Question 1

Can you talk about the link between folic acid intake and uterine fibroids?

Dr. Suman Lal · Accepted Answer

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.

Question 2

What are some of the symptoms of a high-risk pregnancy if it can be detected only with the fibroid?

Dr. Suman Lal · Accepted Answer

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.

Question 3

How exactly do fibroids cause throbbing and burning pain during urination, and does it predispose patients to UTIs?

Dr. Suman Lal · Accepted Answer

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.

Question 4

Can tranexamic acid be used in treatment, like reducing the size of a myoma?

Dr. Suman Lal · Accepted Answer

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.

Question 5

How far can progesterone hormone reduce the size of a fibroid?

Dr. Suman Lal · Accepted Answer

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.

Question 6

What is the management of fibroids using medication without surgery, and what are the possibilities?

Dr. Suman Lal · Accepted Answer

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.

Question 7

What is the role of the gonadotropin agonists used in India, Lupron and Goserelin?

Dr. Suman Lal · Accepted Answer

Both are effective at reducing fibroid size, by around 40-50%. Different centres use different ones, but either can be used.

Question 8

Do you suggest that a scan measuring a 5cm fibroid should be surgically removed?

Dr. Suman Lal · Accepted Answer

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.

Question 9

What is the relationship between fibroids and menstrual pain?

Dr. Suman Lal · Accepted Answer

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.

Question 10

What is the fate of myoma nuclei after embolization, and why is it contraindicated in women wishing to conceive in the future?

Dr. Suman Lal · Accepted Answer

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.

Question 11

In cases of infertility, is there any actual management in terms of medication?

Dr. Suman Lal · Accepted Answer

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.

Question 12

Can endometriosis be cured completely, and how can someone with endometriosis get pregnant easily?

Dr. Suman Lal · Accepted Answer

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.

Question 13

What is the best way to treat PCOS?

Dr. Suman Lal · Accepted Answer

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.

Question 14

After a myomectomy there is some adhesion trouble. Is physical therapy the only helpful therapy for reducing those adhesions?

Dr. Suman Lal · Accepted Answer

No. Adhesion formation is a normal surgical risk that varies between patients regardless of physical therapy, medication or diet. What genuinely helps is surgical technique: precisely opposing tissue, avoiding pooled blood inside the abdomen, thorough cleaning of the surgical field, placing a drain when there's more bleeding, and using an anti-adhesive barrier such as omentum or a purpose-made material over the repair site. Proper instrument sterilisation also matters directly, since infection significantly increases adhesion formation.

Question 15

What is the real cause of fibroids?

Dr. Suman Lal · Accepted Answer

It's still not fully known after many years of study. The working theory is that unopposed oestrogen in the body, when the uterus isn't balanced by adequate progesterone, promotes fibroid formation, but the exact mechanism remains unclear.

Benign Growth in Uterus Causing Gynaecological Problems

Questions Doctors Asked Dr. Suman Lal