Fibroid Removal Surgery

Uterine Fibroid Removal Surgery with IVF-ICSI CENTER

A Fibroid is an abnormal growth of muscular tissue within the uterus. It is not a cancer and usually does not require treatment. In some women, due to the fibroid’s size or location, it may cause problems requiring treatment.

Some of the symptoms women with fibroids may experience include:

  • Heavy or painful periods
  • Infertility
  • Recurrent miscarriage
  • Bladder, bowel or pressure symptoms
  • Pelvic pain

Fibroids can been found in up to 40% of women. Most of these women will not experience any symptoms.

When a clinical history or examination suggests fibroids, an ultrasound will be organised to confirm the diagnosis. Other investigations, such as hysteroscopy (video imagining of the uterine cavity which is done in hospital), CT scan or MRI (performed at radiology departments) may be required.

Fibroids grow at a very slow rate and will often have been present for many years before they are diagnosed. They will continue to grow slowly until the menopause after which they usually shrink in size.

Hormone therapy is safe and will not usually increase the size of fibroids. However fibroids have been reported to grow in women using hormone patches, so these should be avoided.

The role of fibroids in causing infertility is controversial. There is some evidence to suggest that large fibroids may impair fertility and increase the risk of miscarriage, preterm labour and the need for a caesarean delivery. Removal of large fibroids may therefore be considered prior to pregnancy and in the management of some cases of infertility. The benefits will always need to be weighed up against the risks of surgery and you should discuss all options with your doctor.

Very occasionally cancer can occur in a fibroid (sarcoma). Although rare it should be suspected in women who are postmenopausal, who are bleeding and have a rapidly growing uterus.

Different types of Fibroids

Fibroids are categorised by their location, which includes:

  • Intramural – growing in the uterine wall. Intramural fibroids are the most common variety.
  • Submucosal – growing in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain.
  • Subserosal – growing on the exterior wall of the uterus. They sometimes appear like long stalks

Endometrial polyps
Fibroids can prompt the growth of polyps in the uterine lining (endometrium). A polyp is a small protrusion that looks like a tiny ball on the end of a slim stalk. Endometrial polyps can also contribute to menstrual problems, such as excessive bleeding and pain.

Common complications
Fibroids can cause a variety of complications, including:

Anaemia – excessive menstrual blood loss can cause anaemia, a disorder characterised by the body’s inability to carry sufficient oxygen in the blood. Symptoms of anaemia include breathlessness, fatigue and paleness.

Urination problems – large fibroids can bulge the uterus against the bladder, causing a sensation of fullness or discomfort and the need to urinate often.

Infertility – the presence of fibroids can interfere with implantation of the fertilised egg in a number of ways. For example, the egg may try to burrow into a fibroid, or fibroids close to the uterine cavity may’prop open ‘the uterus, which makes successful implantation difficult.

Miscarriage and premature delivery – fibroids can reduce blood flow to the placenta, or else compete for space with the developing baby.

Diagnosis methods

Fibroids can be detected using an ultrasound, where sound waves create a two dimensional picture. The inside of the uterus can be examined with a hysteroscope, which is a thin tube passed through the cervix (neck of the womb). A small camera may be placed at the tip of the hysteroscope, so that the interior of the uterus can be viewed on a monitor.

Treatment

Most fibroids do not cause symptoms, and do not require treatment. A ‘wait and see’ approach is sometimes adopted.

  • Fibroids may require treatment in the following circumstances:
  • Fibroids are growing large enough to cause pressure on other organs, such as the bladder.
  • Fibroids are growing rapidly
  • Fibroids are causing abnormal bleeding
  • Fibroids are causing problems with fertility.

Treatment options

Treatment depends on the location, size and number of the fibroids, but may include:

  • Drugs – such as hormones, used in combination to shrink the fibroids prior to surgery.
  • Hysteroscopy – the fibroids are removed via the cervix, using a hysteroscope.
  • Laparoscopy – or ‘keyhole surgery’, where a thin tube is inserted through the abdomen to remove the fibroids.
  • Open surgery – larger fibroids need to be removed via an abdominal incision. This procedure weakens the uterine wall, and makes Caesarean sections for subsequent pregnancies more likely.
  • Hysterectomy – the surgical removal of some, or all, of the uterus. Pregnancy is no longer possible after a hysterectomy.
  • Uterine artery embolization – This is a newer treatment for uterine fibroids. It works by starving the fibroid of its blood supply. It has been shown to decrease the size of fibroids by up to 50% and may save some women from hysterectomy. It is not without its own complications and may be very painful. Its use in women who still want to have children is controversial as long term effects on fertility and pregnancy are unknown.

WHAT TO EXPECT AFTER YOUR MYOMECTOMY (REMOVAL OF FIBROIDS)

LAPAROSCOPIC MYOMECTOMY

Length of Hospital Stay You will usually go home within 3 days of surgery.
Post operative pain Within a day of laparoscopic myomectomy most patients require only oral pain medication.
Mobility Showering and walking short distances within 24 hours
Return to work Patients can return to non-strenuous employment within a few weeks of surgery. (Usually 3-4 weeks). Light duties can be started within 2 weeks.
Return to work Patients can return to non-strenuous employment within a few weeks of surgery. (Usually 3-4 weeks). Light duties can be started within 2 weeks.

ABDOMINAL MYOMECTOMY

Length of Hospital Stay You will usually go home within 3-5 days.
Post operative pain Patients usually require 48 hours of injections (i.e pethidine, morphine) given either intravenously, subcutaneously or intramuscularly for pain relief.
Mobility Showering and walking short distances within 24-36 hours
Return to work Patients can return to non-strenuous employment within 4-6 weeks of surgery. Light duties can be started within 2 weeks.