Do fibroids cause infertility or recurrent miscarriages?
There is no clear evidence that all fibroids can cause infertility or miscarriages. But we do know that fibroids that go inside the cavity of uterus can distort the cavity and cause problems. Some fibroids which are growing in the wall of the uterus can cause problem implantation and growth of the fetus. So there is some amount of negative impact due to the presence of fibroids with pregnancy. Evidence shows that surgically removing fibroids can improve the pregnancy rates.
CAN ALL FIBROIDS BE TREATED BY MINIMALLY INVASIVE SURGERY?
Minimally invasive surgery, should be considered as valid options for all patients requiring treatment for symptomatic fibroids. Removing fibroids by minimally invasively surgery requires advanced surgical skill and includes techniques, like hysteroscopy, laparoscopy and robotic-assisted surgery. Still so many open surgeries are performed each year merely for removing fibroids suggests that only few surgeons are able to treat this by minimally invasively surgery. Additionally these surgeries become more challenging if they are associated with conditions like endometriosis, adhesions due to prior surgeries or adenomyosis. However, in the hands of an expert minimally invasive surgeon, any size, number or type of fibroid can be treated with minimally invasive either for myomectomy or hysterectomy.
Will having myomectomy ensure a pregnancy?
Having a myomectomy cannot ensure or promise a pregnancy. But if fibroid is the only is the only issue then studies show that your chances of getting pregnant increase by 50-60% irrespective of the type of surgery.
Do I need caesarean section if I get pregnant after myomectomy?
Some women are advised to have a caesarean delivery if they have a myomectomy because there is a theoretical risk of uterine rupture during subsequent labour, which can be catastrophic. There is no hard core scientific evidence regarding this at the moment. One must discuss this with your treating Obstetrician who can evaluate this carefully and advise close to delivery.
Can Fibroids Turn Into Cancer?
Fibroids are usually benign (not cancerous). There is a rare chance (less than one in 1,000) that the fibroid may have evidence of leiomyosarcoma. Leiomyosarcoma has poor outcomes.
Who are at Risk for developing Uterine Fibroids?
There are various factors that can increase a woman's risk of developing fibroids.
- Age. Fibroids are common in women during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
- Family history. Having a family member especially mother or sister with fibroids increases your risk. It increases the risk about three times higher than average.
- Ethnic origin. African-American women are more likely to develop fibroids.
- Obesity. Women who are overweight are at higher risk for fibroids.
- Eating habits. Consuming a lot of red meat is linked with a higher risk of developing fibroids. Green vegetables may have protective effect on the contrary.
Is extreme pain during periods a sign of endometriosis? Can Vomiting and passing out from pain be a sign of endometriosis?
Often painful periods are passed off as normal by elders in the family. However one must remember that incapacitating pain is not normal and can† indicates underlying disease that needs immediate medical care. Women should suffer with this pain as part of their biology should not be accepted and we now know that medical treatment works and one can have pain free life with dignity. Endometriosis is the leading cause of this discomfort. Severe pain due to endometriosis can also cause associated nausea and vomiting and young girls sometimes have giddiness and can pass out.
Can painful sex be due to endometriosis?
Yes it can be due to endometriosis. Some pain in the beginning can be normal but if it is persistent and especially deep which lasts for several hours later needs medical attention. Pain during menstruation or any other chronic pelvic pain should never be accepted as normal. This pain is mainly due to endometriotic deposits in the cul de sac (space between the uterus and vagina).
Can my pain or disease return even after having a surgery for endometriosis?
Endometriosis is often a progressive problem and it can always recur. Even after a surgery there is no guarantee that there will be 100% relief. Scientific evidence in peer-reviewed medical studies also suggest the same. However, even for the most severe cases, the surgical expertise of the operating surgeon can make a difference. Also the availability of infrastructure in terms of advanced laparoscopic instruments can make a difference in surgical outcome. Robotic assistance and availability of laser surgery a two advanced technology that can help in endometriosis surgery.
Can I avoid a laparotomy open surgery even if my endometriosis is advanced stage or severe?
The answer to this question is yes. It is feasible and possible to safely and thoroughly excise endometriosis implants even in most advanced cases by minimally invasive approach. But very few surgeons are skilled enough to be able to perform these very difficult minimally invasive surgeries. So one must choose the center and surgeon carefully. Severe endometriosis can affected the bowel, bladder, blood vessels, ureters, nerves, diaphragm, lungs, and liver, therefore a team approach with colorectal surgeons and urologists maybe needed
I underwent laparoscopy 4 years back for endometriosis and I am not having any pain now, but a recent scan shows that the cyst has again grown considerably (8cm). Is second laparoscopy suggestible or not?
The treatment of your endometriotic cyst depends on your age, problems at present or are you looking for pregnancy at the moment? If you are married and not able to conceive then a second laparoscopy to clear endometriosis to restore pelvic anatomy will improve the chances of your spontaneous conception. If you are not married at present and not having any symptoms, then you can have evaluation every 6 months, plan laparoscopy just before you plan conception or if it becomes painful since you just underwent laparoscopy 4 years ago. Endometriosis is a chronic problem, and repeated laparoscopy does not insure complete cure.
Stories about hysterectomy passed from one generation to the next can frequently contain misinformation. Some myths in our society regarding hysterectomy.
Myth: Hysterectomy causes depression
Fact: Research shows women donít have a higher rate of depression after a hysterectomy than before. Depression is a serious illness. So if it does develop, appropriate medical evaluation is important.
Myth: Sex isnít enjoyable after hysterectomy
Fact: If your sex life was good before a hysterectomy, it will probably continue to be. It may even improve with the discontinuation of contraceptive methods. If your ovaries are removed, the common decrease in sexual interest that can accompany menopause may occur. Diminished sexual interest is a complex problem yet is almost never caused by this surgical procedure alone.
Myth: Hysterectomy results in increasing weight
Fact: Hysterectomy per se is not responsible for increasing weight. Once surgery is done for a disease and you start feeling well, additionally you are taken care of by family members after surgery which all leads to good health.
Myth: Hysterectomy is the solution to all problems in middle age
Fact: If performed at young age it may be the beginning of all the problems starting from early menopausal symptoms, chronic backache etc.
Was invited to operate at Raipur Medical College at the FOGSI North Zone Yuva Congress. Dr Rooma Sinha demonstrated urogynecological surgeries for the delegates and later also gave lecture on setting standards for caesarean Section.