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Uterine Myoma

Fibroids are non-cancerous tumours that arise from the womb (uterus). These growths are made up of muscle and fibrous tissue and vary in size and number.

They are also known as uterine myomas or leiomyomas.

Many women are unaware they have fibroids as they do not have any symptoms. Women who do have symptoms may experience:

  • heavy periods or painful periods, tummy (abdominal) or lower back pain
  • a frequent need to urinate or constipation,
  • pain or discomfort during sex

In rare cases, fibroids can cause significant complications, such as infertility and problems during pregnancy.

Who is Affected?

Fibroids are common, with more than 40% of women developing them at some point in their life. They most often occur in women aged 30 to 50 years. Women who have had children have a lower risk of developing fibroids, and the risk decreases further the more children you have.

Types of Fibroids

Fibroids can grow anywhere in the womb and vary in size considerably. Some can be the size of a pea, whereas others can be the size of a melon.

The main types of fibroids are:

  • Intramural Fibroids

  • the most common type of fibroid, they develop in the muscle wall of the womb.
  • Subserosal Fibroids

  • fibroids that develop outside the wall of the womb into the pelvis and can become very large.
  • Submucosal Fibroids

  • fibroids that develop in the muscle layer beneath the inner lining of the womb and grow into the middle of the womb.

In some cases, subserosal or submucosal fibroids are attached to the womb with a narrow stalk of tissue. These are known as pedunculated fibroids.

Treating Fibroids

If fibroids do not cause symptoms, treatment is not needed. They will often shrink and disappear without any treatment over time, particularly after the menopause.If you do have symptoms caused by fibroids, medication to help relieve the symptoms will usually be recommended first.

If these medications are ineffective, surgery or other less invasive procedures may be recommended.

Current Approaches

Medical therapy may be the best way to treat fibroids causing symptoms in premenopausal women. Synthetic gonadotropin-releasing hormone (GnRH) agonists inhibit estrogen production, causing, the uterine cavity to shrink by 36% within a few months. Fibroids may be reduced by 38% to 90% of their original size. Although these results are impressive, long-term estrogen suppression can cause bone loss. Also, GnRH agonists cannot be taken orally; a long-acting version of the drug requires injection. The drug is expensive and there's no guarantee of continued protection after treatment is stopped. Indeed, fibroids usually return to their original size within 4 months.

Surgical therapy usually involves myomectomy or total abdominal or vaginal hysterectomy.

Selecting the appropriate treatment is controversial. Abdominal or vaginal myomectomy is recommended for women under 40 years of age who wish to have children, and total vaginal or abdominal hysterectomy is suggested for women who have completed their families.

Abdominal myomectomy is considered a complicated procedure because of technical difficulties inherent in removing large fibroids from the abdominal cavity, controlling bleeding, and suturing the uterine defect. Laparoscopic myomectomy is a relatively new technique that treats symptomatic fibroids and avoids the complications associated with laparotomy and hysterectomy. This technique should be performed by advanced laparoscopic surgeons who have mastered techniques of laparoscopic suturing and tissue removal.

Before laparoscopic myomectomy, we perform an endometrial biopsy and a diagnostic hysteroscopy to evaluate the uterine cavity. This is done to exclude women with malignant or premalignant conditions.

Hysterectomy Unacceptable

The use of hysterectomy to treat myomatous conditions in post-reproductive women is no longer acceptable to increasing numbers of patients. Learning these alternative laparoscopic options requires diligence and dedication, but allows us to provide patients with alternatives to major surgery. This type of surgery is also less painful with a faster recovery period. It is also cosmetically more acceptable.

Each surgeon will have his/her level of expertise and experience which will determine the largest size and the number of fibroids they are comfortable removing. You might consider asking the doctor: how many women have you operated on with fibroids as large as mine? How many times have you needed to change to abdominal surgery in those cases? Can my fibroids be removed laparoscopically?

About 90% of fibroids can be removed laparoscopically in a safe environment. An option of hysterectomy is also discussed with the patient depending on the number and size of fibroids and desire of fertility.

See here for laparoscopic surgical options

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