Fibroids

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What are Fibroids?

​Fibroids are benign (non-cancerous) swellings in the womb. Fibroids are also called myomas.

They grow from the muscle tissue of the womb and can be found on the surface of the womb (subserous fibroids), in the muscle of the womb (intramural fibroids) or inside the cavity of the womb (submucus fibroids).

Fibroids feed on the hormone (estrogen) produced by the ovary and grow in size. Therefore they are more common in women in their thirties and forties. They shrink after the onset of menopause.

What are the symptoms caused by fibroids and what treatment will I need?

​Depending on their location fibroids can cause different symptoms. The type of symptoms which the patients experience and the treatments also depends on the location of the fibroid. Fibroids that are inside the cavity of the uterus (submucus fibroids) will usually cause painful and heavy periods. Even a fibroid as small as the size of a grape can cause heavy periods and reduce the chances of falling pregnant. It is possible to remove these fibroids by a simple operation called “hysteroscopic resection,” which can be done with the help of a telescope inserted through the cervix without the need for a cut on the tummy.

​Fibroids that present in the wall of the uterus are called intramural fibroids and can range in size from pea size to larger than a grapefruit.  Sometimes they do not cause any symptoms but when they are large they can cause heavy periods as well as pressure symptoms like increased frequency of urine and pressure on the bowel. There are a number of treatment options for these types of fibroids, but often they do not need any treatment at all.

If fibroids are present on the outside of the women then they are called subserous fibroids. These usually do not cause any symptoms unless they are large in size.

A fibroid may be connected to the uterus by a stalk (pedunculated fibroid). Usually, these do not need treatment but sometimes they can twist and cause pain.  This type of fibroid can be removed by laparoscopy (keyhole surgery)

How can I find out if I have fibroids?

​If the fibroids are large, then they are felt during a pelvic examination. However, small fibroids may not be felt and therefore you will need an ultrasound scan. An ultrasound scan also helps to make a diagnosis of other conditions like ovarian cysts or adenomyosis(see below) which can be mistaken for a fibroid. If there is a doubt about the diagnosis or if the fibroids are very large then you will need an MRI scan which provide very useful information that can help to decide about the most appropriate treatment.

A small fibroid inside the uterine cavity can be diagnosed by a test called hysteroscopy which involves putting a slim telescope into the uterus. This procedure can be done in the outpatient department under a local anaesthetic.

What is adenomyosis?

​This condition also causes enlargement of the uterus and can be mistaken for a fibroid. This condition results from the growth of the lining of the womb into the muscle where it causes a diffuse thickening of the womb. This condition can be diagnosed by an MRI scan. Unlike fibroids, adenomyosis cannot be removed from the uterus and therefore it is essential to make a correct diagnosis before planning treatment.

Can I have medical treatment for fibroids?

​Fibroids cannot be cured with medicines. However, some medicines can control the symptoms caused by fibroids. The heavy and painful periods caused by fibroids can be controlled with tablets. An intra uterine contraceptive device called MIRENA can be inserted inside the uterus in some women to reduce heavy bleeding.

There are also medicines called gonadotropin-releasing hormone analogues (GnRH analogues) which can be used to shrink fibroids. However, this effect is temporary and the fibroids grow again once the effect of the injections wears off. GnRH analogues can cause side effects including hot flushes and if used in the long-term, osteoporosis (thinning of the bones). Therefore, you can only take GnRH analogues for a maximum of six months. The side effects can be treated by giving a small dose of hormone replacement therapy.

What is a myomectomy?

​Myomectomy is an operation to remove fibroids and retain the uterus. This can be done through an open cut on the abdomen (Abdominal Myomectomy) or by keyhole surgery (laparoscopic and hysteroscopic myomectomy)

Mr Kunde has the expertise to perform all types of myomectomies.

What are the advantages of myomectomy?

​Myomectomy is the only surgical treatment for fibroids that preserves fertility.

The purpose of myomectomy is to restore the uterus to normal function. Symptoms such as heavy bleeding and pressure usually get better or resolve completely once the fibroids are removed.

What are the risks of myomectomy?

​Myomectomy is a major operation and therefore it carries a risk of infection, bleeding and a small risk of injury to internal organs like the urinary bladder and the bowel.

Sometimes fibroids can grow back a few years after a myomectomy. This occurs in about 1 in 10 women and is more common when there are many fibroids in the uterus. This is because there are very small fibroids that are not seen at the time of the operation and subsequently these can grow. The risk of recurrence is less if there is a single large fibroid.

Can I have my fibroids removed by keyhole surgery?

​Only certain types of fibroids can be removed by keyhole surgery(laparoscopic myomectomy). This will depend on the type, number and size of your fibroids. Mr Kunde will do a careful assessment of your fibroids and advise you about the feasibility of a laparoscopic myomectomy.

What is uterine artery embolisation (UAE)?

​UAE is a new procedure in which tiny foam particle are injected through blood vessels to block the blood flow to the fibroids. This causes the fibroids to shrink and the symptoms get better. There can be about 50% reduction in the size of the fibroids with this treatment. This procedure is performed by specialists called Interventional Radiologists who specialise in doing procedures that are carried out using X-rays to view blood flow to internal organs. This treatment is not suitable for all patients with fibroids. Mr Kunde will be able to advise you if this treatment is suitable for you.

When is a hysterectomy necessary?

​Hysterectomy may be necessary if all the other treatment options such as medical treatments fail.  It is an option for women who have severe symptoms because of their fibroids and if they do not wish to retain their fertility. A hysterectomy guarantees that the periods will stop completely and that there will be no recurrence of fibroids.  In most of these women a subtotal hysterectomy can be performed. This is a procedure in which the body of the uterus with the fibroids is removed and the cervix is left. Mr Kunde performs a subtotal hysterectomy using keyhole surgical technique which allows women to go home after 24 hours in the hospital.