Fibroids

Fibroids (leiomyoma) are benign muscle tumours found within the uterine wall. Fibroids can occur in up to 40% of women and are classified depending upon where they are situated within the uterus:

• Submucous fibroids involve the cavity of the uterus
• Intramural fibroids sit in the muscle layer of the uterus
• Subserosal fibroids protrude into the abdominal cavity

The cause of fibroids is unclear but we know they have receptors that respond to the female hormone oestrogen. The more receptors that are present the faster a fibroid grows and fibroids tend to shrink after the menopause when the levels of oestrogen drop.

Fibroids may be asymptomatic (have no symptoms) or they can be associated with:

• Heavy painful periods
• Abdominal distension
• Pressure symptoms causing disturbance to the bladder and bowel
• Painful intercourse
• Infertility (inability to get pregnant)
• Recurrent miscarriage

The fibroids are removed leaving the uterus intact, preserving fertility.
Involves a general anaesthetic (being put to sleep).
A telescope is inserted through the umbilicus (tummy button) into the abdominal cavity.
The abdominal cavity is filled with gas so the pelvis and fibroids can be seen.
The fibroids are removed through the telescope.
The procedure usually takes 2-3 hours, requires 1-2 days in hospital, return to work is 10 to 14 days.

If the fibroids need to be removed using an open procedure (Laparotomy) then the stay in hospital will be 3-4 days with return to work in 4-6 weeks. There are risks related to removing fibroids which can be discussed if you require a consultation.

Management of Fibroids:

Fibroids that are asymptomatic can be managed conservatively (no treatment required);

An ultrasound scan can be useful to monitor the growth of the fibroids. Fibroids that are symptomatic (causing a problem) are managed depending upon;

• Their position i.e. submucosal, intramural or subserosal
• Their size
• The number of fibroids present
• Submucous fibroids are usually removed with a Hysteroscope

Intramural fibroids can be managed either surgically, or radiologically using embolisation.

The surgical options for intramural fibroids include:

• Myomectomy (removal of fibroids)
• Hysterectomy (removal of uterus) which can be achieved using a laparoscope using very small ‘key hole’ incisions. Occasionally a laparotomy (large open cut) is required

The most appropriate surgery depends on:

• Whether fertility is required
• Patient preference

Laparoscopic:

The fibroids are removed leaving the uterus intact, preserving fertility.
Involves a general anaesthetic (being put to sleep).
A telescope is inserted through the umbilicus (tummy button) into the abdominal cavity.
The abdominal cavity is filled with gas so the pelvis and fibroids can be seen.
The fibroids are removed through the telescope.
The procedure usually takes 2-3 hours, requires 1-2 days in hospital, and return to work is 10 to 14 days.

If the fibroids need to be removed using an open procedure (Laparotomy) then the stay in hospital will be 3-4 days with return to work in 4-6 weeks. There are risks related to removing fibroids, which can be discussed if you require a consultation.

Laparoscopic hysterectomy:

For those women who have finished their families and have symptomatic fibroids, then removal of the uterus (leaving the ovaries intact), can be a very positive procedure. Laparoscopic Hysterectomy takes approximately 2 hours, requires a 1-2 day hospital stay and a return to work within 2-4 weeks. Occasionally the uterus needs to be removed using an open procedure (Laparotomy). In this case the surgery takes 1-2 hours, requires a 4 day stay in hospital and a return to work in 4-6 weeks.

Embolisation:

Is a non-surgical approach to the management of fibroids performed by a Radiologist. It is not suitable for those women wishing to have a pregnancy in the future. A catheter is inserted into the groin and passed up to the arteries that supply the uterus. Pellets are injected blocking the blood supply to the fibroids, resulting in shrinkage of the fibroids over a period of time. The procedure can be quite uncomfortable, requiring hospitalisation for 2-3 days.

Complications can include:

• Infection
• Premature ovarian failure, particularly in women over 45 years
• Subserosal fibroids are usually removed with a laparoscope