Uterine Fibroids

How are uterine fibroids treated?

The majority of women have small or moderate size fibroids. In general, these women do not experience any problem from the fibroids and do not require treatment. In other women, the decision on initiation and choice of treatment of fibroids depends on individual circumstances. The treatment available includes the following:

Treatment of heavy menstrual flow

Menstrual flow can be reduced with medication such as tranexamic acid, danazol, progesterone hormone or gonadotrophy releasing hormone analogues. This form of treatment is appropriate when the fibroid is small or moderate in size. It is also more appropriate among women who are close to menopause when treatment may be limited to a short period of time before menopause ensues. This treatment is not a cure of fibroids.

Hysteroscopic resection of fibroid

Submucus fibroid or fibroid polyp can be effectively removed by resection through a hysteroscope. It is a minimally invasive procedure through the vaginal and cervical approach. This technique is suitable for women of any age, including those considering pregnancy in the future.

Uterine artery embolisation

Solitary fibroid of moderate or moderately large size can be treated by blocking the blood flow (embolisation) to the fibroid. This is an interventional radiology procedure involving inserting an arterial catheter to the uterine artery under fluoroscopic guidance. This technique is not a complete cure for fibroids.

Instead, after successful arterial embolisation, the size of the fibroid can shrink by almost 60 percent and the heavy menstrual flow can be reduced by almost 80 percent. The treatment is appropriate for women who want to avoid the risk of surgery. It is not appropriate for women whose fibroids need to be submitted for pathological tests.

Surgical removal of fibroids, also known as myomectomy

In this operation, fibroids are removed and the uterus is repaired for resumption of its normal menstrual and childbearing functions. Fibroids of moderate to moderately large sizes can be effectively removed through laparoscopic surgery. Laparoscopy is proven to be efficient and is associated with less pain and shorter recovery time compared to conventional surgery. Robotic surgery is an alternative minimally invasive procedure for treating these types of fibroids.

On the other hand, traditional open surgery remains the most versatile approach to remove all fibroids, regardless of the size and their location on the uterus. Good surgical repair on the incisions on the uterus confers additional safety on the integrity of the wounds in ensuing pregnancies.

Hysterectomy or removal of the uterus

For women who do not desire to conserve the fertility potential, removal of the uterus (hysterectomy) confers the most appropriate and complete treatment.

What are the surgical options for uterine fibroids?

Fibroids are growths made up of connective tissue and muscle cells of the uterus(your womb). They are typically non-cancerous and can present as a single or multiple growth in and around your uterus. Fibroids are very common and most do not require treatment. Depending on your symptoms, the location, size and number of the fibroids, different treatment can be offered. Myomectomy is a surgery in which the fibroids are removed without removing the uterus. This may be recommended if you have severe symptoms like heavy menses, heavy pelvic sensation, urinary problems due to the fibroid etc.

Surgery can be performed in 2 ways:

• Laparotomy(open): a cut of about 10-15cm is made on the abdomen. This can be horizontal or vertical
• Laparoscopy(minimally invasive): Small cuts made on the abdomen (about 1cm). Carbon dioxide is released into your abdomen to facilitate the surgery and a scope is inserted for viewing. Instruments are then placed through the small cuts to perform the surgery. The fibroids are then cut or morcellated into smaller pieces to allow removal through the small cuts

The choice of surgery depends on a few factors including the size and number of fibroids, the location of the fibroids, complexity as well as patient factors and surgeon expertise.

As with all surgeries, complications can sometimes occur even with the best effort of the surgical and nursing teams. Some of these are inherent in any operative procedure. If complications do occur, recovery may take a longer period of time and further procedures may be necessary.

What are the risks and complications of uterine fibroid surgery?

Here are some risks and complications that may occur and this list is not exhaustive:

Common complications include bleeding and infection, wound complications(infection, breakdown, delayed healing, keloid formation), pain or numbness over the wound site

Other less common complications include injury to the surrounding organs(e.g. urinary bladder, bowels, blood vessels etc), formation of clots in the deep veins, scar tissue formation etc.

In certain circumstances, if a laparoscopic surgery was planned, it may be converted to an open surgery due to technical difficulties or complications encountered.

Even when myomectomy is successful and the fibroids are removed, new fibroids may grow. There is a risk of recurrence of 15-30% in 10 years.

In some cases, a Caesarean section for delivery in future pregnancies will be advised if there is a concern regarding the scar on your uterus weakening and opening up during labour. Your doctor will discuss this with you after surgery.