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Uterine Fibroids Care with Footsteps To Fertility Centre

Life with Fibroids is painful and challenging. Timely detection and treatment of fibroids can help you enjoy your personal and sex life and reduce your risk for hysterectomy (Surgical removal of Uterus)

The uterus is composed of a thick layer of smooth muscle (myometrium) that surrounds the lining (the endometrium) into which the embryo implants.

Approximately 10-20% of all reproductive age women will develop benign growths of the myometrium, referred to as fibroid tumors (myomas). Estrogen stimulates their growth and these tumors are rarely malignant (cancerous).

Fibroid tumors can be located in the wall of the uterus (intramural), on the outside of the uterus (subserosal), within the uterine cavity (submucosal), on a thin stalk (pedunculated) or a combination of the above.

At Footsteps To Fertility Centre located  in Nairobi, Kenya, we provide comprehensive, advanced treatment for women with uterine fibroids to improve comfort and quality of life.

Feel free to contact us to schedule a consultation or directly reserve an appointment below.  When you visit us, your concerns are heard, your questions answered, and your health care needs are met in a friendly, professional atmosphere.

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Signs & Symptoms Uterine Fibroids

Fibroids, even large ones, can be present without any symptoms.

However, they can also cause a variety of symptoms depending on their size, location and the absence or presence of complications such as torsion (twisting) or degeneration (fibroid grows to an extent that it starts running out of its blood supply).

The most common symptoms are heavy cyclical menstrual bleeding (menorrhagia) accompanied by menstrual pain (dysmenorrhea).

Sometimes, especially when a fibroid protrudes into the uterine cavity, it can cause erosion of the endometrial lining and produce irregular or continuous bleeding (meno-metrorrhagia).

Other possible symptoms include pain with deep penetration during intercourse (dyspareunia), bladder irritability, rectal pressure, constipation and painful bowel movements (dyschezia).

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Effects Of Uterine Fibroids On Reproduction

Those fibroids that impinge upon the endometrial cavity (submucosal) or multiple fibroids in the muscle layer without a direct impact may adversely affect fertility.

Large intramural fibroids that block the openings of the fallopian tubes into the uterus, and where multiple fibroids cause abnormal uterine contraction patterns.

Surgery to treat fibroids can also affect fertility in several ways. If the endometrial cavity is entered during the surgery, there is a possibility of postoperative adhesion formation within the uterine cavity.

This should always be checked by a hysteroscopy or fluid ultrasound (hydrosonography) prior to beginning fertility treatment.

Because myomectomy can be bloody, there is a high likelihood of abdominal adhesion formation, which could encase the ovaries, preventing the release of the eggs or blocking the ends of the fallopian tubes.

It is important that experienced surgeons or reproductive endocrinologists, who are familiar with surgical techniques to limit blood loss and prevent adhesion formation, perform myomectomy.

In some cases multiple uterine fibroids may also deprive the endometrium of blood flow, that the delivery of estrogen to the uterine lining (endometrium) is curtailed to the point that it cannot thicken enough to support a pregnancy. This results in early 1st trimester miscarriages (prior to the 13th week of pregnancy).

Large or multiple fibroids, by curtailing the ability of the uterus to stretch in order to accommodate the spatial needs of a rapidly growing pregnancy, may precipitate recurrent 2nd trimester miscarriages (beyond the 13th week) and/or trigger the onset of premature labor.

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Diagnosis of uterine fibroids

Sizable fibroids are usually easily identified by simple vaginal–pelvic bimanual examination. However, even the smallest fibroid can be identified by transvaginal ultrasound.

Sometimes it is difficult to tell if a fibroid is impinging on the endometrial cavity. In such cases, a hysteroscopy (where a telescope-like instrument, inserted via the vagina into the uterine cavity) or a hydrosonogram (where salt water distends the uterine cavity, allowing for examination of its contour and inner configuration) can help distinguish between intramural and submucosal fibroids.

Magnetic Resonance Imaging (MRI) can be used to distinguish between fibroid tumors and a related condition called adenomyosis, in which diffuse of endometrium is found within the myometrium.

Medical treatment of uterine fibroids

The growth of fibroid tumors is estrogen-dependent. When a woman enters the menopause and stops producing female hormones, fibroids tend to shrink in size.

The most common of these is treatment with a medication such as leuprolide acetate (Lupron), which shut off the communication of the brain with the ovaries, preventing hormone production.

However, this type of medication can only be taken for a limited period (usually 6 months) and once the medication is stopped the fibroids will usually regain their original size within a few months.

Therefore the medication only a “temporary fix”; used mostly to decrease the size of large fibroids in order to make their ultimate surgical removal easier or to help a woman bridge the gap until spontaneous menopause sets in.

Surgical Treatment of Uterine Fibroids

The treatment of fibroid tumors in infertility patients is surgical removal (myomectomy).

Small, asymptomatic fibroids that do not impinge upon the endometrial cavity will usually not require treatment other than observation.

Large fibroids and submucosal fibroids should be removed prior to starting fertility treatments such as in vitro fertilization (IVF) in order to decrease the chance of implantation failure, miscarriage, pregnancy complications and premature labor.

Intramural and subserosal fibroids are readily removable by laparoscopic resection or via an abdominal incision (laparotomy).

Regardless of whether the laparoscopic or abdominal approach is employed, adequate closure of the uterine wall is essential in order to reduce the subsequent risk of uterine rupture during pregnancy or labor.

Uterine polyps and in some cases, also submucosal fibroids, can often be removed hysteroscopically (through the vagina). This eliminates the need for abdominal surgery and greatly reduces the recovery time.

Hysteroscopic surgery is only useful if the majority of the fibroid protrudes into the endometrial cavity, ensuring that the tumor defect will not be too large.

After hysteroscopic surgery, cyclical hormonal therapy can be prescribed based on the extent of the surgery and endometrial involvement to assist regeneration of the endometrial lining. A hysteroscopy should be performed afterwards to rule out scar tissue formation and to confirm a normal endometrial cavity.

Embolization of Uterine Fibroids

Embolization is a procedure in which small particles are injected into the arteries of the fibroid under radiological guidance to shut off the blood supply to the fibroids, in the hope that they will shrink.

Currently, embolization is not a recommended therapy for fibroids in women who still wish to conceive. It may be considered as an option for the treatment of fibroids in women who do not desire future fertility or have completed childbearing.

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