More aware now, women check for fibroids before conceiving

Delayed pregnancy is leading to an increase in uterine tumours. As many as 25 million Indians have them, leading to problems with pregnancy and infertility. Geetanjali Jhala reports

Like most women, Surekha Sinh went through the usual nervousness and excitement when she found out she was pregnant. But as the pregnancy progressed, she got scared — there were complications she didn’t quite understand. After she lost her premature baby, her gynaecologist diagnosed fibroids —non-cancerous tumours in her uterus.

After a myomectomy — surgical removal of fibroids — and several months of hormone therapy, Surekha conceived again. But post-delivery, she would haemorrhage for most of the month. The diagnosis: Fibroids, again. What followed, along with nursing the baby, were months of bleeding, treatment, medication and another myomectomy.

Yet, the nightmare didn’t end there, she says. After her third child, the fibroids had returned. This time, they were cancerous and had affected her ovaries. Her gynaecologist advised a hysterectomy — removal of the uterus. So, at 28, Surekha had the life-changing operation. “I was advised hormone replacement therapy for 10 years. Menopause hit earlier than usual,” she says.

Nearly 25 million Indian women are currently affected by uterine fibroids, according to a study released this year. The 16-year-long country-wide research conducted by Mumbai-based fertility specialist Dr Prakash Trivedi is being circulated to gynaecologists by the Federation of Obstetrics and Gynaecology Society of India (FOGSI). They hope increasing awareness among patients as well as healthcare providers will prompt more women to go for regular checks. This will help doctors diagnose the problem and suggest treatment before it is too late.

Besides the discomfort and pain associated with it, having a fibroid can hamper pregnancy and child birth. The tumour in the uterus cannot be treated with drugs and more often than not, the fibroid needs to be surgically removed. Many times, women suffering from fibroids don’t realise that the tumour was responsible for a failed pregnancy.

What causes fibroids is as yet not fully known. Doctors say it is genetic: The study found a 30 per cent chance of women developing fibroids if anyone in the family had them. “Also, women who eat more red meat, those who are overweight, and those who have hypertension have a higher chance of developing fibroids,’ says Dr Trivedi, who also runs the Aakar IVF centre in Mumbai.

With more women delaying marriage and pregnancy in India, fibroids are becoming commonplace now, say doctors. “Women who put off pregnancy have a greater chance of developing fibroids,” says Dr Ashwini Bhalerao Gandhi, gynaecologist at the PD Hinduja Hospital. “This is because of the hormone oestrogen, which plays a role in developing fibroids.” Oral contraceptives, say doctors, reduce the chances of fibroids by regulating levels of oestrogen in the body. “Research has shown that fibroids are non-cancerous and can never turn malignant. Malignant tumours are not fibroids, they are known as fibro carcoma,” explains Dr Trivedi.

Not all fibroids cause as much trouble as Surekha’s did. Like Chhaya Joshi found. Four years back she had one incidence of severe pain which prompted the 49-year-old lab technician to get it checked. Sure enough, her sonogram showed fibroids. “When I heard the word tumour, I was out of my mind with worry, but my doctor told me that the fibroid was situated just above the uterus and would cause no problems,” she says.

Only marginally relieved, Chhaya expected to have to come back to the clinic for surgery. “But so far, except a little bladder pressure and an occasional urgency in relieving myself, I have felt no pain or abnormal bleeding ever,” she says. Her fibroid, which was 5cm large in 2003, is 8.7cm today. This, say doctors, is normal. A fibroid grows about half a centimetre in one year.

A fibroid only needs to be removed if it causes severe complications like excessive pain or heavy bleeding. “This is determined by where the fibroid is situated in the uterus,” explains gynaecologist and director of Gynaecworld, Dr Duru Shah. “A fibroid in the cavity or the muscle of the uterus will probably have to be removed but one just above the uterus will cause no problem.”

There are drugs that can help shrink a very large fibroid, but surgery is the only option if fibroids are to be removed. Laparoscopic or key-hole surgery is an enticing option, but can be carried out only by an experienced laparoscopic surgeon as it “requires finesse of suturing,” says Dr Shah. “Very often, if not properly sutured, the scar can rupture during pregnancy, casing complications,” she advises. Open surgery, on the other hand, takes much longer to heal but is ideal for those planning a baby, adds Dr Shah.

There is a newer option too: a hysteroscopy. Unlike the laparoscopy, where a telescope and surgical equipment is passed through a tiny cut in the abdomen, in the hysteroscopy, the telescope and equipment is inserted through the vagina and the fibroid scraped out.
If a patient has multiple fibroids which grow back even after being removed, a hysterectomy is advised. Earlier, a hysterectomy meant removal of the uterus as well as the ovaries, like in Surekha’s case. Today, however, the ovaries need not be removed, causing no hormonal imbalance. For 44-year-old Rihanna (name changed), who suffered from the pain and inconvenience of “six small fibroids and one the size of a tennis ball”, removing her uterus was the only option, she says. “I was approaching menopause, and since the hysterectomy two years ago, I have had no problems,” says Rihanna.   j_geetanjali@dnaindia.net