Wednesday, August 09, 2006

Uterine fibromyoma (Fibroid)

It is commonly known as fibroid but the correct terminology should be fibromyoma or myoma .As it develops from the muscular layer of the uterus. The fibroid is an admixture of muscle tissue and fibrous tissue. It is benign in nature.


Heredity as it runs in families heredity can be one of the causes for the formation of fibroid.
It can also occur during the reproductive period due to increased blood supply to the uterus.
It also depends on the hormone estrogen for its growth.
The associated factors along with fibroid are endometrial hyperplasia and infertility.

IncidenceThis is the commonest type of neoplasm in a women.Negroes get fibroid 3 times more then the whites.

Location of the fibroids
In order to understand the location of the fibroid in the uterus let us understand the structure of the uterus in brief. It is a internal genital organ also known as the womb.
It is situated in the center of the pelvic cavity.

Parts of the uterus
It is divisible in two parts by the slight constriction at the level of the internal os.

a) Corpus or Body: The corpus is further divided into fundus the part which lies above the openings of the uterine tubes (Where the fallopian tubes are attached refer the diagram).The body proper is triangular and lies between the opening of the fallopian tubes and the isthmus.

b) Isthmus: it is the constricted part which measures about 0.5 cm and is situated between the body and the cervix.

c) Cervix: it is the lower most part of the uterus which is almost cylindrical in shape and a part of it is incorporated within the vagina. It is divided in to the supravaginal part which lies above the vagina and the vaginal part which lies within the vagina.The vaginal portion is also known as portio vaginalis .There is an opening at the lower end of the portio vaginalis which is known as the external os.

In women who have not given birth the vaginal part of the cervix is conical in shape and the external os looks circular. In women who have given birth to a child it is cylindrical in shape and the external os has bilateral slits which is caused due to the tear of the circular muscles surrounding the external os during child birth and it gives rise to anterior and posterior lip of the cervix.
Cavity: If the cavity of the uterus is studied in sections; in the saggital section the cavity of the corpus is narrow slit but on coronal section it is triangular in shape and the uppermost part is called the base this communicates into the lumen of the fallopian tubes on either sides.

The cervical canal is spindle shaped which opens above in the uterine cavity through the internal os and below into the vagina through the external os. The length of the uterine cavity from the external os to the fundus is about 6.5 cm of which 2.5cm is the length of the cervical canal.

d) The Fallopian tubesEither of a pair of tubes extending from the uterus to the paired ovaries in the human female also called oviducts, technically known as the uterine tube. At one end the long, slender fallopian tube opens into the uterus; the other end expands into a funnel shape near the ovary. The epithelium that lines the tube is covered with cilia that beat continuously toward the uterus

The Fibroid of the uterus maybe present in the Body of the uterus that is known as Corporeal this is the commonest type. The other type is found in the cervix of the uterus.

Interstitial ( Intramural) :
It grows in the substance of the uterine wall and may remain as such in especially when they are small or maybe sub mucus or subserous.The posterior wall of the uterus is the commonest site for the development of the fibroid.

Subserous (Sub peritoneal): The fibroid lies underneath the peritoneum (Peritoneum is the serous membrane that lines the abdominal and uterine cavity) and it can be sessile or pedunculated.If it grows between the layers of the broad ligament of the uterus then it develops ligamentory fibroids.

Submucous: mostly it is a single fibroid which grows beneath the mucous membranes of the uterus and projects itself in the uterine cavity. It maybe sessile or pedunculated in character. Due to the expulsive force of the uterus the sessile growth can change its character. The following things can happen to a sub mucus fibroid.

a) Formation of sub mucus fibroid polypus
b) It can become infected with pus formation and erosion of the same.
c) This is the commonest variety which can undergo malignant changes
d) It may rarely cause inversion of the uterus due to the expulsive force of the uterus.

Clinical features of corporeal fibromyoma

Occurrence: Uterine fibroid arises during the menarche (beginning of the menses) till menopause. During the age of 35-45 fibroids are more evident. After menopause the fibroids shrink and never develops freshly this occurs due to the hormonal changes that take place in the body after menopause. Sometimes the menopause can be delayed due to the fibroids

Most of the women suffering from fibroid are symptomless.The following symptoms can be seen in some of the patients.

Menorrhagia: excessive bleeding during the menstrual cycle this is the commonest symptom which often becomes a regular feature with passage of clots.

Metorrhagia: irregular bleeding is a feature of submucous fibroid with ulceration or rarely endometrial carcinoma.

Dysmenorrhoea: Pain in the abdomen and lower back can also be noticed. The pain is unbearable in nature.

Leucorrhea: This is the white discharge and it occurs particularly if there is a fibroid polyp.
Abdominal lump the woman comes with the complaint that she feels a lump in the abdomen. The lump has to be big enough which corresponds to 14 weeks of pregnancy to be palpable.
Infertility about 30 % of the females can suffer from infertility due to uterine fibroids.
Pressure symptoms like frequency of urination or urgency to urinate as a result of the pressure of the fibroid on the bladder.

Anemia: it can develop due to the excessive bleeding but it is a gradual process. The patient may suffer from palpitation and weakness.

Pain this is a rare symptoms .pain can develop due to the following reasons.
a) If a fibroid polyp is being expulsed
b) Inflammation
c) Derangement of the blood supply to the fibroid.
d) Twisting of the Subserous fibroid

SignsWhen there is excessive bleeding anemia can be present

On examination of the abdomen there is a feeling of a lump. The surface of the lump maybe smooth .There is dullness on percussion of the area.(A type of Physical examination).
Bimanual examination confirms that the uterus is enlarged in size. Then the uterine fibroid is carefully assessed for red degeneration, infection and rarely for sarcoma.

USG-Abdomen and pelvis
Urinary pregnancy test
Complete blood count
Erythrocyte sedimentation rate (E.S.R)
Laparoscopy and Laprotomy.


Homeopathic treatment: After complete case study the patient is put on the constitutional treatment. This should take care of the problem. The patient is kept under observation and is checked every 6 months for the progress in the treatment

Conservative treatmentIf the bleeding is excessive and the patient is in a bad state then blood transfusion will be helpful. Treatment of the anemia.

Cervical fibromyomaThese are not the common type of fibroids .They contribute 1-2 % of all types of the uterine fibroids.

LocationIt can be located at the portio vaginalis (Please refer to the image) and it can project in the vagina and become polypoidal.

At the supravaginal cervix the fibroid can be situated in the following positions
Anteriorly it pushes the urinary bladder up

Posterior it obliterated the pouch of Douglas and can cause pressure on the rectum.
Lateral in the broad ligament due to this the ureter is pushed laterally but it remains below the fibroid.

Central it causes expansion of the cervix from all the sides.

SymptomsIt doesn’t cause any menstrual disorder but it causes pressure symptoms like frequency of urination, defecation on straining, Constipation.It can also cause problems during child birth.

SignsOn examination of the abdomen the uterus and its parts are felt separate being situated on the top of a firm pelvis mass.

Examination through vagina (Per vaginum)The cervix of the uterus is felt expanded due to the filling up by the tumor. A mass can be felt which is fixed to the cervix which is pushed high up behind the symphysis pubis.
The feature of the mass is its firmness, fixity, pelvic position and the attachment to the cervix. The body of the uterus is felt separate from the mass.Examination through the rectum under anesthesia and sounding the cervical canal are essential steps for diagnosis.

InvestigationsUrine analysis
Urine culture to know the infection
Renal function tests

TreatmentHomeopathy as discussed above
The above article is written by Dr.Santosh Joshi.He practices Classical Homeopathy in Mumbai India.
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