The uterus is made of smooth muscle which allows it to expand greatly during pregnancy before returning to its original size afterwards, but also to change in size and shape during the menstrual cycle. In some cases, discrete benign tumours or growths of this smooth muscle within the wall of the uterus causes the development of fibroids. They are common found in up to 50% of all women and have a genetic predisposition. Their effect on a woman depends largely on their location within the uterus.
Fibroids inside the uterine cavity (sub-mucosal fibroids) often cause heavy menstrual bleeding (menorrhagia) or irregular and persistent bleeding. This bleeding can often be associated with fatigue and lethargy as well as uterine pain.
Fibroids on the outside of the uterus (subserosal) can grow to very large size, sometimes filling the abdominal cavity like a pregnancy. These will present as pressure on the bowel, bladder or pain with activities such as exercise or intercourse
Those within the uterine wall (intramural) may also have an impact on menstrual bleeding, possibly by blocking the return of venous blood flow from the endometrium
The main impact of fibroids are therefore;
- Heavy, prolonged or irregular periods
- Pressure symptoms and pelvic pain
Managing fibroids depends on your individual situation and the particular symptoms you may be experiencing. For some women heavy bleeding can be simply controlled by hormonal methods such as the contraceptive pill. This however is unsuitable for women hoping to fall pregnant.
Removing the fibroids surgically is usually the best plan of action for women hoping to fall pregnant, experiencing issues with infertility and miscarriages and for cases relating to increased pressure on the bladder causing frequent passing of urine.
How can they be removed?
The removal of fibroids depends on where they are located within the abdomen.
Fibroids found inside the cavity of the uterus can be removed by a technique called hysteroscopic resection. Here we place a small camera through the cervix to find the fibroid. Once it has been located a small electrical current is used to cut the fibroid tissue out from the uterine wall. This is usually a routine day-surgery procedure.
Fibroids found on the outside of the uterus can also be removed surgically using a similar method. In the past hysteroscopic resections were not available and this procedure required a large cut across the lower abdomen allowing access to the uterus and then removal of the fibroids (laparotomy). This not only caused scarring and adhesions but was also quite a painful procedure which required a long recovery period. Advanced laparoscopic surgeons such as Dr Rosen are now able to remove fibroids of almost any size using the less invasive keyhole techniques.
Are there any other options?
Some patients may be suitable for fibroid embolization using advanced radiological techniques to block the blood supply to the fibroid. Others, who have completed their family, may find a laparoscopic hysterectomy (keyhole operation) more suitable. These options can all be discussed at your consultation