Fibroid Treatment in Mumbai: When Fibroids Need Treating, and How

Fibroid treatment in Mumbai is provided by Dr. Vaishali Joshi, FRCOG, Senior Consultant Obstetrician & Gynaecologist at Kokilaben Dhirubhai Ambani Hospital, Andheri West, who holds a European University Diploma in Gynaecological Operative Endoscopy. Uterine fibroids are benign muscular growths in the wall of the uterus and are extremely common. Most need no treatment at all — what matters is not whether you have fibroids, but whether they are causing symptoms, where they sit, and what you want for your fertility.

A great many women are told they have fibroids after a scan performed for some entirely unrelated reason, and understandably assume that something must now be done about them. Usually nothing needs to be. Fibroids are benign, they are common, and in the absence of symptoms the correct management is very often observation.

The opposite error is equally common: living for years with periods heavy enough to cause anaemia, or with pressure symptoms affecting daily life, because heavy bleeding has been normalised. Both errors are avoidable with a clear framework, which is what this article sets out.

What are uterine fibroids?

Fibroids — also called leiomyomas or myomas — are non-cancerous growths of the smooth muscle of the uterus. They are hormonally responsive, tending to grow during the reproductive years and to shrink after the menopause. They range from a few millimetres to very large masses, and a woman may have one or many.

Their position matters far more than their number, and often more than their size:

When do fibroids need treatment?

Treatment is indicated by symptoms and by consequences, not by the presence of a fibroid on a report. The recognised reasons to treat are:

• Heavy menstrual bleeding — particularly where it has caused iron-deficiency anaemia, or where it restricts what you can do for several days each month.
• Pressure symptoms — urinary frequency, difficulty emptying the bladder, constipation, or abdominal distension from a large fibroid.
• Pain — including the acute pain of a degenerating fibroid, or the pain of a fibroid on a stalk that has twisted.
• Fertility and pregnancy — where a fibroid distorts the uterine cavity, or where there is recurrent miscarriage attributable to it.
• Rapid growth, and any growth after the menopause, which warrants prompt assessment.

How are fibroids assessed?

Pelvic ultrasound, usually transvaginal, is the first-line investigation and is sufficient in most cases — it establishes number, size and position. Saline infusion sonography or hysteroscopy is used where a submucosal fibroid is suspected, since the relationship to the cavity is what determines the surgical approach. MRI is reserved for large or multiple fibroids where precise mapping is needed to plan surgery, or where the diagnosis is uncertain.

A full blood count is important where bleeding is heavy, because anaemia is common, frequently significant, and worth correcting before any operation.

Non-surgical treatment

Where bleeding is the main problem and the cavity is not distorted, medical treatment is often tried first.

• Tranexamic acid taken during menstruation, and non-steroidal anti-inflammatories, both of which reduce blood loss without hormonal effect.
• The levonorgestrel intrauterine system, which markedly reduces bleeding in suitable women — though it is less reliable where the cavity is distorted by a submucosal fibroid.
• Combined hormonal contraception or progestogens for cycle control.
• GnRH agonists, which shrink fibroids temporarily. Their main role is as a bridge — correcting anaemia and reducing fibroid size before surgery — rather than as long-term treatment, as fibroids regrow when the drug stops.

Uterine artery embolisation, performed by an interventional radiologist, is an alternative for suitable women who wish to avoid surgery. It is generally not the preferred option for a woman planning future pregnancy, and that trade-off should be discussed explicitly.

Laparoscopic myomectomy: removing fibroids, keeping the uterus

Myomectomy removes the fibroids and reconstructs the uterus, leaving it in place. It is the procedure of choice for a woman who wants to preserve fertility, and for any woman who wishes to keep her uterus.

Performed laparoscopically, it offers the established advantages of keyhole surgery: small incisions, magnified visualisation of the operative field, less blood loss, markedly less postoperative pain and a faster return to normal activity than open myomectomy. It is, however, technically demanding surgery — the difficult part is not removing the fibroid but repairing the uterine wall securely in layers, by laparoscopic suturing, so that it will withstand a future pregnancy.

Which approach for which fibroid

• Hysteroscopic myomectomy for submucosal fibroids — performed entirely through the cervix with no abdominal incision at all, usually as a day case.
• Laparoscopic or robotic myomectomy for intramural and subserosal fibroids. Robotic assistance can help with complex suturing in selected cases.
• Open myomectomy, which remains the right choice for very large or very numerous fibroids, where laparoscopic removal would compromise the quality of the uterine repair. Choosing an open operation in those circumstances is good surgical judgement, not a lesser option.

Recovery

After laparoscopic myomectomy, most women stay one to two nights and return to desk-based work in around two weeks, with heavy lifting and strenuous exercise deferred for longer. After open myomectomy the stay and the recovery are both longer. Where pregnancy is planned, an interval is usually advised to allow the uterine repair to heal fully before conception.

Fibroids and fertility

The effect of fibroids on fertility depends almost entirely on position. Submucosal fibroids, which distort the cavity, clearly reduce implantation rates and their removal is generally accepted to improve outcomes. Intramural fibroids that distort the cavity are usually treated on similar reasoning. Small intramural or subserosal fibroids that do not touch the cavity are much less likely to be the reason a woman is not conceiving, and removing them is not automatically helpful.

This distinction matters because myomectomy is not a risk-free procedure. It leaves a scar in the uterine wall, and depending on how deep the repair was, may influence the recommended mode of delivery in a future pregnancy. Operating on a fibroid that was never the problem exposes a woman to that trade-off for no gain. A careful discussion about which fibroid is actually causing what is time well spent.

Hysterectomy

For a woman who has completed her family and whose fibroids are causing significant symptoms, hysterectomy is the definitive solution — it is the only treatment after which fibroids cannot return. It can very often be performed laparoscopically or vaginally rather than by open surgery, with a correspondingly shorter recovery.

It should be a considered choice rather than a default. Many women with symptomatic fibroids have good alternatives, and the decision belongs to the woman once she understands them properly.

Frequently asked questions

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