Fibroids and Uterine Conditions in Jaipur

What fibroids and adenomyosis are and how they develop

Uterine fibroids are benign growths that arise from the muscle layer of the uterus. They are the most common pelvic tumours in women of reproductive age. Fibroids contain smooth muscle, fibroblast cells and a large amount of fibrous extracellular matrix that gives them a firm structure.

They vary widely in size, number and position; some women have a single small nodule while others have many large ones.

Adenomyosis is a different condition where the inner lining of the uterus grows into the muscle wall. This makes the uterus thicker and often tender. Both conditions are driven by the hormones oestrogen and progesterone, which stimulate growth of the muscle and the surrounding matrix.

Genetic changes in the MED12 gene are found in the majority of fibroids and appear to be an early step in their formation. Other, less common genetic alterations involve HMGA2, the COL4A5-COL4A6 region and the FH gene. The extracellular matrix acts as a reservoir for growth factors such as TGF‑β and activin‑A, which keep the fibrotic process active. Because fibroids are hormone‑dependent, they often shrink after menopause when hormone levels fall.

Symptoms of fibroids and adenomyosis and when to seek urgent care

Many women with fibroids have no symptoms at all.

When symptoms occur, they can include:

• Heavy or prolonged menstrual bleeding
• Irregular vaginal bleeding
• Pelvic pain or a feeling of pressure
• Lower back pain
• Frequent urination
• Constipation
• Difficulty becoming pregnant

Adenomyosis typically causes heavy, painful periods and a bulky, tender uterus.

Contact your doctor or attend the emergency department on the same day if you experience:

• Very heavy bleeding that soaks a pad in an hour or less
• Sudden, severe abdominal or pelvic pain that does not settle with simple pain relief
• Fever with pelvic pain
• Dizziness, fainting or shortness of breath suggesting significant blood loss

These signs may indicate severe anaemia, a twisted fibroid, infection or another complication that needs immediate assessment.

Causes and factors that raise the risk of fibroids

The exact cause of each fibroid is not fully known, but several factors increase the likelihood of developing them. Age and being premenopausal are strong risk factors because fibroids grow under the influence of ovarian hormones. A family history of fibroids raises risk.

Higher body weight, increased body mass index, greater waist‑to‑hip ratio and body fat above 30% are all associated with higher risk. Visceral fat in the abdomen adds further risk. Hypertension and raised diastolic blood pressure are linked to a several‑fold increase in risk. Women who have never given birth (nulliparous) are more commonly affected, and each subsequent birth tends to lower risk.

Dietary patterns matter: higher intake of green vegetables, fruit and fish is associated with lower risk, while diets rich in citrus fruits show a marked protective effect. Consumption of food additives and soybean milk has been linked to higher risk. Oral contraceptive use before adulthood may increase later risk, whereas use after adolescence appears protective.

Vitamin D deficiency is common in women with fibroids, and very high serum vitamin E has been noted as a possible risk factor in some groups. Black women have a two‑ to three‑fold higher incidence compared with white women. Overall, lifetime prevalence ranges widely from about 4.5% to 68.6% depending on the population studied.

How fibroids and adenomyosis are diagnosed

Diagnosis begins with a detailed history of your periods, pain, pressure symptoms and fertility plans. A pelvic examination allows the doctor to feel the size and shape of the uterus; an enlarged, irregular or tender uterus suggests fibroids or adenomyosis.

The main imaging test is a pelvic ultrasound, performed either on the abdomen or through the vagina, which shows the number, size and location of fibroids and the thickness of the uterine wall in adenomyosis. In some cases an MRI is advised to map the fibroids more precisely before planning treatment.

Blood tests are done to check for anaemia from heavy bleeding and to assess general health before any procedure. An endometrial biopsy may be taken if there is unusual bleeding, to rule out other causes; in studies such biopsies have shown benign histology.

Non‑surgical treatment options and when surgery is considered

If fibroids are small and not causing troublesome symptoms, watchful waiting with regular follow‑up is often appropriate. Medical treatments aim to control bleeding and shrink fibroids temporarily. Gonadotropin‑releasing hormone (GnRH) agonists such as leuprolide acetate and GnRH antagonists such as cetrorelix acetate lower hormone levels and reduce fibroid size.

Selective progesterone receptor modulators like ulipristal acetate and asoprisnil, and the antiprogestin mifepristone, have been studied for bleeding control and volume reduction. In clinical trials, ulipristal acetate controlled uterine bleeding in about 90‑98% of women and reduced median fibroid volume by roughly 45% after one three‑month course, with further reduction after repeated courses.

Hot flashes were less frequent with ulipristal acetate than with leuprolide acetate. Vitamin D and natural compounds such as resveratrol have also been investigated.

Non‑surgical interventional options include uterine artery embolisation, where tiny particles are injected through a catheter to block the blood supply to the fibroids, causing them to shrink. Radiofrequency ablation is another minimally invasive technique.

Surgery is considered when symptoms are severe, medical therapy has not helped or is not suitable, or when fibroids are thought to be affecting fertility. The main surgical options are myomectomy (removing fibroids while keeping the uterus) and hysterectomy (removing the uterus). Myomectomy is generally advised for women who wish to preserve fertility.

The type of myomectomy — open, laparoscopic or hysteroscopic — depends on the size, number and location of the fibroids. Hysterectomy is an option for women who have completed their families and have severe symptoms. Approximately three‑quarters of all fibroid treatments in some settings are hysterectomies.

