Conditions

Fibroids (leiomyoma) are benign lumps of muscle found in the uterus. 

Fibroids can occur in up to 40% of women and are classified depending on where they are situated in 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

Click here - to view different types of fibroids and removal procedures.

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 on;

• Their position i.e. submucousal, 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) and can be done with either a laparoscope or a laparotomy with horizontal abdominal incision

The most appropriate surgery depends on:

• Whether fertility is required
• Patient preference

Laparoscopic Myomectomy:

• 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 2-3 days in hospital and return to work is 7 to 10 days.

If the fibroids need to be removed using an open procedure ( Laparotomy) then the stay in hospital will be 4-5 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 3 day hospital stay and a return to work on an average of 3 weeks.

Occasionally the uterus needs to be removed using an open procedure (Laparotomy). In this case the surgery takes 1-2 hours and requires a 4-5 day stay in hospital and a return to work in 4-6 weeks.

To find out more about hysterectomies - click here.

Embolisation;

Is a nonsurgical approach to the management of fibroids performed by a Radiologist.

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 the a laparoscope.