Uterine fibroids

These are benign smooth muscle growth of the uterus. About 20 to 35% of women over the age of 35 years would have fibroids. About half of those with fibroids would develop symptoms related to the fibroids. Fibroids are commoner in Afro- Caribbean Afro-American women. They are rare below the age of 20years and shrink after menopause. They are oestrogen dependent growths. The exact cause of fibroids is unknown.

Site and shape of the fibroids on the uterus varies. They could be inside the muscle (intramural), extending into the uterine cavity (submucous), suspended by a stalk in the cavity of the uterus (fibroid polyp), within the outer covering of the uterus (subserous) or suspended by a stalk on the body of the uterus (pendunculated).

It may be found on the bladder or the bowel and in some cases even in other parts of the body such as the lungs and spinal cord.

Hysteroscopy-Submucous Fibroid

Symptoms of Fibroids

The commonest presentation is that of heavy menstrual period which may be associated with pain and could also lead to anaemia.
Pressure symptoms from the size of the fibroid especially if the are resting on the bladder. This may result to frequency in emptying the bladder of urine. There may be pressure on the bowel leading to difficulties emptying the bowel.

Maybe associated with pain during sexual intercourse and maybe a cause of repeated miscarriages of pregnancy.

There could be recurrent pain in pregnancy which could necessitate admission to the hospital.

Diagnosis of Fibroids

The diagnosis of fibroid can be made by Ultrasound (Transvaginal or abdominal), MRI, hysteroscopy (if submucous or fibroid polyp) or by laparoscopy.
Ultrasound
Transvaginal approach is better for smaller fibroids. A probe with a covering sheath is inserted in the vagina and this produces an image on the monitor (screen).
The abdominal route is better for large fibroids. There may be need to drink water to fill the bladder before the abdominal scan.
MRI
This may be used in some cases for making diagnosis of fibroid; however, there are cost implications.

Hysteroscopy

This involves using a small telescope to view directly inside the uterine cavity. It could be performed under local or general anaesthesia depending on the circumstances.

Laparoscopy

This employs the use of a small telescope to view the abdominal and pelvic structures through the abdominal wall. It is generally performed under general anaesthesia.

Treatment of Fibroids

Treatment will depend on symptoms, size of fibroids, age of patient, and the necessity to have more pregnancies.
Most women may require GnRH analogue e.g. Zoladex for 2-3 months before surgery to help shrink and make the operation easier. The Zoladex would also help improve anaemia before the operation.

Depending on size and symptoms the fibroids these may be removed (Myomectomy) by keyhole surgery or by open (laparotomy) surgery

Myomectomy means removing the fibroids and leaving the womb intact.

Open Surgery

Depending on the size of the fibroids a bikini cut or a midline cut extending from below the belly button to the hair line region if it is a huge fibroid. The operation would require a general anaesthetic. You may need to stay in hospital for about 4-5 days.
Recovery may take about six weeks. Do not lift any heavy objects until you have been seen for your follow up check.

Key-hole Surgery

This is performed through the abdomen. There are about 3-4 small key hole cuts. A laparoscope (small telescope) is introduced through the small cut bellow the belly button to view the pelvis. The operation is performed under general anaesthesia. The operation may take longer but recovery is quicker than open operation.

Recurrence of Fibroid
In some cases there is about 10 to 25 % chance of new growth of the fibroids and these may occasionally require repeat surgery.

Pregnancy
It is possible to get pregnant after myomectomy. However, how you will deliver your baby needs to be discussed with your doctor because of the small chance of uterine rupture during labour.