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Year: 2024

which size of fibroid is dangerous
23Jan

Fibroids are noncancerous growths that develop in the uterus, affecting millions of women worldwide. While most fibroids are benign and don’t cause noticeable symptoms, some can lead to complications, prompting the need for medical intervention. One crucial factor in assessing the risk associated with fibroids is their size.

Understanding Fibroids:

Fibroids are abnormal growths of muscle tissue in the uterus. They can vary in size, ranging from as small as a seed to as large as a grapefruit or more. Fibroids can develop inside the uterus, on its outer surface, or within the uterine wall. Although the exact cause of fibroids remains unclear, factors such as genetics, hormonal fluctuations, and pregnancy can contribute to their formation.

After diagnosing fibroids, the first thing a doctor discusses is the size of the fibroids. Why is the size of fibroids important to know? There are multiple reasons for it.

  • The course of treatment for fibroids depends on their size.
  • The location and size of fibroids are also crucial in predicting potential complications. For instance, there has been a reported case where emergency surgery was required for a woman with a large fibroid causing respiratory problems.
  • Additionally, the size of the fibroid can serve as an alarm for determining when treatment should be initiated. It plays a significant role in guiding healthcare professionals toward the most appropriate and timely interventions.

Assessing Fibroid Size:

The fibroid size chart varies globally, with different centers employing diverse methods to characterize uterine size. Physicians may measure fibroids in centimeters, categorizing them as small, medium, or large.

  • Small fibroid: Less than 3 cm in length (Comparable to the size of a pea or cherry)
  • Medium fibroid: 3 to 6 cm (Similar in size to a plum or large orange)
  • Large fibroid: 6 cm or more (Resembling the size of a grapefruit and beyond)

Some physicians define fibroid size based on obstetric weeks, where a small fibroid corresponds to the 4th obstetric week, a medium fibroid to weeks 10 to 11, and a large fibroid to weeks 12 to 16.

Which size of fibroid is dangerous in mm?

A common misconception is that the larger the fibroids, the more serious complications they will cause. However, it’s important to note that while larger fibroids can cause discomfort, they are not always guaranteed to pose problems. Similarly, a smaller fibroid doesn’t automatically signify any cause for concern. So, there is no straight forward answer to this question: which size of fibroid is dangerous.

How much does a 7 cm fibroid weigh?

While fibroids don’t directly cause weight gain, they contribute to overall body weight due to their mass. The weight of a 7 cm fibroid can vary, but generally, larger fibroids, including those over 6 cm, can weigh up to 25 pounds. Consequently, women with larger fibroids may experience heaviness in the lower abdomen and a protruding belly due to the presence of a substantial fibroid in the uterus.

When should you be concerned about fibroid size?

While many women with fibroids never experience any symptoms, the size of a fibroid can become a concern when it leads to the following issues:

Symptoms: Larger fibroids can cause symptoms such as heavy menstrual bleeding, pelvic pain or pressure, frequent urination, and backache. The size and location of the fibroid play a role in the severity of these symptoms.

Complications during Pregnancy: Depending on their size and location, fibroids can lead to complications during pregnancy and childbirth. Larger fibroids may obstruct the birth canal or interfere with the optimal positioning of the baby.

Impact on Fertility: In some cases, larger fibroids can affect fertility. They may block the fallopian tubes, interfere with the implantation of the embryo, or disrupt the blood flow to the uterus.

Degeneration: Larger fibroids are more prone to degeneration, a process in which the central part of the fibroid outgrows its blood supply, causing pain and sometimes requiring medical attention.

Rapid Growth: If a fibroid undergoes rapid growth, it may indicate malignancy, although fibroids are overwhelmingly benign. Any sudden increase in size should be thoroughly evaluated by a healthcare professional.

What is the solution?

The treatment of fibroids depends on the location and size of fibroids. Doctor can recommend one of the following:

Watchful Waiting:

Small, asymptomatic fibroids may not require immediate treatment. Regular monitoring through pelvic exams or imaging studies (ultrasound, MRI) can be done to track any changes.

Surgery:

For larger and heavier fibroids causing significant symptoms, surgery is often recommended. The two primary surgical options are myomectomy and hysterectomy.

