Fibroid Treatment in Ahmedabad: Keyhole and Medical Options

Fibroids in brief

How common: up to 70% of women have one by the age of 50.
Nature: benign (not cancer)
Main test: pelvic ultrasound
Wait before pregnancy after myomectomy: usually 3–6 months

Fibroids - also called myomas or leiomyomas - are non-cancerous growths of the muscle of the uterus. Most women with fibroids never find out they have them. Finding a fibroid on an ultrasound does not, by itself, mean an operation is needed. What I recommend depends on three things: your symptoms, where exactly the fibroid sits, and whether a pregnancy is in your plans. A small fibroid on the outer wall in a woman with normal periods usually needs nothing more than an occasional scan. A small fibroid pushing into the cavity in a woman who is trying to conceive, on the other hand, may need to come out.

Divine Women's Hospital, where I operate, is NABH-certified.

Fibroid in Uterus: Causes, and Who Is More Likely to Get Them

Each fibroid starts from a single muscle cell in the uterus that keeps dividing. Fibroids depend on the hormones oestrogen and progesterone: they commonly appear in the 30s and 40s, can enlarge during pregnancy, and usually shrink after menopause.

You are more likely to have fibroids with:

Increasing age, up to menopause.
A family history of fibroids.
An early first period
Obesity
Never having had children

Low vitamin D, which is very common in India, has also been linked with fibroids.

Fibroid in Uterus: Symptoms Women Bring to Me

Heavy or long periods, with clots and flooding.
Anaemia - tiredness, breathlessness, hair fall, dizziness.
Pelvic pain, or period pain that has become worse.
Pressure on the bladder - passing urine often and waking at night to do so.
Pressure on the bowel - constipation or a dull backache.
A firm swelling low in the abdomen, or a waistband that has become tight.
Pain during intercourse with some fibroids.
Difficulty conceiving or repeated miscarriage, mainly when a fibroid distorts the cavity.

Fibroid Position and Why It Changes My Advice

Fibroids are numbered 0–8 in the FIGO system. In practice, three groups shape most of my decisions, plus a small fourth group.

Group (FIGO type)	Where it sits	Problems it tends to cause	Usual way of removing it, if needed
Submucosal (0–2)	Bulges into the cavity of the uterus	Heavy bleeding even when small; can affect fertility and miscarriage risk	Hysteroscopic myomectomy, through the cervix
Intramural (3–4)	Within the muscle wall	Heavy periods, pain, bulk; large ones may affect fertility	Laparoscopic myomectomy; open myomectomy, by referral, if very large or numerous
Subserosal (5–7)	Grows outwards, sometimes on a stalk	Pressure on bladder or bowel; seldom heavy bleeding	Laparoscopic myomectomy
Cervical and other (8)	In the cervix or outside the body of the uterus	Pressure, difficulty passing urine	Planned case by case - laparoscopic where suitable, otherwise referral for open surgery

How I Map and Assess a Fibroid

Pelvic ultrasound (transvaginal where you are sexually active) shows how many fibroids there are, their size and exactly where they lie. It also lets me check the ovaries and the lining.
3D ultrasound or saline sonography shows how far a fibroid projects into the cavity.
MRI is used when fibroids are large or numerous, or when surgery needs complex planning.
Haemoglobin and iron studies - anaemia must be corrected before any operation.
Thyroid tests and a check of the lining are added when the bleeding pattern suggests another cause, especially after 40.

Adenomyosis - where the lining grows into the muscle wall - can look like fibroids. Unlike a fibroid, it cannot be shelled out, so telling the two apart changes the plan. Some women have both.

Uterine Fibroids Treatment in Ahmedabad: The Options I Discuss

My aim is the least invasive treatment that will work, while protecting your fertility if that matters to you.

Watchful waiting: a scan every 6–12 months for fibroids that cause no symptoms.
Non-hormonal tablets during periods: tranexamic acid, which can reduce bleeding by up to about half, and anti-inflammatory tablets for pain.
Hormonal options: the levonorgestrel IUS (hormonal IUD) or the combined pill, when the cavity is not distorted.
GnRH-analogue injections for 3–6 months, to shrink fibroids and correct anaemia before surgery or to bridge the time to menopause. They are used only for a limited period because they thin the bones.
Iron tablets or an iron infusion, together with any of the above.
Hysteroscopic myomectomy for submucosal fibroids, usually as day care.
Laparoscopic myomectomy for intramural and subserosal fibroids, keeping the uterus.
Open myomectomy - sometimes needed for very large or very many fibroids. I do not perform open surgery, so for this I refer you to a surgeon who operates that way.
Laparoscopic hysterectomy, when your family is complete and other treatments have not worked.
Uterine artery embolisation - for selected women who wish to avoid surgery, I refer to an interventional radiologist.

