What is the treatment for submucosal fibroid?
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have had submucosal fibroid for over ten years. Now for the past three months, I have been facing irregular bleeding. My urine does not flow in a straight line when the volume is less. Also, I have a small cyst in the clitoris, which creates occasional itching once or twice a month. I have had this cyst for almost 12 years.
Please help.
Hi,
Welcome to icliniq.com.
For submucosal fibroid, you can opt for hysteroscopic removal or arterial embolization, or MRI (magnetic resonance imaging) guided focused ultrasound therapy. Because at 30 years, I do not think you would like to go for open surgery. Urine may not come out in a straight line if the volume is less and the force is low. But, if you think it is a worrying problem, you can go for a simple procedure called cystoscopy. Regarding the cyst on the clitoris, no comment can be made without looking at it. For occasional itching, you can apply any simple cream. Do not wash with medicated lotion or harsh soaps. Wash only with bathing soap.
I hope this helps.
Take care.
Patient's Query
Hi doctor,
Will they cut uterus in the open surgery? Please explain the procedure. Can cyst in clitoris cause pregnancy problem?
Please answer.
Hi,
Welcome back to icliniq.com.
In open surgery, your tummy is opened, and the uterus is cut through to remove the fibroid. If you are trying for pregnancy, then it is not suitable for you. Cysts on the clitoris will never cause problems in getting pregnant or even during pregnancy. So, just relax.
I hope this was helpful.
Patient's Query
Hi doctor,
Regarding my irregular bleeding and submucosal fibroid, I have consulted two doctors. The doctor whom I contacted first gave me Duphaston to regularize my period and told me to go for laparoscopic ovarian drilling for PCOS and diagnostic hysteroscopy to check out the portion of the fibroid indenting into the endometrial cavity and said that he would do only resection of that part. Since my family is against surgery, we contacted another doctor who did a second TVS to find out that only 20 x 21 mm was projecting into the endometrium. He put me on Novelon for 21 days and told me to repeat the blood test. He is not willing to do surgery right now. If the doctor resects only part of the fibroid, can the remaining part easily grow during pregnancy? Novelon is actually a birth control pill. So, once I come out of it, how long will it take to conceive? Also, can this birth control pill grow the fibroid? Which doctor's prescription to follow? I am 30 already and have crossed advanced maternal age. Will I be able to conceive in the future if I rectify the defects?
Please answer.
Hi,
Welcome to icliniq.com.
I have read and understood your problem.
Yes, any residual fibroid can grow during pregnancy. Yes, hormones in Novelon (Desogestrel and Ethinylestradiol) may increase the size of the fibroid. You can conceive any time after one to two months of stopping pills. PCOS (polycystic ovarian syndrome) can be treated with medicines without going for laparoscopic ovarian drilling. Up to the age of 35 chance of pregnancy is good, but it suddenly drops after that. You are already 31, so you should not delay things anymore; the earlier, the better.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you for your reply.
My 0.7 inch fibroid is mostly intramural with 20 mm endometrium encroachment. What kind of surgery can get the entire fibroid out keeping the uterus intact? Even if I conceive after surgery should I take bed rest throughout pregnancy? Should I take Novelon for 21 days and then do a blood test for prolactin, AMH and LH as prescribed?
Please suggest.
Hi,
Welcome back to icliniq.com.
Complete removal of intramural fibroid laparoscopic myomectomy is a better choice and if it becomes impossible then it can easily be converted to abdominal myomectomy keeping uterus intact and preserving fertility. You may not need bed rest if you have no problem during pregnancy. But, you will have to avoid travel and exertion.
Remember that successful pregnancy and childbirth can occur without any complications in presence of fibroid. But, it cannot be predicted. Taking Novelon for only 21 days does not make any sense, because it is not going to help you in fibroid problem. For PCOS, it must be taken at least three cycles. Also doing blood test for prolactin, AMH (anti-mullerian hormone) and LH (luteinizing hormone) are not relevant for fibroid and are needed if you have very infrequent periods. Also you should do the test before taking Novelon (oral contraceptive pill) and not after taking it, because hormones in Novelon may affect the test results.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you for your reply.
I have taken Novelon tablets for nine days totally in the wrong order. Today I realized it. Now what shall I do? Will this mistake affect my health? Should I start taking the correct order now? Will it affect my periods? Can a 0.7 inch intramural fibroid get removed by laparoscopy? Does the scar tissue cause uterine rupture or ectopic pregnancy later?
Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
I have read the query and understood your problem.
All the tablets have the same composition; the order is there only to remind you. So, you take the remaining tablets, one tablet daily at a fixed time. It will not affect your health or your periods. Laparoscopy is good for sub-serous (on the surface) fibroids. But, a good laparoscopist can remove an intramural as it depends on skill. But, the scar is usually small and usually does not cause uterine rupture or ectopic pregnancy later. You can try MRI-guided focused ultrasound therapy or hysteroscopy.
Thanks and best wishes.
Patient's Query
Hi doctor,
Thank you for your reply.
