Fibroids

What are Uterine Fibroids?

Uterine fibroids are noncancerous (benign) tumours, commonly seen in women of childbearing age. Fibroids are composed of muscle cells and other tissues.

They develop in and around the wall of the uterus or womb. Uterine fibroids are usually round or semi-round in shape.

Fibroids are common and only need treatment if there is a specific indication.

Types of Fibroids

Based on their location within the uterus, uterine fibroids can be classified as:

• Subserosal fibroids: Sited beneath the serosa (the membrane covering the outer surface of the uterus)
• Submucosal fibroids: Sited inside the uterine cavity below the lining of the uterus – endometrium.
• Intramural fibroids: Sited within the muscular wall of the uterus

Causes of Fibroids

The exact cause for the development of fibroids remains unknown. 

Symptoms of Fibroids

The majority of women with uterine fibroids are asymptomatic. Others may experience

• Prolonged menstrual periods
• Heavy periods
• Pelvic pressure or pain
• Frequent urination
• Constipation
• Backache or leg pain
• Difficulty in emptying your bladder
• Difficulty getting pregnant
• A mass in the lower abdomen

Effect on Fertility

Submucosal fibroids have a significant effect on fertility and have to be removed.  Intramural fibroids could have an effect but the removal of these fibroids will leave a weekend scar in the uterine muscle that may tear during labour or childbirth. Subserosal fibroids rarely have an effect on fertility.

A large fibroid can cause pain in pregnancy and if it is low in the uterus it may also interfere with the birth.

Diagnosis of Fibroids

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. Other imaging techniques such as MRI scan and CT are rarely needed.

Treatments for Fibroids

Different methods are being used for managing uterine fibroids. Surgery is considered the best modality of treatment. The common operations performed for the management of fibroids include:

• Hysterectomy or removal of the uterus
• Myomectomy or selective removal of the fibroids within the uterus
• Other techniques employed are uterine artery embolisation (UAE). To be a suitable candidate for this procedure there are certain requirements. There are possible side effects and complications so this procedure is not performed very often. 

Myomectomy

Myomectomy is a surgical procedure done to remove uterine fibroids.

Myomectomy is the treatment of choice in women with fibroids who are planning to have children in the future. It removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy.

Before your surgery, a GnRH-releasing hormone analogue therapy may be used to shrink the uterine fibroids, thus reducing the risk of excessive bleeding during the surgery.

Depending on the size, location and number of fibroids, we may choose one of three surgical approaches to remove the fibroids:

• Hysteroscopy: This is performed under general anaesthesia or spinal anaesthesia. We use a tiny viewing tool called a hysteroscope which is passed through the vagina and cervix into the uterus to look inside the uterus. We can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove submucosal fibroids. We may also take tissue samples for biopsy. Fibroids located on the inner wall of the uterus that has not gone deep within the wall of the uterus can be removed using this technique.
• Laparotomy: A laparotomy is the surgical removal of fibroids through an incision in the lower abdomen. If the fibroids are large and many in number or have grown deep into the uterine wall we may opt for laparotomy. 
• Laparoscopic removal of the fibroids is also performed by some surgeons.
  
  

Recovery from Myomectomy

After myomectomy surgery, your pelvic pain and bleeding from fibroids are reduced and your chances of having a baby are improved. If the fibroids are large and are more in number, they can re-grow after surgery.

Recovery after Hysteroscopic resection of the fibroid is fast- few days to a week at the most. 

Recovery post open myomectomy is 2-5 weeks. You are not able to drive until you stop taking painkillers and you feel pain-free and well. You may or may not have mild vaginal bleeding. 

Complications with Myomectomy

The possible complications of myomectomy include

• Infection
• bleeding that may require a blood transfusion
• scar tissue formation,
• damage to the bladder or bowel, and
• rupture of the uterine scars in late pregnancy or during labour.
• you might be advised to have an elective caesarean section by your surgeon

Rarely, a myomectomy causes uterine scarring that can lead to infertility.

Fibroids and Pregnancy

Because fibroids can grow back, those women who are planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, we will advise you to wait at least 2 to 6 months until the uterus heals.

Risks During Pregnancy

Studies indicate that the presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as breech presentation, increased chance of Caesarean section, increased bleeding post-delivery of the baby, premature labour and rarely growth restriction.