Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram
Part 8 of 9 in Benign Growth in Uterus Causing Gynaecological Problems
Beyond Fibroids: PCOS, Endometriosis and Infertility
August 25, 2024
Several questions during the session moved beyond fibroids to related gynaecological conditions doctors see alongside them.
Infertility: finding the actual cause first
Asked about managing infertility, Dr. Lal was clear that treatment depends entirely on identifying the specific cause first: blocked fallopian tubes, inadequate egg reserve, or structural problems like fibroids, adenomyosis or endometriosis all need different treatment. For a woman with fibroids wanting to avoid surgery before conceiving, a GnRH agonist can shrink the fibroid over six to nine months, improving the chance of a subsequent pregnancy.
Endometriosis: why early, adequate surgery matters
Endometriosis cannot usually be completely cured, but early detection and adequate treatment change the outlook substantially. If an endometrioma is found, cystectomy to remove all endometriotic tissue at the first surgery is the key step. Getting the first surgery right, rather than a partial or delayed one, meaningfully reduces the chance of recurrence and preserves the chance of pregnancy afterward.
PCOS: lifestyle first, medication for specific symptoms
PCOS is fundamentally a lifestyle-related condition, so lifestyle change, reduced stress, better diet, regular exercise, is the most important treatment. Beyond that, treatment targets specific symptoms: hormonal pills for delayed periods, targeted medication for acne or hair loss, and ovulation induction with specialist input for women who are not conceiving.
This article is based on a Jivo Masterclass session conducted by Dr. Suman Lal, Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Suman Lal taught doctors across Africa on August 25, 2024.
FROM THE LIVE Q&A
Moderator
Do you suggest that a scan measuring a 5cm fibroid should be surgically removed?
Dr. Suman Lal
Not automatically. If the 5cm fibroid is inside the uterus causing heavy bleeding or obstruction, yes. If it's outside the uterus and not causing any problem, there's no need to operate. If it's in the muscle layer and the patient is trying to conceive or undergo IVF, removal is often needed. Symptoms, location and fertility goals all have to be weighed together, not size alone.
Frequently Asked Questions
What is the relationship between fibroids and menstrual pain?▼
A fibroid inside the uterine cavity acts like a foreign body. When menstrual contractions begin, the uterus tries to expel the fibroid the same way labour contractions try to expel a baby, causing cramping. An intramural fibroid also increases the uterus's surface area, independently increasing both pain and bleeding.
What is the fate of myoma nuclei after embolization, and why is it contraindicated in women wishing to conceive in the future?▼
Embolization blocks the artery supplying the uterus, so blood flow to the entire uterus decreases, not just to the fibroid. That reduced blood flow is exactly why the procedure is contraindicated for women planning pregnancy afterward, since it can compromise the nutrition and growth of a future baby. For these patients, myomectomy (surgical removal) is the right choice instead.
In cases of infertility, is there any actual management in terms of medication?▼
Infertility has several possible causes, blocked tubes, inadequate egg count, or structural issues like fibroids, adenomyosis or endometriosis, and each needs a different treatment. For a woman with fibroids who wants to avoid surgery before conceiving, a GnRH agonist can shrink the fibroid over six to nine months, after which medication can be given to support pregnancy.
Can endometriosis be cured completely, and how can someone with endometriosis get pregnant easily?▼
Complete cure of endometriosis is mostly not possible, but early detection and adequate treatment are key. If an endometrioma is found, a thorough cystectomy removing all endometriotic tissue at the first surgery is the most important step; getting this first surgery right substantially reduces recurrence and preserves the chance of pregnancy.
What is the best way to treat PCOS?▼
PCOS is fundamentally a lifestyle disease, so lifestyle changes, decreased stress, better diet, exercise and meditation, are the most important treatment. Beyond that, treatment targets specific symptoms: hormonal pills for delayed periods, targeted medication for acne or hair loss, and ovulation induction with specialist support for women not conceiving.
Why does the first endometriosis surgery matter so much?▼
A thorough cystectomy removing all endometriotic tissue at the first surgery meaningfully reduces recurrence risk and preserves fertility, compared to a partial or delayed procedure.
What is the most important treatment for PCOS?▼
Lifestyle change, reduced stress, improved diet and regular exercise, is the most important treatment, with medication targeted to specific symptoms like delayed periods, acne or infertility.
In This Series: Benign Growth in Uterus Causing Gynaecological Problems
- 1.Uterine Fibroids
- 2.What Are Uterine Fibroids? Risk Factors and Symptoms
- 3.Diagnosing and Classifying Fibroids by Location
- 4.Fibroids, Fertility, Pregnancy Risk and Menstrual Pain
- 5.Medical Management: Painkillers, Progesterone and GnRH Agonists
- 6.Uterine Artery Embolization: When It Works and When It's Contraindicated
- 7.Surgical Removal: Hysteroscopic, Laparoscopic and Robotic Myomectomy
- 8.Beyond Fibroids: PCOS, Endometriosis and Infertility
- 9.Preventing Adhesions After Myomectomy: What Actually Works