Uterine fibroids

Fibroids are tumours that arise from muscle cells in the wall of the uterus. Fortunately 99.9% of uterine fibroids are benign. The problems that fibroids cause are related to their size and position as illustrated to the left. Common symptoms are heavy periods and pressure symptoms from the fibroids pressing on the bladder or bowel. This may include difficulty in passing urine, frequent urination and constipation.

We do not understand why fibroids grow in some women and not others. There may be a range of genetic and hormonal factors that come into play. We also have little understanding of the factors that control the growth of fibroids and why some fibroids that have been small for many years can suddenly start growing rapidly.

Many medications have been used to try and treat uterine fibroids. Unfortunately none have been very successful at permanently affecting the growth or size of fibroids. Embolisation or cutting off the blood supply to fibroids can be an effective treatment in certain circumstances. However this treatment has been associated with a number of serious complications such as severe pain and infection. Embolisation can therefore be considered to be an experimental treatment at this stage, and I believe should only be carried out within a well controlled clinical trial. Surgery remains the cornerstone of treatment of fibroids.

 

Hysterectomy

If you have completed your family and have symptomatic uterine fibroids, hysterectomy may be the best surgical option for you. Even if you have very large fibroids it is usually possible to carry out a hysterectomy through keyhole surgery (laparoscopic hysterectomy)

This avoids a large abdominal incision and obviously speeds your recovery.

Laparoscopic Myomectomy

Surgically removing individual fibroids from the uterus (myomectomy) may be an appropriate option if fibroids are causing either difficulty conceiving or recurrent miscarriages. You may also elect for this surgical option if you wish to retain your uterus. You must be aware that if the uterus is retained you may grow other fibroids. In most cases myomectomy can be performed with keyhole surgery. This is an advanced laparoscopic prodedure and is not carried out by all gynaecologist

Small fibroids on the inside of the uterus (submucous fibroids) can be removed by keyhole surgery carried out through the cervix (Hysteroscopic surgery). Removal of these sorts of fibroids is commonly carried out during the course of fertility treatment.

If you conceive following myomectomy you may be advised to have an elective caesarian section. This will depend on the size of the scar on your uterus.