Fibroid Specialist in Chennai: Treatment Options, Symptoms & When Surgery Is Needed

Uterine fibroids — quick answers

What are the symptoms of fibroids?

Heavy or prolonged periods, anaemia, pelvic pressure or a swollen lower abdomen, frequent urination, constipation, pain during intercourse and, in some women, difficulty conceiving. Many fibroids cause no symptoms at all.

Do fibroids need to be removed?

Only if they cause symptoms, affect fertility or grow rapidly. Small fibroids that cause no problems are simply monitored.

What is the best treatment for fibroids?

It depends on symptoms, fibroid size and location, and whether you want children. Options range from tablets that reduce bleeding, to a hormonal IUD, to removing the fibroids (myomectomy) or the uterus (hysterectomy), usually by laparoscopy.

Can fibroids be treated without surgery?

Yes. Tranexamic acid, hormonal treatments, the levonorgestrel IUD and GnRH-based medicines control bleeding and shrink fibroids for many women. Uterine artery embolisation is a non-surgical procedure that shrinks fibroids by blocking their blood supply.

Can fibroids turn into cancer?

Almost never. Fewer than 1 in 1,000 fibroids are cancerous (leiomyosarcoma). Rapid growth after menopause is the main warning sign that needs investigation.

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Uterine fibroids (myomas or leiomyomas) are non-cancerous growths of the muscle wall of the uterus. By the age of 50, most women have at least one. Most cause no trouble, but for a substantial number they mean heavy, exhausting periods, pain, or problems getting or staying pregnant. Here is how a fibroid specialist approaches diagnosis and treatment, and how to know when surgery is genuinely needed.

Recognising the symptoms

Symptoms depend more on where a fibroid sits than on its size:

• Submucosal fibroids (bulging into the cavity of the uterus) cause heavy bleeding and fertility problems even when small.
• Intramural fibroids (within the wall) cause heavy periods and pressure as they enlarge.
• Subserosal fibroids (on the outer surface) cause pressure on the bladder or bowel and a swollen abdomen, but usually not heavy bleeding.

Warning signs that need assessment rather than waiting: soaking through a pad or tampon every hour, passing large clots, periods lasting more than seven days, tiredness or breathlessness from anaemia, and any bleeding after menopause.

How fibroids are diagnosed

A pelvic examination often detects an enlarged uterus. Transvaginal ultrasound confirms fibroids and measures them. MRI is used when the picture is complex, before surgery for multiple fibroids, or when a fibroid is being considered for embolisation. A hysteroscopy (camera inside the uterus) or saline sonogram shows whether a fibroid is distorting the cavity, which matters for fertility.

Treatment options, from least to most invasive

Watchful waiting

Small fibroids with no symptoms need only a yearly scan. Fibroids typically shrink after menopause.

Medicines to control bleeding

• Tranexamic acid taken during periods reduces blood loss by about a third.
• Combined pill or progestogen tablets regulate and lighten periods.
• Levonorgestrel IUD (hormonal coil) cuts bleeding dramatically and is an excellent option when the fibroids are not distorting the cavity.
• GnRH analogues and antagonists shrink fibroids by 30 to 50 percent and stop periods; they are used for short courses, often to shrink fibroids and correct anaemia before surgery.

Procedures that keep the uterus

• Hysteroscopic myomectomy. Submucosal fibroids are shaved away through the cervix with no cuts in the abdomen. Day-care procedure; ideal before fertility treatment.
• Laparoscopic myomectomy. Fibroids in the wall or on the surface are removed through keyhole incisions, and the uterus is repaired. Preserves fertility, with a one-to-two-night stay.
• Uterine artery embolisation (UAE). An interventional radiologist blocks the arteries feeding the fibroids, which shrink over months. Effective for bleeding and pressure; less suitable for women planning pregnancy.

Hysterectomy

Removing the uterus is the only treatment that guarantees fibroids will not return. It is the right choice for women who have completed their family and have severe symptoms, very large or multiple fibroids, or have not responded to other treatment. Laparoscopic hysterectomy means small incisions, a one-to-two-day stay and a return to normal activity in two to three weeks. The ovaries are usually preserved, so menopause is not brought forward.

When surgery is needed

Surgery is advised when:

• bleeding causes anaemia despite medicines,
• pain or pressure symptoms affect daily life,
• a fibroid is distorting the uterine cavity in a woman who wants to conceive, or is linked to repeated miscarriage,
• the uterus is large enough to press on the kidneys' drainage (hydronephrosis), or
• a fibroid is growing rapidly, especially after menopause.

Whether the operation should be a myomectomy or a hysterectomy comes down to one question: do you want the option of pregnancy in future? If yes, myomectomy. If no, hysterectomy avoids the chance of new fibroids forming.

Fibroids and pregnancy

Most women with fibroids conceive and carry normally. Submucosal fibroids and large intramural ones that distort the cavity lower implantation rates and raise miscarriage risk; removing them improves outcomes. During pregnancy fibroids can grow and occasionally cause pain, but they are rarely removed until after delivery.

At Iswarya Hospital in OMR, Chennai, our gynaecologists offer the full range of fibroid care, from the hormonal IUD and medical treatment to hysteroscopic and laparoscopic myomectomy and laparoscopic hysterectomy, with fertility planning built into every decision.