Fibroid Treatment Without Surgery: What Medicines and Embolisation Can Do

Many women with fibroids never need a procedure, because medicines can control the symptoms. Strictly speaking, though, a fibroid cannot be removed without one. Medicines treat the symptoms rather than the fibroid itself. Tranexamic acid and anti-inflammatory tablets reduce bleeding and pain on the heavy days. A hormonal IUD or the combined pill can control periods when the cavity is not distorted. GnRH-analogue injections shrink fibroids for a few months. This helps to correct anaemia or to bridge the years to menopause, but the fibroids grow back once the injections stop.

Uterine artery embolisation blocks the blood supply to the fibroids so that they shrink, without an abdominal cut. It is done by an interventional radiologist, to whom I refer selected women. If a fibroid sits inside the cavity, hysteroscopic removal through the cervix needs no cut at all.

Laparoscopic Myomectomy: Fibroid Removal Through Laparoscopy

In a laparoscopic myomectomy I shell the fibroids out through small openings, close the wall of the uterus in layers, and bring the tissue out in pieces. The operation usually takes 2–3 hours, and most women stay in hospital for 1–2 days.

Risks: bleeding (sometimes needing a transfusion), infection, adhesions, and a small chance that the operation cannot be completed by keyhole and has to be changed to open surgery.
Keeping blood loss down: I correct anaemia beforehand, sometimes give GnRH injections first, and use medicines during surgery that narrow the blood vessels.
Rare cancer: very occasionally a fibroid turns out to be an unsuspected leiomyosarcoma. I review the scans before surgery, and every specimen goes to the laboratory.
New fibroids later: a myomectomy removes the fibroids you have, not the tendency to form them. New fibroids appear within 5 years in a sizeable proportion of women, although only a minority need treatment again.

No single size automatically means a fibroid must come out - the decision rests on your symptoms, the fibroid's position and your pregnancy plans.

Fibroid in Uterus: Pregnancy, Conceiving and Delivery

Many women with fibroids conceive and have their babies without any difficulty.
Submucosal fibroids that distort the cavity have the clearest link with trouble conceiving and with miscarriage; removing them hysteroscopically can improve the chances.
Large intramural fibroids may also play a part - whether to remove them is an individual decision.
Once a laparoscopic myomectomy has healed, a gap of about 3–6 months before trying to conceive is what I usually suggest.
The risk of the scar on the uterus giving way in a later pregnancy is low, generally well under 1 in 100. If the fibroid was deep or the cavity was opened, I may advise a planned caesarean.
In early pregnancy a fibroid can undergo "red degeneration", which causes pain. Rest and pain relief usually settle it within a few days.
A large or low-lying fibroid can affect the baby's position or how the baby is delivered; I keep track of this on growth scans.

How I Look After Women with Fibroids at Divine Women's Hospital

I go through your symptoms and scans and explain, in Gujarati, Hindi or English, whether you need treatment at all.
I set out the options side by side - what each offers, its risks and its recovery time - and the decision is yours.
I perform hysteroscopic myomectomy, laparoscopic myomectomy and laparoscopic hysterectomy at Divine Women's Hospital, Gota; I do not perform open surgery.
The hospital's labour and emergency service runs 24×7. If you conceive after a myomectomy, I can look after the pregnancy at the same hospital.

Fibroid Removal Surgery Cost: What Shapes the Estimate

The cost of fibroid treatment depends first on whether you need surgery at all - monitoring and tablets cost far less than any operation. If removal is advised, the estimate depends on the points below.

The type of operation - a hysteroscopic myomectomy is usually day care, while a laparoscopic myomectomy takes about 2–3 hours and a 1–2 day stay.
How many fibroids there are and how large - more and bigger fibroids mean a longer operation.
Preparation - GnRH injections or iron treatment beforehand, and an MRI when planning is complex.
Anaesthesia, theatre and the tissue report sent from every operation.