Myomectomy is a uterus-saving procedure in which only the diseased part, typically the fibroids, is removed, leaving the rest of the uterus intact. On the other hand, hysterectomy involves the complete removal of the uterus. This procedure is considered more extensive, as it eliminates the entire uterus, preventing the possibility of future pregnancies.

The choice between myomectomy and hysterectomy depends on various factors, including the severity of symptoms, the desire for future fertility, and the overall health of the patient. This decision is typically made in consultation with the patient and their healthcare provider.

Uterine Artery Embolization:

This is a minimally invasive procedure initially used for the smaller fibroids but now also for the large ones. During the procedure, a catheter is guided through blood vessels to the uterine arteries, where small particles are injected to block blood flow to the fibroids. This process aims to reduce the size of the fibroids and alleviate associated symptoms, offering an alternative to surgical options.

Dr. Imtiaz Ahmed is the pioneer of this procedure in Pakistan. Email now at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

adenomyosis causes
15Jan

Uterine adenomyosis is a medical condition that often goes undiagnosed due to its overlap of symptoms and similarities to other reproductive health issues. Lack of MRI facilities is one of the factors in under diagnosis of this crippling disease. This condition occurs when the tissue lining the uterus, called the endometrium, grows into the muscular walls of the uterus. While adenomyosis is not life-threatening, it can cause significant pain and discomfort with major impact on person’s quality of life.

Adenomyosis Causes:

The exact cause of adenomyosis of the uterus remains unclear. There are several theories about the etiology of this condition. The most commonly accepted one says that when the boundary between endometrium (the innermost layer of uterus) and myometrium (the middle layer of uterus) is disrupted a series of inappropriate cell proliferation happens. The endometrial cells start growing into the myometrium resulting in adenomyosis. Here are some risk factors for uterine adenomyosis that may disrupt the boundary between two layers.

Hormonal Influences:

Changes in hormonal levels, particularly an excess of estrogen relative to progesterone, are believed to play a role in the development of this disease. Estrogen promotes the growth of the endometrial tissue.

Inflammation:

Inflammation within the uterus may lead to the development of adenomyosis. This inflammation can cause a breakdown in the normal boundaries between the layers of the uterine wall.

Childbirth:

Women who have undergone multiple pregnancies and childbirths may have an increased risk of developing this condition. The stretching and contractions of the uterus during childbirth could contribute to the displacement of endometrial tissue.

Invasive Procedures:

Uterine surgeries, such as cesarean sections or fibroid removal, may increase the risk of adenomyosis. These procedures can disrupt the normal structure of the uterine walls.

Symptoms of Adenomyosis:

Adenomyosis often presents with symptoms that overlap with those of other reproductive health issues, making it challenging to diagnose. Common symptoms include:

Menstrual Pain:

Increased and prolonged menstrual cramps, often beginning before the period and lasting throughout its duration, are hallmark symptoms of adenomyosis.

Heavy Menstrual Bleeding:

Women with adenomyosis may experience heavier than usual menstrual bleeding, leading to anemia in some cases.

Pelvic Pain and Discomfort:

Persistent pelvic pain or a feeling of fullness in the lower abdomen may occur, especially during menstruation.

Painful Intercourse:

Adenomyosis can contribute to pain or discomfort during sexual intercourse.

Menstrual Irregularities:

Changes in menstrual patterns, such as irregular periods or spotting between periods, may be indicative of adenomyosis.

Diagnosis and Treatment:

Diagnosing adenomyosis can be challenging due to its nonspecific symptoms. However, healthcare providers may use a combination of medical history, physical examinations, imaging studies such as ultrasound (both abdominal and transvaginal) or MRI, and, in some cases, exploratory surgery to confirm the diagnosis.

The difference between a normal uterus vs adenomyosis ultrasound is the uterus appears globally enlarged and bulky. The walls are thicker and more heterogeneous in contrast to normal homogenous appearance. if the lesion is focal, there may be localized thickening. Sometimes the advanced disease can distort the shape of the uterus.

How is uterine adenomyosis treated?

Treatment options vary based on the severity of symptoms and the individual’s reproductive goals. Common approaches include:

Pain Management:

Over-the-counter pain relievers or prescription medications may help manage pain associated with adenomyosis.

