Fibroids or leiomyomas are one of the commonest issues with which a child bearing women presents in her reproductive age. Fibroids are smooth muscle tumours of benign cause that is they are non-cancerous. Most of these tumours go unnoticed, it is only when they present with symptoms like heavy bleeding or pain that they are generally diagnosed. With Ultrasound being one of the mainstay diagnosis in a workup of infertility these tumours are picked up early which may result sometimes to unnecessary interventions and overenthusiastic management.
Fibroids can cause infertility either by altering uterine contours, changing endometrium (lining of the uterus) structure and alter the chemical mediators of the uterus. The management of these fibroids depends on their size, locations, symptoms caused and desire of fertility.
The treatment modalities are
1) Pain killers and medicines like tranexamic acid to reduce blood loss.
2) Hormonal pills like Combined hormonal pills, mifepristone, ulipristal.
3) Hormonal injections like GNRH analogues.
4) Hormonal devices like Mirena and LNG IUS devices.
5) Surgical removal of fibroids or myomectomy either through open surgery or laparoscopically or hysteroscopically.
6) Surgical removal of uterus that is hysterectomy either by open surgery or by vaginal route or laparoscopically.
7) Newer modalities of treatment like uterine artery embolization and MRI guided focused ultrasounds.