Once the plan is agreed, Divine Women's Hospital can tell you its current charges for it.

Fibroid Care with Me, Stage by Stage

Consultationyour symptoms, period pattern, plans for pregnancy and haemoglobin level.
Mapping the fibroidsultrasound, adding a 3D scan or MRI where needed.
Choosing a treatmentthe options compared, with their benefits and risks.
Preparation and treatmentanaemia corrected first; if surgery is chosen, you know the likely hospital stay and recovery time in advance.
Follow-upthe tissue report and your recovery, with advice on future scans and when to plan a pregnancy.

When to Have Your Fibroids Looked At

You soak a pad every 1–2 hours, or your periods last more than 7 days.
You feel tired or breathless and your haemoglobin is low.
You have pelvic pressure, a lump in the abdomen, or you are passing urine more often.
A fibroid has been found on a scan and you are planning a pregnancy.
You have had difficulty conceiving, or more than one miscarriage, and have a known fibroid.
You have been advised a hysterectomy and would like to explore options that keep the uterus.

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Fibroid Symptoms That Need Same-Day Care

Soaking a pad every hour for two hours or more, or feeling faint.
Sudden severe pelvic pain with fever - a fibroid may be degenerating, or a fibroid on a stalk may have twisted.
Being unable to pass urine.
Severe abdominal pain in pregnancy when you know you have a fibroid.
A known fibroid growing quickly, or any bleeding after menopause.

With any of these, ring Divine Women's Hospital and make your way to its emergency unit, which is staffed through the day and night.

What People Believe About Fibroids - and the Facts

Belief: Every fibroid has to be operated on.

Most need only monitoring. Treatment is for symptoms, fertility concerns or marked growth.

Belief: Fibroids turn into cancer.

Fibroids are benign. A leiomyosarcoma is rare and can look like a fibroid, which is why unusual scan features or growth after menopause are investigated.

Belief: Having fibroids means losing the uterus.

Medicines, hysteroscopic removal and myomectomy all keep the uterus. Hysterectomy is one choice among several, usually once a family is complete.

Belief: Certain foods cause fibroids.

No food causes them; genes and hormones are the main drivers. A healthy weight and adequate vitamin D may help.

Questions Patients Ask Me About Fibroids

Can fibroids be managed without an operation?

Often, yes. Fibroids that cause no symptoms can simply be monitored, and heavy bleeding can be treated with tablets or a hormonal IUD. Surgery is for symptoms that do not settle, fibroids that affect fertility, or a large fibroid that is growing.

At what size does a fibroid need surgery?

There is no single cut-off. A 2 cm fibroid inside the cavity can cause real problems, while a 6 cm fibroid on the outside may cause none. It depends on your symptoms, the fibroid's position and your pregnancy plans.

Is there a risk that a fibroid becomes cancer?

Fibroids are benign. Leiomyosarcoma is very rare and is thought to arise separately rather than from an ordinary fibroid. A fibroid that grows after menopause, or looks unusual on a scan, is investigated.

Can tablets or injections make fibroids disappear?

No medicine gets rid of fibroids permanently. GnRH injections can shrink them by roughly a third to a half over three months, but they grow back once the injections stop.

Is pregnancy possible if I have fibroids?

Many women with fibroids do become pregnant. Fibroids inside the cavity have the most effect on conceiving and on miscarriage, so the position of your fibroids should be checked before fertility treatment.

After a myomectomy, is a normal delivery still possible?

Sometimes. If the fibroids removed were small and near the surface, a vaginal birth may be possible. If they were deep, or the cavity was opened, a planned caesarean is usually advised.

Will fibroids grow back after they are removed?

A myomectomy does not take away the tendency to form new fibroids, though many women never need further treatment. Once the uterus is removed (hysterectomy), new fibroids cannot form.

Do fibroids get smaller after menopause?

Yes. Because fibroids need oestrogen to grow, they usually shrink after menopause and symptoms often settle. A woman close to menopause whose symptoms are manageable may choose to wait.

How long does recovery take after a laparoscopic myomectomy?

Most women go home in 1–2 days and return to desk work in about 2–3 weeks. Full activity takes 4–6 weeks, depending on how many fibroids were removed and how large they were.