What are fibroids?
Uterine fibroids are non-cancerous growths made up of muscular and fibroid tissue. Fibroids, also known as leiomyomata, may either grow as a single fibroid or in clusters. A single fibroid may vary in size.
On the basis of their location in the uterus, fibroids can be divided in to three groups:
Subserosal - Fibroid(s) that grow on the outer covering of the uterus (womb).
Intramural - Fibroid(s) that grow within the muscular wall of the uterus.
Submucosal - Fibroids(s) that grow underneath the uterine lining. 3
Most fibroids do not cause problems and do not require treatment. However, sometimes they can be troublesome and can cause a number of symptoms including:
- Heavy periods.
- Pressure effects on your bladder or bowel
- Problems with becoming pregnant.
How are fibroids treated?
There are a number of ways of dealing with fibroids:
Drug treatment - You can take drugs (known as GnRH analogues). These reduce oestrogen levels in your body and this causes the fibroids to shrink, but this is unlikely to be permanent and the fibroids may grow back. Your doctor may want you to start these drugs to shrink the fibroids before you have surgery (myomectomy), however, these drugs also stop menstrual bleeding and pelvic pain and should not be taken for more than six months. They can cause a number of undesirable side effects, including menopause-like symptoms, such as hot flushes and vaginal dryness.
Uterine Artery Embolisation - This is a method of shrinking single fibroids by cutting off their blood supply. Under X-ray guidance a fine tube (catheter) is passed into the uterine arteries and small particles are injected to embolise (block) the supply of blood without removing the fibroid. This procedure is done under a local anaesthetic and is minimally invasive, with no scars.
Hysterectomy - This is an operation to remove your uterus. If you never want to become pregnant and do not mind losing your uterus then this would be a certain way of dealing with the problem.
Myomectomy – this is a surgical procedure that removes fibroids and leaves the uterus (womb) intact. A myomectomy may not always be possible as it depends on your personal circumstances, such as the size, number and position of your fibroids.
Why would I have a Myomectomy?
Surgery may be considered if your fibroid symptoms are particularly severe and all forms of medication have proved ineffective.
How is the Myomectomy performed?
There are different ways to perform the myomectomy
In an abdominal myomectomy, an incision is made in your abdomen (which may be around 12 cm or less). This enables the doctor to reach the uterus so that the uterine fibroids can be removed from the wall of the womb (intramural) and the outer layer of the womb (subserous). Once the fibroids have been removed the uterus and abdomen are stitched up. You will be given a general anaesthetic for this procedure. You can expect to stay in hospital for 3-4 days.
Sometimes smaller fibroids can be removed using keyhole instruments passed through tiny cuts in your abdomen. This is called a laparoscopic myomectomy . A laparoscope (a narrow tube with a fibre optic light) is inserted into the womb through a tiny cut in the abdomen. Other small cuts are made in the same area to insert instruments that can dissect and remove the fibroids. You will be given a general anaesthetic for this procedure. You can expect to stay in hospital for 1-2 days.
A hysteroscopic myomectomy (or hysteroscopic resection) is where a small hysteroscope is inserted through the vagina and the cervix, so that one or more fibroids can be removed. This procedure can only be done where there are small fibroids which are just underneath the uterine lining (submucous fibroids). You will be given a general anaesthetic and will probably be able to go home the same day.
What are the complications of a Myomectomy?
Most women will not experience any problems following a myomectomy. As with any surgery, there is a slight risk from the general anaesthetic. Other risks may include, some blood loss, infection and perforation of any of the organs of the pelvis, mainly the uterus, bowel, bladder or blood vessels.
Will the fibroids grow back?
Once fibroids are removed those particular fibroids cannot grow back. But fibroids are caused by genetic mutations within uterine muscle cells. This process can over time create new fibroids. In addition, there can be tiny fibroids that cannot be seen or felt, and therefore cannot be removed. This is most likely to happen in someone who has many little fibroids. Recurrence is least likely in women with one or a few large fibroids than with multiple small ones.
What can I expect immediately after the operation?
To perform a successful laparoscopy your abdomen will be inflated with air. This can cause lower abdominal, upper leg and commonly shoulder tip pain. You will also have 2-4 incision sites where the laparoscope and instruments were inserted. These may be tender immediately after your operation and for the next 10-14 days.
If you are having an abdominal myomectomy, or uterine artery embolisation, you may return to the ward with a Patient Controlled Analgesia System (PCA). This will allow you to control your own pain relief. It administers a set dose of morphine or pethidine each time you press the hand held green button. It has a safety lock out system of five minutes to prevent overdose occurring. The PCA will remain with you for 1-2 days following your operation and can be topped up with oral and/or rectal analgesia (pain relief). Once the PCA is discontinued you will receive regular oral pain relief.
For Uterine Artery Embolisation you may have a tube inserted into your bladder (which will drain urine into a bag) prior to your procedure. This may also be in place after your procedure. If you are having an abdominal myomectomy, you may have a catheter placed in your bladder during your operation whilst you are asleep. It may be removed the day following your surgery.
How will my wound be closed?
Your incision sites may either be closed with very small sutures (stitches) if having a laparoscopy or with surgical glue. If you are having an abdominal myomectomy your wound will be slightly bigger. Stitches, surgical glue, clips or staples may be used. Sutures usually dissolve within 10-14 days for a laparoscopy. Glued sites may be left to heal, no intervention is required. If you are having an abdominal myomectomy, your stitches, clips or staples are normally removed by the nurse between 5-10 days.
It is common to have some mild vaginal bleeding for up to seven days after your operation. Do not use tampons during this period, only sanitary towels. Tampons may increase your risk of developing a mild infection. If you feel your bleeding is prolonged or becomes offensive, please seek advice from your doctor. Excessive or prolonged menstrual bleeding is one of the most common symptoms of fibroids. Treatment of your fibroids should now stop this.
How should I care for my wound?
Some oozing from the site(s) may be noted for the first 24 hours after your operation and a dry dressing may be applied. After this time the site should be left clean, dry and exposed. (Please do not use any perfumed products on your wound). Should oozing continue and/or the areas become inflamed/red/ smelly, when you are at home, please seek advice from your doctor, as you may have developed a mild infection. You may bathe and/or shower as normal, it does not matter if you get the sutures or glue wet. Do not use any perfumed products on your wound when bathing/showering. Please ensure that you dry your wound with a clean towel after personal cleansing.
Will I have a scar?
Laparoscopic scarring is minimal as the incision sites are very small and any scarring will fade with time. If you are having an abdominal myomectomy you may have a slightly bigger scar but, again, this will fade with time.
When can I return to my normal activities?
You will feel tired in the first few days following your operation. Rest and recover and resume your normal activities when you feel ready to. However, avoid heavy lifting, housework and strenuous exercise for 10-14 days. Following laparoscopic surgery you can normally return to work within 7-14 days. After an abdominal myomectomy this might be slightly longer. Do not attempt to drive until you can wear your seatbelt comfortably and feel confident that you would be able to perform an emergency stop without any abdominal discomfort.
When can I have sex again?
Do not resume having sexual intercourse until vaginal bleeding has stopped and you feel able and comfortable to have sex.
Will my periods be affected?
Your periods can be affected by your operation. They may be heavier, lighter or delayed. Constipation following surgery This is avoidable. Eat a high fibre diet and drink plenty of water (approximately eight glasses per day) and gradually increase your exercise.