Gynaecology -Fibroid, Endometriosis
FIBROIDS
- Fibroids are mostly benign growth (tumor) in the uterus (womb). Very rarely a fibroid can turn malignant.
- If the size of submucous fibroid is small, medical therapy can be tried only in symptomatic women.
- For fibroids larger than 4 cm, its better to remove them surgically. Sometimes smaller but symptomatic fibroids also warrant removal eg those causing heavy bleeding etc.
- A fibroid can be diagnosed by ultrasonography, HSG, MRI etc. USG is the most common mode of diagnosis.
- Plan of surgery (LAPAROSCOPY OR HYSTEROSCOPY) is decided pre operatively depending upon the following factors:
- Location of fibroid
- Distance from serosa ( outermost layer of uterus) & mucosa ( innermost layer of uterus )
- Number and site of incision
You may be prescribed some medicines and injections after the surgery for prevention of recurrence of fibroid.
What is Endometriosis?
- Endometriosis is a common condition that affects women during the reproductive years. Endometriosis is a condition where tissue, similar to the one that normally grows inside the uterus (lining of uterus), also grows outside of the uterus. The tissue inside the uterus is called “endometrium” and the tissue outside of the uterus is called “endometriosis”. The most common places where endometriosis occurs are the ovaries, the fallopian tubes, the bowel, and the areas in front, in back, and to the sides of the uterus.
- If you have severe pain during menses and also having some trouble in conceiving then you may be having endometriosis. While some women with endometriosis have severe symptoms some may have few or no symptoms.
- There is no cure for endometriosis, but there are several treatment options. The best treatment depends on your individual situation which can be judged by your infertility specialist.
- The treatment is custom made for each individual depending upon the symptoms and severity of the condition. Such individualization gives the best results to our patients.
What are the causes of endometriosis?
- The cause of endometriosis is not known.
- A common theory is that some menstrual blood and endometrial flows backwards through the fallopian tubes and into the pelvis during a menstrual period. Normally these tissues are taken care by our immune system and hence most of the women don’t develop endometriosis; unfortunately some women have failure of these immune system and the endometrial tissues persist in the pelvic organ. This later on gets blood supply from the surrounding organs and stars growing in each cycle under the influence of the hormones and starts producing symptoms . This tissue then grows where ever it lands in the pelvis. This is called the retrograde menstruation theory. It explains external endometriosis. As the bleeding occurs from the endometriotic tissue and is on the surface of the organs, hence leads to adherence of the organs leading to alteration in the relationship between the fallopian tubes and ovaries, and thereby difficulty in conception.
- In some cases internal endometriosis is seen. The Germ line theory explains it. In these cases the endometrium grows internally due to the germ cells that grow in this abnormal location causing endometriosis. In these women, the bleeding occurs within the ovarian tissue, hence mostly these women do not have any symptoms of the disease. It remains silent for a long time till the internal damage due to cyclic bleeding and ovarian blood filled cyst ( chocolate cyst ) formation takes places. This can then be diagnosed on ultrasonography (USG). However by this time due to damage to the ovarian tissue the ovarian reserve gets diminished, which can be seen by the low AMH (Anti Mullerian Hormone) levels in these women. If it is not treated timely, then it will further decrease the ovarian reserve and hence hamper the chances of conception.
- There are several other theories. However it is best to focus on treatment rather than cause in cases of endometriosis.
