Uterine fibroids are very common and rarely develop into cancer (although the risk is 1:1000). Fibroids may be small as a seed or as big as an orange or even larger. They give you symptoms depending on their size and place in the uterus. For example:
- Abnormal vaginal bleeding and iron deficiency or anaemia especially fibroids that opened into the uterine cavity.
- Pelvic pressure against the rectum or against the bladder (urinary frequency).
- Lower backache or pelvic pain.
- Pelvic masses.
- Pain with sexual intercourse.
- Infertility and problems with implantation causing recurrent miscarriages (intracavitary fibroids).
Although the cause for developing fibroids is not known, estrogens (childbearing age) and genetic causes (fibroids may be common in certain families) may be responsible for the fibroids.
Fibroids may be suspected or diagnosed through an internal examination by your Doctor. Other tests like a pelvic ultrasound may be needed as well. Assessment of your pelvis by laparoscopy (keyhole surgery) or by hysteroscopy (thin telescope to assess the uterine cavity) may also reveal you have fibroids. Treatment for fibroids should be individualized - depends on the size of the fibroids, degree of symptoms, your need for a future pregnancy, your age, rate of growth of the fibroids, etc.
Treatment for fibroidsManagement of fibroids is by either observation (if they are not giving symptoms or are very small) or surgery. Surgical options are as follows:
- Myomectomy: The excision of the fibroid with preservation of the uterus. It can be achieved in some situations with keyhole surgery.
- Myolysis: Destruction of the fibroids using an electrical needle.
- Embolization of the uterine arteries: A relatively new procedure where a catheter is passed into one of your legs arteries until the uterine artery is reached. Then small plugs are injected with the purpose of blocking the blood supply of the fibroids. It is not without complications and you should discuss it with your Doctor first.
- Hysterectomy: This is the removal of the uterus with all the fibroids. Most of the times can be achieved with keyhole surgery and morcellation (cutting into pieces) of the uterus.
There are 3 Types of Hysterectomy
Abdominal hysterectomyThis operation is indicated where there is significant pathology and especially when the uterus is significantly enlarged and therefore removal of the uterus through the vagina becomes too technically difficult. An incision, which is usually 15 cm in length, is done in the lower abdomen to remove the uterus. The operation takes 1 to 2 hours. You are likely to need pain relief by narcotics/injections and the stitches or clips are removed on day 5 after your operation. A full recovery may take 2 months.
Vaginal hysterectomyThe uterus is removed through the vagina without a cut or punctures in the abdominal wall. This conventionally has a good reputation with a minimal degree of postoperative pain. It is suitable for those ladies in whom prolapse is a major indication for surgery and when the uterus is reasonably normal sized, and there is no reason to suspect any other intra-abdominal problem particularly relating to the ovaries requiring inspection and/or operation. The operation takes 1 to 1.5 hours or longer if a pelvic floor repair is needed. A thorough examination of your pelvis is not possible and the removal of the ovaries may be difficult or impossible.
Laparoscopic hysterectomyThis is an innovative procedure as the first laparoscopic hysterectomy in the world was performed only in 1988. A thin telescope connected to a camera is placed through a small incision in the navel. Three or four other incisions are made to enable other instruments to be used. The largest incision is only 10 mm long. This operation takes 2-2.5 hours. The advantage of this operation is that the degree of pain is very minimal requiring pain relief not by injection but rather by tablets. There is therefore a substantial reduction in the use of narcotics. The expected duration of stay in hospital after the operation should be of the order of 2 days and the woman undergoing this procedure should be able to return to work in 2 weeks. The disadvantage of this innovative procedure is that it is more expensive.
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