Hormonal Therapy:

Hormonal treatments, such as birth control pills or intrauterine devices containing hormones, may help regulate menstrual cycles and alleviate symptoms.

Surgery:

Sometimes when the medical treatment fails and the family is completed doctors may recommend surgery. This surgery requires removal of the uterus.

Dr Imtiaz Ahmed believes that the uterus is as necessary as any other organ of the body and should never be removed like an appendix, regardless of the family status. He introduced a minimally invasive nonsurgical procedure for treating adenomyosis in Pakistan. This procedure is called 3-D Precison Guided Uterine Artery Embolization (UAE).

UAE as the name indicates is an embolization of the vessel. The basic principle of this procedure is to cut off the blood supply to the lesion by embolizing. Once the disease is no longer receiving the blood, it dies. The procedure starts with a thorough evaluation of the lesion. Firstly, the patient is comforted by giving some sort of conscious sedation. Then a catheter is inserted through a small skin hole, usually in the groin, no skin incisions are given, small catheter is guided through the blood vessels to the uterine arteries. The embolizing material is then injected through the catheter into the uterine arteries. It blocks the blood flow to the areas affected by adenomyosis.

The progress of the procedure is monitored using 3-D imaging techniques including digital fluoroscopy, to ensure accurate delivery of embolic particles. After the embolization is completed, the catheter is removed, and hemostasis is achieved by applying gentle manual pressure or by applying a closure device. Patients are typically monitored overnight or for a few hours before being allowed to go home.

This procedure has several benefits when compared with the conventional hysterectomy. The symptoms alleviate quickly, no additional pain and trauma of the major surgery, conservation of the uterus and quick recovery time are some of the advantages of the UAE.

For more information about the non-invasive treatment of adenomyosis email us at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

how to get pregnant with adenomyosis naturally
9Jan

Fertility struggles can be a challenging and emotional journey for many couples. Adenomyosis, a condition where the tissue lining the uterus starts to grow into the muscular wall, can further complicate the path to conception.

Does adenomyosis affect fertility?

Adenomyosis initiates when the natural boundary between the internal and middle layers of the uterus is disrupted, leading to the growth of endometrial tissue within the uterine walls. Individuals with this condition often encounter symptoms such as heavy periods, pain, and lower abdominal fullness. These symptoms can disrupt the normal conception process, making the implantation of the zygote challenging and compromising adequate uterine support for the developing fetus. Consequently, this heightened difficulty increases the risk of miscarriage and premature birth.

Infertility in adenomyosis

Adenomyosis presents certain symptoms that serve as potential indicators of infertility. The foremost and most important of these is experiencing a painful period. Pain serves as a sign of inflammation, and where inflammation occurs, scar tissue formation follows. The inflamed uterus poses a challenge for the easy implantation of a fertilized egg.

Another notable symptom of adenomyosis is heavy bleeding, often indicative of hormonal imbalance that significantly impacts physiological processes crucial for pregnancy. Additionally, the globally enlarged uterus, a consequence of the presence of endometrial tissue within the uterine wall, adversely affects normal implantation.

Risk Factors for Adenomyosis-Related Fertility Issues

Several factors increase the likelihood of adenomyosis affecting fertility. These are:

  • having a history of pelvic infections
  • endometriosis
  •  previous uterine surgery raises the risk
  •  multiple miscarriages
  • age 35 years or more

Certain lifestyle factors can contribute too. Smoking and having a high body mass index (BMI) may make it harder for women with adenomyosis to get pregnant or sustain a pregnancy.

It’s essential to understand that not all women with adenomyosis will experience fertility problems. For those who do, there are various treatment options, including medication, surgery, and assisted reproductive technologies like in vitro fertilization (IVF).

How to get pregnant with adenomyosis naturally?

Lifestyle Modifications:

Adenomyosis diet: Adopting a nutrient-rich, balanced diet is crucial for overall health and fertility. Include a variety of fruits, vegetables, whole grains, and lean proteins in your daily meals. Antioxidant-rich foods such as berries, leafy greens, and nuts can help combat oxidative stress associated with adenomyosis.

Eating lots of fresh vegetables: Add more veggies in the diet, especially cruciferous ones like cauliflowers, radish, and turnips. These are rich in antioxidants, which fight inflammation caused by adenomyosis.

Don’t skip fruits: Despite concerns about sugar, fruits provide essential vitamins, minerals, fiber, and antioxidants. Berries, in particular, are excellent for their antioxidant properties. Include two servings of fruit daily for a healthy diet.

Include grains and carbs: Contrary to some advice, don’t cut out grains and carbs completely. They are essential for energy and meeting fiber needs. Opt for whole grains like brown rice, wholemeal pasta, and quinoa.

Incorporate healthy fat: Healthy fats, such as omega-3 fatty acids and vitamin E, can help manage pain. Include foods like avocados, nuts, seeds, oily fish, and extra virgin olive oil in your diet.

Cut down on saturated fats and excess sugars: Research suggests that foods high in saturated fats can trigger inflammation. Minimize foods like butter, coconut oil products, ghee, fried items, and sugary treats to manage inflammatory responses associated with adenomyosis.

Maintain a Healthy Weight:

Maintaining a healthy weight is essential for fertility. Both underweight and overweight conditions can negatively impact reproductive function. Achieving a healthy BMI through regular exercise and a balanced diet can improve hormonal balance and enhance fertility.

Regular Exercise:

Engaging in regular physical activity is beneficial for fertility and overall well-being. Exercise helps regulate hormones, improve blood flow to the reproductive organs, and reduce stress. Opt for activities you enjoy, such as walking, swimming, or yoga, and aim for at least 30 minutes of moderate exercise most days of the week.

Adenomyosis treatment for fertility

The treatment approach for adenomyosis-related fertility problems may involve a combination of medical and surgical interventions. It’s important to consult with a healthcare professional for personalized advice based on an individual’s specific situation. Here are some general treatment options:

Pain Management:

Over-the-counter pain relievers such as ibuprofen or naproxen may help manage pain associated with adenomyosis. Prescription medications, such as hormonal therapies, may be recommended by doctors to control pain and reduce inflammation.

Hormonal Therapies:

Hormonal treatments like birth control pills, hormonal IUDs (intrauterine devices), or progestin therapy may help regulate menstrual bleeding and reduce symptoms. Gonadotropin-releasing hormone (GnRH) agonists may be prescribed to induce a temporary menopause-like state, suppressing estrogen production and reducing adenomyosis symptoms.

Fertility Treatments:

If adenomyosis is affecting fertility, fertility treatments such as in vitro fertilization (IVF) may be considered. IVF involves retrieving eggs, fertilizing them outside the body, and then transferring the embryos into the uterus.

Surgery:

In some cases, surgery may be recommended to remove adenomyosis-affected tissue. This can be done through a procedure called adenomyomectomy. In severe cases or when fertility is not a concern, a hysterectomy (removal of the uterus) may be considered.

3-D Precision Guided Uterine Artery Embolization (UAE):

3-D Precision Guided UAE is a minimally invasive procedure where tiny particles are injected into the blood vessels supplying the uterus, cutting off the blood flow to the adenomyosis-affected tissue.

Dr. Imtiaz Ahmad, an expert endovascular surgeon and interventional radiologist, is the pioneer of this procedure in Pakistan. With extensive experience in treating fertility issues in both males and females, he has played a crucial role in helping numerous couples realize their dream of starting a family. Dr. Ahmad is committed to the principle of utilizing minimally invasive technology in his practice, emphasizing a patient-centric approach to provide effective and compassionate care.

For further assistance email us at at info@drimtiazahmad.com. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.

varicocele vs hydrocele
5Jan

Scrotal swelling is a common symptom of various scrotal pathologies. At times, the similarity of other symptoms can make it challenging for doctors to establish a clinical diagnosis without conducting tests. Two common conditions that can share similar presentations are varicocele and hydrocele. Both involve the scrotum, but they differ in their causes, symptoms, and treatments.

Varicocele vs Hydrocele

Varicocele:

Varicocele is a condition characterized by the enlargement of the veins within the scrotum (the pampiniform plexus).

Causes:

It occurs when the valves within the veins that regulate blood flow back to the heart do not function properly, leading to blood pooling and the enlargement of the veins.

Symptoms:

Apart from varicocele testicle lump other symptoms are:

Pain or Discomfort: Aching or dragging pain in the scrotum is a common symptom. This pain may vary from mild to moderate and can be more pronounced after standing or physical exertion.

Visible Swelling: Swelling or enlargement of the veins in the scrotum may be noticeable, particularly when standing. This presentation can sometimes be mistaken for an inguinal hernia, as both conditions share similar symptoms. However, in the case of varicocele, the veins may feel like a bag of worms, helping differentiate whether it is hernia or varicocele.

Testicular Atrophy (Rare): In some cases, prolonged or severe varicoceles may lead to testicular atrophy (shrinkage), although this is rare.

Infertility (in some cases): Varicoceles can potentially affect fertility in some men. The increased blood flow and higher temperature in the scrotum caused by the varicocele may interfere with sperm production or function.

Diagnosis:

Diagnosis is usually made through physical examination, and additional tests such as ultrasound may be conducted to assess the severity.

Treatment:

Treatment may not be necessary if the varicocele is not causing symptoms or fertility issues. If treatment is needed, options include surgical procedures like varicocelectomy or non-surgical approaches such as embolization. However, we recommend minimally invasive 3-D Precision Guided Varicocele Embolization for all grades of varicoceles.

Hydrocele:

Definition:

Hydrocele is a condition characterized by the accumulation of fluid in the sac surrounding the testes (tunica vaginalis).

Causes and Types of hydrocele :

The hydrocele can be communicating or noncommunicating. The 4 types of hydrocele are:

Communicating Hydrocele: This type of hydrocele occurs when there is a communication or connection between the tunica vaginalis and the abdominal cavity, allowing fluid to flow into the scrotum. It is often caused by the incomplete closure of the processus vaginalis, a tube-like structure that connects the abdomen and the scrotum during fetal development. This incomplete closure creates a pathway for fluid to move into the scrotum.

Non-Communicating Hydrocele: In this type of hydrocele, there is no direct communication between the abdominal cavity and the tunica vaginalis. Instead, fluid accumulates within the tunica vaginalis itself. Non-communicating hydroceles are often the result of irritation, inflammation, or injury that leads to an increased production of fluid or a decreased absorption of fluid within the tunica vaginalis.

Congenital Hydrocele: Some hydroceles are present at birth and are referred to as congenital hydroceles. These may result from the persistence of the processus vaginalis or other factors during fetal development.

Acquired Hydrocele: Acquired hydroceles develop after birth and may be caused by conditions such as infections, trauma, or inflammation.

Symptoms:

Hydrocele symptoms are:

Swelling:The most noticeable symptom of a hydrocele is swelling in the scrotum. The size of the swelling can vary, and it may be more prominent after physical activity or at the end of the day.

Painless enlargement: Hydroceles are typically painless, and the swelling is often not associated with discomfort or tenderness. However, if there is sudden pain or tenderness, it may indicate another underlying issue, such as infection or injury.

Heaviness or dragging sensation: Some individuals with hydroceles may experience a feeling of heaviness or a dragging sensation in the affected side of the scrotum due to the increased size and weight of the fluid-filled sac.

Transillumination: In some cases, the doctor may use a light source to shine light through the scrotum to help distinguish a hydrocele from other conditions. A hydrocele will typically transmit light, whereas a solid mass (such as a tumor) will not.

Diagnosis:

Diagnosis is usually based on physical examination, and transillumination (shining a light through the scrotum) may be used to differentiate it from other conditions.

Treatment:

Small, asymptomatic hydroceles may not require treatment. If the hydrocele is large, causes discomfort, or if it persists, treatment options may include drainage through aspiration or surgical intervention.

This brief overview of hydrocele vs varicocele may help clarify the distinctions between these two conditions. It is always crucial to consult a doctor for the proper management of these diseases. Attempts at self-diagnosis can often delay treatment and, eventually, lead to complications such as infertility.

Dr. Imtiaz Ahmed, an expert endovascular surgeon and interventional radiologist, stands out as a leading doctor in the field. His specialization lies in the treatment of male infertility issues. Dr. Ahmed employs the principles of minimally invasive surgery, ensuring that his approach is not only swift but also pain-free and highly effective.

Contact now at info@drimtiazahmad.com for further assistance. Follow us on Instagram @Profdr_imtiaz_ahmad for daily updates.