Myomectomy

1. What are uterine /broids?

Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus . They also are called leiomyomas or myomas. The size, shape, and location of 3broids can vary greatly. They may be inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one 3broid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.

Who is most likely to have fibroids?

Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African women than in white women. They also seem to occur at a younger age and grow more quickly in African women.

What are symptoms of fibroids?

3. Fibroids may have the following symptoms:
   • Changes in menstruation
   • Longer, more frequent, or heavy menstrual periods
   • Menstrual pain (cramps)
   • Vaginal bleeding at times other than menstruation
   • Anaemia (from blood loss)

• Pain
  • In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
  • During sex
• Pressure
• Difficulty urinating or frequent urination
• Constipation, rectal pain, or difficult bowel movements
• Abdominal cramps
• Enlarged uterus and abdomen
• Miscarriages
• Infertility

Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.

What complications can occur with /broids?

Fibroids that are attached to the uterus by a stem may twist and can cause pain, nausea, or fever. Fibroids that grow rapidly, or those that start breaking down, also may cause pain. Rarely, they can be associated with cancer. A very large fibroid may cause swelling of the abdomen. This swelling can make it hard to do a thorough pelvic exam.

Fibroids also may cause infertility, although other causes are more common. Other factors should be explored before fibroids are considered the cause of a couple’s infertility. When 3broids are thought to be a cause, many women are able to become pregnant after they are treated.

6. How are fibroids diagnosed?

The first signs of fibroids may be detected during a routine pelvic exam. A number of tests may show more information about fibroids:

• Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
• Hysteroscopy uses a slender device (the hysteroscope) to see the inside of the uterus. It is inserted through the vagina and cervix (opening of the uterus). This lets your health care professional see 3broids inside the uterine cavity.
• Hysterosalpingography is a special X-ray test. It may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
• Sonohysterography is a test in which fluid is put into the uterus through the cervix. Ultrasonography is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
• Laparoscopy uses a slender device (the laparoscope) to help your health care professional see the inside of the abdomen. It is inserted through a small cut just below or through the navel. Fibroids on the outside of the uterus can be seen with the laparoscope.

Imaging tests, such as magnetic resonance imaging and computed tomography scans, may be used but are rarely needed. Some of these tests may be used to track the growth of 3broids over time.

When is treatment necessary for fibroids?

Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal the need for treatment:

• Heavy or painful menstrual periods that cause anaemia or that disrupt a woman’s normal activities
• Bleeding between periods
• Uncertainty whether the growth is a fibroid or another type of tumour, such as an ovarian tumour
• Rapid increase in growth of the fibroid
• Infertility
• Pelvic pain

Can medication be used to treat fibroids?

Drug therapy is an option for some women with 3broids. Medications may reduce the heavy bleeding and painful periods that fibroids sometimes cause. They may not prevent the growth of fibroids. Surgery often is needed later. Drug treatment for fibroids includes the following options:

Birth control pills and other types of hormonal birth control methods— These drugs often are used to control heavy bleeding and painful periods.

• Gonadotropin-releasing hormone (GnRH) agonists—These drugs stop the menstrual cycle and can shrink 3broids. They sometimes are used before surgery to reduce the risk of bleeding. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her 3broids usually return to their previous size.
• Progestin–releasing intrauterine device (IUD) —This option is for women with 3broids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the 3broids themselves.

What types of surgery may be done to treat fibroids?

• • Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new 3broids may develop. If they do, more surgery may be needed.
  • Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

Are there other treatments besides medication and surgery?

Other treatment options are as follows:

• Hysteroscopy—This technique is used to remove fibroids that protrude into the cavity of the uterus. A

resectoscope is inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. Hysteroscopy often can be performed as a day procedure.

• Uterine artery embolization (UAE)—In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases.

• Magnetic resonance imaging-guided ultrasound surgery—In this new approach, ultrasound waves are used to destroy fibroids. The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging. Whether this approach provides long-term relief is currently being studied.