Fibroid treatment in Chennai

A fibroid (myoma, leiomyoma) is a firm ball of muscle and fibrous tissue that grows in the wall of the uterus. There can be one or many, from the size of a pea to larger than a grapefruit. They grow under the influence of oestrogen, so they appear in the reproductive years and usually shrink after menopause. They are not cancer, and they do not turn into cancer except in very rare cases.

What a fibroid does depends on where it sits, more than on its size. A fibroid that bulges into the cavity of the uterus (submucosal) causes heavy, long periods and can stop an embryo implanting, even when it is small. A fibroid in the wall (intramural) enlarges the uterus and makes periods heavier. A fibroid on the outer surface (subserosal) can grow large without changing periods at all, and shows up as a lump, a feeling of fullness, or pressure on the bladder or bowel.

Many women hear the word fibroid for the first time when a scan done for another reason mentions one. A fibroid that causes no symptoms usually needs nothing beyond a check once a year.

The visit starts with your periods: how many days, how many pads on the heaviest day, clots, and how long this has been going on. Dr. Ragavi asks about pregnancy plans, because they decide the treatment as much as the fibroid does.

An abdominal and pelvic examination, in the separate examination room with the lady attender present, tells her the size of the uterus in weeks, the way an obstetrician measures it. A pelvic ultrasound (transvaginal, or through the tummy if you prefer) then maps each fibroid: number, size in centimetres, and whether it sits in the cavity, the wall or the outer surface. That map is what decides between watching, tablets, and the type of operation.

Blood tests check haemoglobin and iron stores, and thyroid where periods are irregular. An MRI is asked for only before a myomectomy for many fibroids, or where the scan cannot tell a fibroid from an ovarian mass; it is done at a diagnostic centre. A fibroid with an unusual appearance, rapid growth, or bleeding after menopause is investigated for a rare cancer of the uterine muscle (sarcoma) before any treatment.

The choice depends on three things: how much the fibroid troubles you, whether you want children, and how close you are to menopause. Nothing is decided at the first visit if you need time.

Watching, with a yearly scan

For fibroids that cause no symptoms, or mild ones near menopause, a scan once a year and iron tablets if needed are the whole treatment. Fibroids usually shrink once periods stop.

Medicines for heavy bleeding

Tranexamic acid taken only on heavy days cuts blood loss by about a third. Mefenamic acid helps pain and bleeding together. Combined pills, progesterone tablets or a hormonal IUD (a small device placed in the uterus at the clinic) make periods lighter for as long as they are used. They control bleeding but do not remove the fibroid. Iron tablets, or an iron infusion when haemoglobin is very low, rebuild the blood while the cause is treated.

Medicines that shrink fibroids

Hormone injections (GnRH analogues) shrink fibroids by a third to a half within three months and stop periods altogether. They cause menopause-like symptoms and bone loss, so they are used for a few months only: to correct anaemia before an operation, to make a large fibroid small enough for keyhole surgery, or to carry a woman who is close to menopause across the line. Fibroids regrow when the injections stop.

Myomectomy: removing the fibroid, keeping the uterus

This is the operation for women who want to keep their uterus, whether for a future pregnancy or by choice. A fibroid inside the cavity is removed through the vagina with a hysteroscope, with no cut on the tummy. Fibroids in the wall or on the surface are removed by keyhole surgery when their number and size allow, or through a bikini-line cut when they do not; see laparoscopic gynaecological surgery in Chennai. Dr. Ragavi performs all three routes herself. Fibroids can grow again after a myomectomy, more often in women under 35 or with many fibroids, which is why timing it close to a planned pregnancy matters.

Hysterectomy: removing the uterus

For a woman whose family is complete, with a large fibroid or many of them and heavy bleeding that medicines have not controlled, removing the uterus ends the problem for good. The ovaries are usually left in place, so there is no early menopause. The route, vaginal, keyhole or abdominal, depends on the size of the uterus; the hysterectomy (uterus removal) page explains the choice and the recovery.

Other options

Uterine artery embolisation, which blocks the blood supply to fibroids through a thin tube passed in at the groin, is done by an interventional radiologist rather than a gynaecologist. It suits some women who want to avoid an operation and are not planning a pregnancy. Dr. Ragavi discusses it where it fits and refers you for it.

If you have been advised a hysterectomy for fibroids and are unsure, a second opinion from a gynaecologist is a reasonable step. Fibroids are the commonest reason for a hysterectomy, and many women with fibroids have an alternative worth hearing about first.

Consultation, examination, scans, medicines, the hormonal IUD and follow-up happen at RV Clinic Madipakkam or RV Clinic Thalambur, whichever is closer to you. Every operation, whether a hysteroscopic or keyhole myomectomy, an open myomectomy or a hysterectomy, is done by Dr. Ragavi herself at Unittas Multispeciality Hospital, which is 21 km from the Madipakkam clinic and 5 km from the Thalambur clinic. The date is fixed with you at the clinic, and the follow-up visits after the operation are at the clinic. RV Clinic is an outpatient clinic. No operation is done at either clinic address. Thalambur, off OMR, has evening hours.