Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram
Series overview · 9 articles
Uterine Fibroids
August 25, 2024
Uterine fibroids are the most common benign growth in women of reproductive age, and the practical challenge for any doctor is that identical symptoms, heavy bleeding, pain, infertility, can come from wildly different situations depending on exactly where the fibroid sits and how large it is. Dr. Suman Lal, Principal Director & Unit Head, Obstetrics and Gynaecology at Max Hospital, Gurugram, used her Jivo Masterclass to walk through fibroid risk factors, diagnosis, medical and surgical management, before fielding one of the most extensive live discussions of this entire masterclass series.
A masterclass built almost entirely around real questions
The session drew a very large volume of submitted and live questions, on medication versus surgery, embolization, fertility, PCOS, endometriosis and post-surgical adhesions, and Dr. Lal worked through them methodically. This guide introduces a series built around both her core lecture and that extended discussion.
What this series covers
This series works through what fibroids are and their risk factors, how they're diagnosed and classified by location, their effect on fertility and pregnancy, medical management options including hormones and GnRH agonists, uterine artery embolization and its real contraindications, surgical removal by hysteroscopy, laparoscopy and robotic myomectomy, and a set of real questions on fibroid pain, PCOS, endometriosis, infertility and preventing adhesions after surgery.
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
Can you talk about the link between folic acid intake and uterine fibroids?
Dr. Suman Lal
Any diet rich in folic acid gives nutritional support to the uterus and can help reduce fibroid growth in epidemiological studies, but folic acid isn't a treatment. It can be given as a preventive measure in high-risk cases, not as a cure once a fibroid is present.
Frequently Asked Questions
What are some of the symptoms of a high-risk pregnancy if it can be detected only with the fibroid?▼
Pelvic pain out of proportion to a normal pregnancy, urinary symptoms from an anterior fibroid pressing on the bladder, rectal or pelvic pressure from a posterior fibroid, and localised pain when the uterus is touched, which often signals degeneration within the fibroid. Any of these should prompt an ultrasound.
How exactly do fibroids cause throbbing and burning pain during urination, and does it predispose patients to UTIs?▼
Since the bladder sits anterior to the uterus, a fibroid growing on the front surface of the uterus can press into and separate the bladder, causing difficulty passing urine and the resulting pain sensation.
Can tranexamic acid be used in treatment, like reducing the size of a myoma?▼
No. Tranexamic acid doesn't reduce the size of a fibroid. It works by promoting clot formation, so it reduces heavy bleeding caused by a fibroid, but has no effect on the fibroid's size.
How far can progesterone hormone reduce the size of a fibroid?▼
Progesterone reduces fibroid size by only around 20%. It's given to women waiting for surgery or unable to have surgery who have heavy bleeding, not routinely to patients without symptoms.
What is the management of fibroids using medication without surgery, and what are the possibilities?▼
If bleeding is heavy and the fibroid isn't inside the cavity, medical management with painkillers, oral contraceptive pills, and GnRH agonist injections is possible. GnRH injections reduce fibroid size but the effect reverses within six months to a year of stopping, so medical management is generally a one-to-two year bridge, not a permanent solution, and is most useful pre-menopause, pre-surgery, or pre-pregnancy attempts.
What does this masterclass series cover?▼
Fibroid risk factors and diagnosis, classification by location, fertility effects, medical management, uterine artery embolization, surgical myomectomy techniques, and related conditions like PCOS and endometriosis.
Who is Dr. Suman Lal?▼
Principal Director & Unit Head, Obstetrics and Gynaecology at Max Hospital, Gurugram, with over 31 years of experience in advanced gynaecological laparoscopy and robotic surgery.
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