Urogynaecology & Pelvic Reconstructive Surgery,
Minimally Invasive & Robotic Laparoscopic Gynae Surgery

What Are Uterine Fibroids?

Uterine fibroids are not cancer. Uterine leiomyomata are the most common benign tumours in a woman’s pelvis. Cause of fibroid is unknown, we know they result from an over-growth of the muscle in the uterus. Symptoms include menorrhagia and painful periods. Common treatment for fibroids is removal; either by laparoscopic myomectomy or abdominal surgery. Most women do not know that they have uterine fibroids, because the fibroids vary from microscopic to the size of a melon. Fibroids may occur singly or in multiples, and they arise from different muscle layers of the uterine body.

Uterine Fibroids Symptoms

Uterine fibroids cause many symptoms, either directly or indirectly. Their size and location eventually determine the symptoms the woman may have. Fibroids thrive in an estrogenic environment. It is known that uterine fibroids stopped growing after the menopause, and many of them shrink with time.

Types Of Fibroids

Uterine fibroids are classified according to where they are located in the structure of the uterus. They may be: Intra-cavitary, almost completely within the womb cavity
    Submucous fibroids, partially in the cavity, arising from the wall of the cavity
    Intramural or intramyommetrial fibroids, completely within the substance of the womb muscle
    Subserous fibroids, protruding outside the confines of the womb, with the base arising from the surface of the womb
    Pedunculated fibroids, attached to the womb surface via a stalk

How To Diagnose Uterine Fibroids?

Uterine fibroids are traditionally diagnosed by clinical complaints and a pelvic examination. A good impression of the fibroids distorting the normal uterine anatomy is obtained by palpation. This strategy however may miss diagnosing smaller sypmptomatic intra-cavitary fibroids and also fail to distinguish solitary fibroid from adenomyosis. Pelvic ultrasound scan, either placing the probe abdominally or transvaginally, has become an extremely convenient and reliable method to diagnose fibroids. Diagnosis of intra-cavitary fibroid can be enhanced by infusing saline into the cavity while performing the ultrasound scan (saline sonohysterography). When the woman has many fibroids or if they are large ones that enlarge the uterus up to the upper abdomen, additional magnetic resonance imaging (MRI) becomes necessary to plan the treatment approach. The use of endoscope to visualize the womb cavity assesses the feasibility of hysteroscopic removal of intra-cavitary and submucose fibroids.

Problems With Uterine Fibroids

50-70% of women have fibroids, but only 10-15% are symptomatic, and therefore, majority of them do not need to be treated. Most women become symptomatic in their forties; when they present with heavy periods or prolonged painful periods. As the fibroids become larger, you may begin to have abdominal bloating, pelvic pain, urinary and bowel disturbances and backache. Many women also present with difficulty in getting pregnant or repeated miscarriages.

Medical Treatment Of Uterine Fibroids

The treatment depends on the women’s age, desire for further childbearing, the size of the fibroids, her symptoms and their severity. If a woman has uterine fibroids, but has no symptoms she may not need any treatment. However a regular check up is required to see if the fibroids have grown. Fibroids are hormone dependant and hence usually decrease in size after menopause. Medical treatment of fibroids aims at shutting down the release of estrogen from the ovaries. We can use one of the gonadotropin releasing hormone agonist (GnRHa), which effectively resolve the symptoms and shrink the size of the fibroids as well. The problems with GnRHa use are the side effects of hot flashes and decrease bone density. Besides, we usually do not prescribe GnRHa for more than six months, and once its suppressive effects are lifted, the fibroids start to grow again.

Definitive Surgical Treatment Of
Uterine Fibroids

The definitive treatment of fibroids is to remove them on their own (myomectomy) or together with the womb (hysterectomy). Myomectomy is indicated if you wish to preserve your fertility or wish to keep your womb. It is a major operation and involves the cutting out of the fibroids through one or several incisions, and then stitching the womb back together. It is not physically possible to remove all fibroids because the smaller ones cannot be identified easily. In keeping the womb, there is the 15% to 30% chance that further fibroids will develop in the years ahead; and you may therefore require another procedure in about 10% (Iverson 1996). Depending on the number, size and position of the fibroids, you may encounter excessive blood loss during the procedure and the womb may have to be removed to stop the bleeding. If you plan to have children after the myomectomy, the procedure often gives rise to adhesions that may impair fertility. If you become pregnant subsequently, uterine rupture (through the womb incision) may occur. Removing the womb is the certain method of curing fibroids. If the uterus is enlarged, hysterectomy will be performed by the traditional abdominal approach. If the uterus is not too large, removing it using the laparoscopic approach is considered. You must recognize that hysterectomy is a major operation and has significant risks. After the surgery, you may need three to four days of hospital stay and an average of six weeks to recover.


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