city in India. Few Cities in the World has the power to attract and motivate a casual visitor to move there permanently. Bangalore is one of those rare cities, which makes people who are new to the City to call themselves proud Bangaloreans. Bangalore, with a wonderful climate is already a Pensioner's Paradise.
Nagpur - Capital of the "land of oranges" and geographically at the virtual centre of India, Nagpur is endowed with rich forest resources and in itself is the second greenest city in India. The forests around Nagpur are full of best quality teak plantations. Shopping in Nagpur may turn out to be a pleasant experience for the discerning shopper. Nagpur is designed specifically for its many tourists and families to avoid any small annoyances.
Kerala - The Land Kerala is a dramatic, narrow, leaf-shaped strip of land, flanked by the formidable Western Ghats on the east, and the Arabian Sea on the west. A land of unabashed wealth, its people are amongst the most progressive and literate of the Indian populace. This tropical spice garden has lured the Arabs, Chinese and Europeans for many centuries. Christianity and Judaism entered the subcontinent through the legendary white sand beaches of Kerala.
Delhi - Delhi the capital of India main point of arrival for overseas visitors, and the major transport hub. Delhi is just not a city but it is a book that narrates the history of India. The city was built and destroyed seven times and has been witness to the various events, which has brought India through the history books.
Pune - The city of Pune is situated in Maharashtra and is said to be the cultural capital of the state. Located at a distance of approximately 120 km from Mumbai, the city is one of major tourist destinations in India. The rich history, architecture and culture of the city makes it a must visit destination for the tourist coming to India.
Jaipur – The city of Jaipur, painted in pink, grasp the appreciation of every visitor. One can see that hoary charm still alive in the avenues of Jaipur. Jaipur offers World Class Medical Facilities, comparable with any of the western countries. It has state of the art Hospitals and the best qualified doctors.
Chennai – The Gateway to South India, Chennai is famous for its sandy beaches, parks and historic landmarks. With a very distinct culture, the people of Chennai have a special interest in music, dance and all other art forms of South India. Capital of the state of Tamil Nadu, Chennai has embraced both the new and the old with ease
Gurgaon – Gurgaon, the commercial capital of Haryana, is one of the most sought after destination for MNCs, Corporate, residents and Investors as it offers world class standard of living and globally comparable business address in the form of IT parks and Business Centers and along with that very prominent medical hub.
Chandigarh - Chandigarh is the best-planned city in India, with architecture which is world-renowned, and a quality of life, which is unparalleled. Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads.