Uterine Fibroids in Nepal: Surgery vs Non-Surgical Treatment Options

Uterine fibroids are the most common benign tumors of the female reproductive system. They are made of smooth muscle and fibrous connective tissue, grow within or around the uterus, and are almost always non-cancerous. Despite their benign nature, they cause significant symptoms in many women — heavy menstrual bleeding, pelvic pain, pressure, and fertility difficulties — and are among the most frequent indications for gynecologic surgery in Nepal.

Fibroids are particularly common in South Asian and African women. In Nepal, many women with fibroids are either unaware they have them (fibroids found incidentally on ultrasound during antenatal care) or are managing severe symptoms without having received a diagnosis or treatment plan.

A&B International Hospital in Pokhara provides the complete fibroid treatment spectrum, from conservative observation through laparoscopic myomectomy (fibroid removal preserving the uterus) and hysterectomy when clinically appropriate.

What Are Uterine Fibroids and How Common Are They in South Asian Women?

Uterine fibroids (also called uterine leiomyomas or myomas) are benign tumors composed of smooth muscle and fibrous tissue that develop from the muscular wall of the uterus. They range in size from a few millimeters to larger than a grapefruit, and a single uterus may contain one fibroid or dozens.

Fibroids are hormone-sensitive — they grow when estrogen and progesterone levels are high (during the reproductive years) and shrink after menopause when ovarian hormone production ceases. This is why most women’s fibroids improve after menopause without any intervention.

Prevalence in South Asian women: Studies from India and Nepal estimate that 20–40% of women of reproductive age have uterine fibroids detectable on ultrasound, with higher rates in South Asian and Black African women than in White European or Asian populations. The reasons for this racial disparity are not fully understood but likely involve genetic, hormonal, and environmental factors.

Many women with fibroids have no symptoms at all — their fibroids are discovered coincidentally on a pelvic ultrasound done for another reason. Those with symptoms experience a spectrum depending on the fibroid’s size, number, and location.

What Symptoms Do Uterine Fibroids Cause?

The type and severity of symptoms depend significantly on where in the uterus the fibroid is located.

By fibroid location:

• Submucosal fibroids (growing into the uterine cavity): The most symptomatic. Cause heavy, prolonged menstrual bleeding, inter-menstrual bleeding, and are the most common fibroid type associated with infertility and pregnancy loss. Even small submucosal fibroids can cause significant bleeding.

• Intramural fibroids (within the uterine wall): Cause heavy periods and pelvic pain when large. Also associated with fertility difficulty and miscarriage if they distort the uterine cavity.

• Subserosal fibroids (on the outer surface of the uterus): Cause pelvic pressure, urinary frequency (if pressing on the bladder), constipation (if pressing on the rectum), and pelvic pain. Less likely to cause heavy bleeding unless very large.

• Pedunculated fibroids (attached by a stalk, projecting outside or inside the uterus): Can twist on their stalk (torsion), causing acute severe pelvic pain.

Common symptoms:

• Heavy menstrual bleeding (menorrhagia) — the most common presenting symptom; may cause iron-deficiency anemia
• Prolonged periods (more than 7 days)
• Pelvic pain and pressure — especially lower abdominal, back, or pelvic region
• Urinary symptoms — frequency, urgency, or incomplete bladder emptying from bladder compression
• Painful intercourse (dyspareunia)
• Bloating and abdominal distension with large fibroids
• Fertility difficulties — implantation failure, miscarriage, preterm birth

How Are Uterine Fibroids Diagnosed at A&B Hospital?

Uterine fibroids are primarily diagnosed by pelvic ultrasound — a quick, non-invasive, accurate imaging modality available at A&B International Hospital.

Ultrasound: Transabdominal and transvaginal ultrasound map the number, size, and location of all fibroids within and around the uterus. This mapping is essential for surgical planning. Submucosal fibroids projecting into the cavity are confirmed with saline infusion sonography (SIS/sonohysterography) where available.

MRI: Provides more detailed fibroid mapping for surgical planning in complex cases — particularly useful when multiple or large fibroids are present, or when adenomyosis (a related condition involving myometrium) needs to be distinguished from fibroids. MRI referrals are coordinated from A&B.

Blood tests: Full blood count is checked to assess the degree of anemia from heavy bleeding. TSH is checked to rule out thyroid disease as a contributing cause of heavy bleeding. Where malignancy is a concern (uncommon), CA-125 may be requested.

What Is the Full Treatment Spectrum for Uterine Fibroids?

Fibroid treatment is not one-size-fits-all. The correct approach depends on symptom severity, fibroid size and location, the woman’s reproductive plans, and her preferences. The treatment spectrum at A&B ranges from watchful waiting through medical management to surgery.

