Wednesday, 8 July 2015

Perplexing question - whether to retain or remove “FIBROIDS”

If fibroids should be surgically removed is one of the most perplexing and controversial topics in Gynaec OP. There is no straight answer to this question.The decision can be arrived upon, only after careful investigation and evaluation and the judgment will differ from patient to patient. Many people are not aware that fibroid is only a ‘BENIGN TUMOUR’ and it is not  ‘CANCER’.

I am sharing the case of one of my patient (name has been changed to protect privacy) Laila had initially come to me four years back requesting for myomectomy (surgery to remove fibroids).  She had fibroid measuring 4 cm, but I had convinced her that time that it was not necessary and she decided against the surgery. Now after four years it was found that the fibroid has grown into 7 cm size and her family panicked. She again came to me ready to undergo myomectomy. As found in some cases, she had absolutely no symptoms or discomfort due to the fibroids.

I again discussed with her all the pros and cons of surgery. The surgery is a major procedure and involves hospital admission and General Anesthesia. It may also require blood transfusion and is quite expensive. Laparotomy (open surgery) is cheaper in India compared to  laparoscopy ( keyhole surgery ), but it may involve more blood loss and requires two months rest. In rare cases, the surgeon may have to remove the whole uterus, instead of just the fibroid, if there is heavy bleeding during the procedure.

This patient was having some financial constraints and her husband was working abroad. There was no one to help her during the surgery, other than her old mother. So I advised her to analyse her decision properly and discuss with her partner and arrive at a decision. We are doing regular scans on her to make sure there is no sudden growth. One of her relatives had suggested a hysterectomy. Hysterectomy is totally out of question and will be imprudent, considering the fact that she is only 34 years old. No one should choose to voluntarily undergo menopause without a valid reason. 

Patients go thru severe symptoms after a surgical menopause and I have had some patients describing that death is better than surgical menopause. Even if ovaries are preserved during hysterectomy they tend to fail in a couple of months, so it is not an assurance that the ovaries are preserved and only the uterus is removed.  

For the time being, I have convinced her and she has decided to wait till her husband come for holidays  and we will reevaluate the situation again. Considering the fact that they are under financial stress, I feel that the hard earned money of her husband working in Gulf, should be spent on things like her kid's education and building their own house rather than on an unwanted surgery.

Some facts about  fibroids  

Generally, most of the fibroids are silent and 30 % of women have these lumps on the uterus and many of them may not be even aware of it. A general scan may pick up the diagnosis and women starts panicking and start getting stressed for no reason most of the time. Fibroids may result in heavy periods, but it is easily treatable with medications. It might also lead to discomfort and urinary symptoms if the size is very big, and may necessitate surgery if the person cannot bear the symptoms. But such difficulties are observed only in a small percentage of women.

Submucous fibroids may interfere with chances of conception and infertile patients may require hysteroscopic removal of these inner ones. The fear of cancer is the leading reason for surgery, but fibroids are not malignant or cancerous. There is a rare variety of cancer similar to fibroids called fibromyosarcoma, but it grows very fast and causes heavy bleeding. The time progression is only few days in that cancer, whereas it takes years for a fibroid to grow. 

I am actually quite happy that many of my women patients followed my advice and still have their uterus intact, keeping them young and healthy.

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Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre 
+91 484 2475031,  +91 484 2475034, 


Dr. Anita Mani is a renowned infertility specialist in south India with 18 years experience in ART (Assisted Reproductive Technology). Dr. Anita has successfully set up ART hospitals in Cochin and Bangalore,  along with her spouse  Dr. S Mani, who specialises in surrogacy. She completed MRCOG, from Royal College of Obstetrician and Gynaecologist  London, DFFP from  ART Warwick university and  worked in UK for 5 years. Dr. Anitha believes in scientific and ethical practice and is currently the director of Gift Gyno IVF centre Cochin and  Bangalore.  Apart from advanced laparoscopic surgeries, she is also an expert in various ART techniques including IVF, IUI, ICSI , donor egg / sperm  and surrogacy. Her proficiency is in genetic abnormalities and high risk pregnancies.