I took Novelon for 21 days after my last periods. But, till date I did not get the period for this month. Only having some brownish mucus that too scanty amount since last 2 days. Is there any underlying problem? I did not have any intercourse over the last month. Can the scar tissue after myomectomy cause uterine rupture or septicemia later?
Please give your answers.
Hi,
Welcome back to icliniq.com.
You wait for one more week. Most probably you will get clear periods by then. There does not seem to be an underlying issue. Chance of septicemia or scar rupture is very rare after myomectomy.
I hope this helps.
Patient's Query
Hi doctor,
Thank you for your reply.
After taking Novelon for 21 days I had some brown discharge like fake periods for 4 days. Now I am not on Novelon. Again after a week I started releasing brown discharge with mild cramping. The blood is brown and very thick and does not contain the foul smell like menstrual fluid. The bleeding is moderate. Is the bleeding due to fibroids or stopping birth control pill? Can the bleeding be due to endometrial or cervical cancer?
Please help.
Hi,
Welcome back to icliniq.com.
The brown thick blood is usually not fresh blood but some old blood clot which was retained and came out after being liquefied. This is very common and not related to any major problem. The brown bleeding was from a part of bleeding that was not cleared after stopping of pills and does not seem to be due to any cancer. In your several interactions you seem to be worried about cervical cancer. Do you have a family history of cancer? Still I advise, if you are so much obsessed with cancer then you can go for a cervical cytology and relax.
Take care.
Patient's Query
Thanks doctor,
Usually how long will this brown bleeding stay? Is this an alarming feature? The brown blood does not contain the foul smell of menstrual blood but it is producing mild menstrual like cramping. I do not have any family history of cancer.
Thank you.
Hi,
Welcome back to icliniq.com.
This should stop in some five to six days. Mild cramp can occur. As you have no family history of cancer, do not worry about it.
I hope this helps.
Patient's Query
Hi doctor,
Thank you for your reply.
I had spotting only for three days. I had blood test and PCR test on the third day of menses. Prolactin came down normal and PCR test was negative. Doctor again prescribed me Glyciphage SR 500, Normoz tablet two times a day to be continued for 90 days and to take Cifran 500 from day 2 to day 11 of menses and advised to do HSG test on day 6 of the cycle. Doctor does not wish to operate for tumor as according to him the size is small. Now I got periods. On the basis of these facts I have the following questions. I wish to get conceive immediately. Doctor is treating me for PCOS even though I am having periods on time, but not doing anything for fibroid. Is this approach correct? Is HSG test painful and will I be able to resume normal activities after test? The volume of the blood in menses has decreased from last two periods but span is still the same. Is it alarming? If I am diagnosed with tubal blockage then is IVF the only option for me? Can HSG test give a correct position of the fibroid in the uterus than TVS ultrasound?
Kindly share your opinion.
Hi,
Welcome back to icliniq.com.
Yes you need to be treated with these medicines as they help conception. PCOS needs to be treated, even if period is regular, as I mentioned earlier fibroid cannot be treated with medicines but the size is less so it does not matter for pregnancy. Only some discomfort will be present after HSG (hysterosalpingogram), you can resume activity after 30 minutes and can take pain killer like Paracetamol one hour before test. Depends on the HSG report tubes can be opened in some cases by a HSG like procedure called hydrotubation. No, for position of fibroid TVS (transvaginal scan) is best and HSG is not so good. You are advised it on day 6, it can be done up to day 10. The best is to do it at least two days after menstrual flow stops.
Patient's Query
Hi doctor,
Thank you for your reply.
I had my HSG test today. I did not feel much pain but radiologist told something like bilateral spillage. What does that mean? Will it be tough for me to conceive naturally?
Kindly reply.
Hi,
Welcome back to icliniq.com.
Bilateral spillage means both tubes are open and you have good chance of getting pregnant.
You can upload pictures of HSG.
Thanks and regards.
Patient's Query
Hi doctor,
Thank you for your reply.
My HSG reports are normal spillage seen on both sides of the tube and uterine cavity normal. Results of TVS ultrasound are uterine fibroid 16 x 17 mm compressing endometrial cavity. No dominant follicle seen on ovaries. Doctor has mentioned ovulation dysfunction in TVS ultrasound reports even though I am having regular periods. My cycle is 30 to 33 days. But, recently I found my vaginal mucous more fluid and a mild abdominal pain and increased sex drive. So, I am feeling that was the day of my ovulation. Doctor had told me to conceive and prescribed to take tablets Ovagen 50 and Darden on second day of my cycle if my periods do not stop for this month. I have heard Ovagen creates multiple pregnancies and my husband wishes to start this after three months and not now. Should I take Ovagen now? Is there any way to prevent multiple births?
Hi,
Welcome back to icliniq.com.
Your HSG report is good (attachment removed to protect the patient's identity).
The uterine fibroid is small. Depending on the stage of the menstrual cycle, your cycle is 30 - 33 days. So, on the 11th day, no dominant follicle may be visible. Ovulation dysfunction can be diagnosed with serial TVS (folliculometry) and not with a single scan. Your doubt regarding your day of ovulation may be true. Multiple pregnancies are caused in a small percentage and not in all women. Lower doses give some protection. If you do not want to try for the next three months, then no need to take medicine now.
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