Option 1: Watchful Waiting (No Treatment)

For women with fibroids that are small, not causing significant symptoms, and who are approaching menopause (when fibroids naturally shrink), watchful waiting — with periodic monitoring by ultrasound — is appropriate. Treatment is not always necessary just because a fibroid is present.

Option 2: Medical Management

Medical treatment does not eliminate fibroids permanently but manages symptoms:

• NSAIDs (ibuprofen, mefenamic acid): Reduce menstrual blood loss and dysmenorrhea; most effective for mild-to-moderate heavy bleeding
• Tranexamic acid: Reduces menstrual blood loss by inhibiting clot breakdown in the uterus — does not affect hormones or fertility; taken during the period only
• Combined oral contraceptive pill: Reduces menstrual blood loss and regulates periods; does not cause fibroid shrinkage
• Progestogen-releasing IUD (Mirena): Highly effective at reducing menstrual blood loss and protecting the endometrium — particularly useful for women with intramural fibroids causing heavy bleeding who want long-term contraception
• GnRH agonists (leuprorelin, buserelin): Cause temporary menopause-like estrogen suppression, shrinking fibroids by 30–60% over 3 months. Used as pre-surgical preparation to reduce fibroid size and blood loss, or as a bridge to natural menopause. Not a long-term solution — fibroids regrow when the medication is stopped.

Option 3: Surgical Treatment

Surgery is indicated when symptoms are severe, medical management has failed, fibroids are causing significant reproductive problems, or the woman prefers definitive treatment.

Hysteroscopic myomectomy: Removal of submucosal fibroids through the cervix using a hysteroscope — no incisions. Day-case procedure; fastest recovery. Appropriate only for fibroids projecting into the uterine cavity.

Laparoscopic myomectomy (fibroid removal, uterus preserved): The primary surgical option at A&B for women who want to preserve their uterus — either for future fertility or personal preference. The fibroid(s) are removed laparoscopically (through small keyhole incisions), and the uterus is repaired. Recovery time is 1–2 weeks; significantly faster than open myomectomy. Best suited for subserosal and accessible intramural fibroids.

Open myomectomy (laparotomy): Required for very large fibroids (>10 cm), multiple fibroids, or deeply intramural fibroids where laparoscopic access is technically unsafe. Longer recovery (4–6 weeks) than laparoscopy.

Hysterectomy (uterus removal): Definitive treatment that eliminates all fibroids and prevents recurrence. Appropriate for women who have completed their family or do not wish to preserve fertility, with severe symptoms not controlled by other options. Can be performed laparoscopically (for smaller uteri) or by open surgery.

What Are Fibroid Recurrence Rates After Myomectomy?

Myomectomy removes existing fibroids but does not prevent new ones from forming. Recurrence rates after myomectomy are approximately 20–30% at 5 years — meaning 2–3 out of 10 women will develop new symptomatic fibroids requiring treatment within 5 years.

Factors associated with higher recurrence rates:

• Multiple fibroids at the time of initial surgery
• Younger age at surgery (more years of estrogen exposure remaining)
• Family history of fibroids

Women who have completed childbearing and wish to avoid recurrence may prefer hysterectomy over myomectomy for this reason.

What Fertility Preservation Options Exist for Women with Fibroids?

For women with fibroids who want to conceive, fertility preservation is central to the treatment decision. Submucosal and intramural fibroids that distort the uterine cavity impair implantation and increase miscarriage risk — surgical treatment is recommended before attempting pregnancy in these cases.

Fertility-preserving options at A&B:

• Hysteroscopic myomectomy for submucosal fibroids
• Laparoscopic myomectomy for subserosal and accessible intramural fibroids
• Uterine repair after myomectomy, including appropriate healing period (typically 6 months) before attempting conception

After myomectomy, the uterine scar requires adequate healing before pregnancy. Women are advised to use contraception for 3–6 months post-surgery and should discuss the mode of delivery with their obstetrician — some myomectomy cases require C-section at delivery to avoid uterine rupture through the scar.

Book a Uterine Fibroid Consultation at A&B International Hospital Pokhara

If you have heavy periods, pelvic pain, or have been told you have fibroids, a specialist consultation at A&B International Hospital helps you understand your treatment options — including which approach best fits your symptoms and your reproductive plans.

A&B International Hospital

Pokhara-02, Bindhyaabasini

Phone: +977 061-412512

Website: abinthospital.com

Laparoscopic myomectomy available in Pokhara. ECHS-eligible patients receive cashless gynecology and surgical care. Appointments by call or walk-in.