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. Uterine fibroids are usually round or semi-round in shape.

Types of Fibroids

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

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

Causes for Fibroids

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

  • Genetic abnormalities
  • Alterations in expression of growth factor (protein involved in rate and extent of cell proliferation)
  • Abnormalities in the vascular system
  • Tissue response to injury
  • Family history of fibroids
  • Uterine infection
  • Consumption of alcohol
  • Elevated blood pressure
  • Hormonal imbalance during puberty

Symptoms of Fibroids

The majority of women with uterine fibroids may be asymptomatic. However, the basic symptoms associated with fibroids include:

  • Heavy menstrual bleeding
  • Prolonged menstrual periods
  • Pelvic pressure or pain
  • Frequent urination
  • Constipation
  • Backache or leg pain
  • Difficulty in emptying your bladder

  • Diagnosis of Fibroids

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. Other imaging techniques such as MRI scan and CT scan may also be employed.

Treatments of Fibroids

Different methods are being used for managing uterine fibroids. Surgery is considered the best modality of treatment. The common surgeries performed for the management of fibroids include:

  • Hysterectomy or removal of the uterus
  • Myomectomy or selective removal of the fibroids within the uterus
  • Destructive techniques that involve boring holes into the fibroids with a laser or freezing probes (cryosurgery)
  • Other techniques employed are uterine artery embolisation (UAE) and uterine artery occlusion (UAO)

The last two procedures are found not to be effective, practical or widely used.

Risks during pregnancy

Some studies indicate that the presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as first trimester bleeding, breech presentation, placental abruption, increased chance of Caesarean section and problems during labor.

MYOMECTOMY

Myomectomy is a surgical procedure to remove uterine fibroids, benign or noncancerous growths appearing in your uterus.

Uterine Fibroid Symptoms

Many women with uterine fibroids do not experience any symptoms. However, some women may experience symptoms that are

  • mild and they include heavy and prolonged menstrual bleeding,
  • bleeding between periods,
  • pelvic pain,
  • lower back pain,
  • pain during intercourse and
  • urinary problems.

In rare cases, some women may  

  • have difficulty emptying the bladder,
  • difficulty moving the bowels,
  • anaemia due to heavy menstrual bleeding and
  • reproductive problems such as infertility.

Treatment for Uterine Fibroid

Myomectomy is the treatment of choice in women with fibroids who are planning to have children in the future. Myomectomy removes only the fibroids and leaves your uterus intact and increases your chances of pregnancy.

Before your surgery, a GnRH-releasing hormone analogue therapy will be used to lower oestrogen levels and may be used to shrink the uterine fibroids, thus reducing the risk of excessive bleeding during the surgery.

Depending on the size, location and number of fibroids, Dr Alexander may choose one of three surgical approaches to remove the fibroids:

  • Hysteroscopy: This is an outpatient surgical procedure and is performed under general anaesthesia or spinal anaesthesia. Dr Alexander uses a tiny viewing tool called a hysteroscope which is passed through your vagina and cervix into your uterus to look inside the uterus. Dr Alexander can see the inside of the uterus to examine the lining of the uterus (endometrium) and remove the fibroids. Dr Alexander 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.

  • Laparoscopy: A laparoscopic myomectomy procedure is a minimally invasive surgery during which a laparoscope, a long thin instrument attached with a camera is used. A small incision is usually made below the navel and a laparoscope is inserted through this incision. Carbon dioxide gas is injected into the abdominal cavity using a special needle to create more space to work. Dr Alexander identifies and removes the fibroids. During the procedure, tissue samples can also be taken for biopsy. This procedure is the preferred option to remove one or two fibroids up to 5.1 cm across that grow on the outside of the uterus.

  • Laparotomy: A laparotomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large and many in number or have grown deep into the uterine wall Dr Alexander may opt for laparotomy. Urinary or bladder problems can be corrected using laparotomy.

When is a Myomectomy Required?

Myomectomy is a treatment option if

  • you have anaemia and pain or pressure not relieved with medications.
  • the fibroids have changed the uterus so as to cause infertility or
  • repeated miscarriages as this method improves your chances of becoming pregnant even after the procedure.

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.

Complications with Myomectomy

The possible complications of myomectomy include

  • infection,
  • scar tissue formation,
  • damage to the bladder or bowel, and
  • rupture of the uterine scars in late pregnancy or during labour.

Rarely, a myomectomy causes uterine scarring that can lead to infertility.

Fibroids and Pregnancy

Because fibroids can grow back, those women who are planning to become pregnant in the future must try to conceive as early as possible after the myomectomy procedure. However, following surgery, Dr Alexander will advise you to wait for 4 to 6 months until the uterus heals.

Before undergoing any treatment for infertility, Dr Alexander may recommend a hysterosalpingogram, an X-ray test to check the uterus and fallopian tubes.

The incisions made in the wall of the uterus to remove fibroids may cause placental problems and improper functioning of the uterus during labour may need a caesarean delivery. In rare cases, a hysterectomy may be needed if the uterus has grown too large with fibroids.