Fibroids are innocent (benign) round balls of fibrous tissue found in the womb (uterus). The medical name is uterine leiomyoma or uterine myoma. They are very common and are often without symptoms. If they are small and not causing a problem, they do not always need treatment.
Fibroids can grow
- in the lining of the womb (submucosal fibroid)
- inside the womb muscle (intramural fibroid)
- from the outside of the womb (subserous or pedunculated fibroid)
Whether they cause any symptoms depends on their size and where they are growing. They can cause abnormal bleeding, pressure on the bladder or bowel, and difficulty getting pregnant.
There are now several options for treatment of fibroids. They can be removed by an operation (myomectomy) or reduced in size by uterine artery embolisation or focussed ultrasound/laser treatment of fibroids.
This is a major operation with 4-5 days in hospital and six weeks recovery. Intramural fibroids are shelled out from the womb - rather like peeling an orange from inside its peel.
If the fibroid is growing into the lining of the womb, the fibroids can be cut away using a special telescope inserted through the entrance of the womb (cervix). This type of operation is called a Transcervical resection of fibroid and involves 1-2 days in hospital. It is still considered a major operation, but the recovery is shorter (usually about 2 weeks).
About 1 in 4 women need further surgery after myomectomy, either because more fibroids grow, or because their symptoms still need some treatment. If there is major bleeding at the time of the operation, it is possible to place extra stitches to control it, but an an emergency hysterectomy may be required for life-theatening bleeding. The literature reports that this happens in 1 in 200 operations.
Myomectomy will leave a scar on the womb. This will be very strong, but can weaken during labour. You may be advised that Caesarean section is needed. The operation can result in adhesions that reduce your chance of getting pregnant naturally.
If you have completed your family, then hysterectomy may be the right choice for you. Fibroids are the commonest reason for a woman choosing a hysterectomy.
Hysterectomy has less blood loss at operation, is a shorter operation, is less painful afterwards, fewer complications and a shorter hospital stay (3-4 days) than myomectomy.
Treatment with Gonadotrophin releasing hormone agonist given as an injection or nasal sniff produces a temporary and reversible menopause. This shrinks the fibroids, but the effects are only temporary. The fibroids re-grow to their original size, within a few months of stopping treatment. These medicines are mainly used to reduce the size of fibroids prior to surgery and to reduce blood loss at operation.
Uterine Artery Embolisation
Introduced about ten years ago, uterine artery embolization is a new treatment for fibroids. There is no long-term data available. The treatment is only recommended if you need an operation because of symptoms from your fibroids and if the fibroids aren’t too large. Symptoms improve in up to 9 out of ten women. Up to one in ten women go on to have a hysterectomy, either because the treatment didn’t work, or because of infection. Death as a result of overwhelming infection has been reported.
A needle is inserted into the groin (femoral) artery, through an area of skin that has been locally anaesthetised. A plastic catheter (tube) is inserted down the centre of the needle and threaded through the arteries to reach the uterine arteries. Tiny particles of plastic are injected which block the uterine arteries and deprive the fibroids of their blood supply, so that they shrink.
Magnetic Resonance (MR) Image - Guided Percutaneous Laser Ablation of Uterine Fibroids
Again, a new treatment for fibroids and the long-term effects are not known. The treatment is carried out under sedation. A local anesthetic is injected into the skin and under MR–image guidance, needles are inserted, into the centre of the targeted fibroid. Laser fibres are inserted down the centre of each of the needles and laser energy is then used to destroy the fibroid.