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. They can also be found on the exterior wall of the uterus.

Uterine fibroids are usually round or semi-round in shape and are found in 20-25% of women, most commonly in their 30s to 40s.


Types of Fibroids

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

  • Submucosal fibroids: Sited inside the uterine cavity below the inside layer of the uterus – the endometrium.
  • Intramural fibroids: Sited within the muscular wall of the uterus
  • Subserosal fibroids: Sited beneath the serosa (the membrane covering the outer surface of the uterus)
  • Pedunculated fibroids: Develop on a stalk attached to the outer wall of the uterus


Causes of Fibroids

The exact cause for the development of fibroids remains unknown, but some of the proposed causes include the following:

  • Genetic abnormalities
  • Alterations in the expression of growth factor (a protein involved in the rate and extent of cell proliferation)
  • Abnormalities in the vascular system
  • Tissue response to injury
  • Family history of fibroids


Symptoms of Fibroids

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

  • Heavy periods
  • Prolonged menstrual periods
  • Bleeding between periods
  • Pelvic pressure or pain
  • Awareness of a pelvic or abdominal mass
  • Frequent urination
  • Difficulty in emptying your bladder
  • Constipation
  • Backache or leg pain
  • Difficulty getting pregnant


Some women do not have any symptoms 


Fibroids' Impact on your Health

In some cases, fibroids can cause complications, including:

  • Excessive menstrual blood loss can cause anaemia. Symptoms of anaemia include breathlessness, fatigue and paleness.
  • Large fibroids can press against the bladder, causing a sensation of fullness or discomfort and the need to urinate.
  • The presence of fibroids can interfere with the implantation of a fertilised egg and cause infertility or difficulty conceiving.
  • During pregnancy, fibroids can reduce blood flow to the placenta or compete for space with the developing baby. This may result in problems such as a miscarriage or premature delivery.


Diagnosis of Fibroids

The diagnosis of uterine fibroids involves: 

  • a pelvic examination 
  • followed by an ultrasound evaluation. 


Other imaging techniques, such as MRI scans and CT, are rarely needed.


Treatments for Fibroids

Different methods are being used for managing uterine fibroids. These include conservative / non-hormonal approaches, the use of hormonal medications and surgery. 


Common surgeries performed to manage fibroids include:

  • Hysteroscopic Myomectomy: also called a Hysteroscopy, is the removal of fibroids growing in the cavity of the uterus. Certain types of advanced Hysteroscopy, such as a Myosure, may be used
  • Laparoscopic Myomectomy: is the removal of fibroids via keyhole surgery. 
  • Open Myomectomy: also called Myomectomy, requires an open cut to remove a large fibroid ro multiple fibroids. This is performed as an open (laparotomy) procedure.
  • Hysterectomy: removal of the uterus
  • Uterine Artery Embolisation (UAE): destroys the fibroid using injections to stop blood flow to the fibroid
  • Uterine Artery Occlusion (UAO)


Myomectomy

A Myomectomy is a surgical procedure to remove the uterine fibroid. Myomectomy is the treatment of choice in women with fibroids who are planning to have children, when fibroid removal is required.


Myomectomy removes only the fibroids, leaving your uterus intact, and may increase your chances of pregnancy.


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


Depending on the size, location and several 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 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 have 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 or have grown deep into the uterine wall, we may opt for laparotomy. 
  • Laparoscopic Surgery: Some surgeons also perform laparoscopic removal of the fibroids.


In many instances, removal of fibroids via Myomectomy is not required. Certain symptoms, such as bleeding can often be managed effectively with other approaches, such as with use of hormonal treatment. 


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 - a few days to a week. 


Recovery post open myomectomy is 3-6 weeks. You cannot drive until you stop taking painkillers and 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 planning to become pregnant must try to conceive as early as possible after the myomectomy procedure. However, following surgery, we will advise you to wait at least 3 to 6 months until the uterus heals. This should be discussed specifically with your treating doctor. 


Risks During Pregnancy

Studies indicate that the presence of uterine fibroids, 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.

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