Your surgeon will discuss which approach fits your situation, the expected hospital stay of one to three nights, and a typical recovery of two to six weeks. New fibroids can develop after myomectomy, especially in women under 40 with many fibroids.

Preparing for fibroid and uterine condition surgery

Before your operation, your surgeon will ask for a few routine tests.

These usually include:

• Blood counts
• Blood group
• Kidney and liver function
• A test for infections

A chest X-ray and an ECG are common if you are over 40 or have other health problems. An ultrasound or MRI done earlier helps the surgical team plan the procedure.

Tell your surgeon about every medicine you take, including those from a chemist without a prescription, and any supplements. Blood thinners, aspirin, and some painkillers may need to be stopped a few days before surgery. Your surgeon will give you a clear list.

You will be asked not to eat or drink anything for about six hours before the operation. This is because general or spinal anaesthesia is used.

Pack a small bag for a stay of one to three nights. Bring comfortable loose clothes, your regular medicines in their original packets, sanitary pads, and any aids you use such as glasses or a walking stick. An attendant can stay with you in the room.

How fibroid and uterine condition surgery is done

Your surgeon will advise which technique suits you based on the size, number, and location of the fibroids, and whether you wish to keep your uterus. The main options are:

• Laparoscopic myomectomy: The fibroids are removed through small cuts in the abdomen while the uterus is kept. This is often chosen when you want to preserve fertility.
• Hysteroscopic myomectomy: A thin instrument is passed through the vagina and cervix to remove fibroids that bulge into the uterine cavity. No cuts are made on the abdomen.
• Laparoscopic hysterectomy: The uterus is removed through small abdominal cuts. This is considered when the family is complete and symptoms are severe.
• Uterine artery embolisation: An interventional radiologist blocks the blood supply to the fibroids through a tiny puncture in the groin, causing them to shrink.

On the day of surgery, you will be taken to the modular operation theatre. The anaesthetist will give general or spinal anaesthesia. The operation usually takes one to three hours. After the procedure, you will spend some time in the recovery area before moving to your room.

Risks and possible complications of fibroid surgery

All operations carry some risk. In studies, possible complications of myomectomy include infection, bleeding, injury to nearby organs such as the bladder or bowel, and internal scarring called adhesions.

Medical treatments used to shrink fibroids before surgery can cause side effects. In one trial, moderate to severe hot flashes occurred in about 11 percent of women taking 5 mg of ulipristal acetate, 10 percent of those taking 10 mg, and 40 percent of those taking leuprolide acetate.

After surgery, contact the hospital if you develop a fever, severe abdominal pain that is not relieved by the prescribed painkillers, or heavy vaginal bleeding. Your surgical team will discuss the risks that apply to your specific case before you sign the consent form.

Recovery and aftercare after fibroid surgery

Recovery time depends on the type of operation. After an open abdominal myomectomy, full recovery before returning to normal activities can take up to six weeks. After a laparoscopic myomectomy, you may go home the same day or the next day, and recovery at home is about two to four weeks.

If the procedure is done hysteroscopically through the vagina without cuts, full recovery can be just a matter of days.

In the first few days, you will need help at home for cooking, cleaning, and looking after children. Arrange for someone to stay with you for the first one to three days. You will be given pain relief tablets and advised on wound care if you have abdominal cuts. Vaginal spotting or light bleeding is common for a few weeks.

Avoid heavy lifting, strenuous exercise, and sexual intercourse for about four to six weeks, or as your surgeon advises. Most people return to desk work in two to three weeks after keyhole surgery, and four to six weeks after open surgery. Your surgeon will see you for a follow-up visit, usually two to three weeks after discharge.

Call the hospital or visit the 24×7 emergency department if you have a fever above 38°C, increasing pain, heavy bleeding that soaks a pad in an hour, foul-smelling discharge, or difficulty passing urine.

Results of fibroid surgery: symptom relief and recurrence

In studies, most people experience lighter and more regular periods after myomectomy. Medical treatment with ulipristal acetate controlled uterine bleeding in 90 to 98 percent of women in a clinical trial. The same trial showed median fibroid volume shrank by about 45 percent after one three-month course, and by 63 to 72 percent after repeated courses.

However, new fibroids can grow after myomectomy. Younger women under 40 who had many fibroids are at greater risk of developing more fibroids later. Approximately three-quarters of all fibroid treatments in large populations are hysterectomies, which removes the uterus completely and prevents recurrence.

Your surgeon will discuss the likelihood of long-term relief based on your age, the number of fibroids, and the procedure chosen.

Cost and insurance for fibroid surgery in Jaipur

The typical price range for fibroid surgery in India is ₹50,000 to ₹2,00,000. The final cost depends on the type of operation, the complexity of your case, the length of stay, and the room category you choose.

For reference, average costs reported in India are around ₹65,000 for hysteroscopic myomectomy, ₹75,000 for open myomectomy, ₹85,000 for laparoscopic myomectomy, ₹95,000 for total laparoscopic hysterectomy with fibroids, and ₹1,50,000 for robotic myomectomy.

Jaipur Hospital is a NABH-accredited multispeciality hospital.

We accept patients under:

• RGHS
• MAA Yojana
• CGHS
• A panel of private insurers and TPAs

If you are covered under one of these schemes, bring your card and any pre-authorisation letter. The hospital's insurance desk can help with the paperwork. For self-pay patients, a deposit is taken at admission and the final bill is settled at discharge. Ask us for an estimate based on your planned procedure.