Gynaecology

Fibroids or myomectomy

Fibroids (myomas) are benign tumours that arise in the uterus (womb) and are a common cause of health problems that affect some women.

They are more common in women above the age of 35 but can sometimes affect younger women.

In our specialist Heavy Menstrual Bleeding Clinic more than 40% of women referred to us have fibroids, they are also the potential cause of sub-fertility (difficulty in falling pregnant). Women with fibroids may be seen in any of our gynaecology clinics.

Fibroids are benign with very little or no potential for malignant (cancer like) change. Rarely there are malignant tumours that can be mistaken for fibroids, these are excluded through and careful assessment.


SymptomsShow [+]Hide [-]

There are a number of symptoms or signs that women may notice and alert them or their doctor to possible fibroids:

  • Heavy Menstrual Bleeding/Heavy Periods
  • Fertility Problems (difficulty in falling pregnant)
  • Feeling a Mass (lump) in the abdomen
  • Effect of pressure from the fibroid on other organs (frequent passing urine, constipation, bloating or general pelvic discomfort).

Such symptoms or signs are not only seen with fibroids but would at least indicate the need for an examination or scan. This will help inform your doctor in how to manage your symptoms. Fibroids that are smaller and do not distort the uterine cavity are less likely to need treatment. If you attend one of our clinics, your doctor will want to know about the following:

  • Heavy menstrual bleeding – The amount of sanitary protection needed, episodes of “flooding” or passing blood clots, soiling the bed or anaemia due to blood loss
  • Your menstrual cycle - How often you bleed, for how long and whether you bleed between periods, after sex or in an unpredictable way
  • Pain – At the time of menstrual bleeding/your period or during sex
  • Your contraception – Condom, pill, injection, vasectomy, coil, none etc.
  • Fertility plan – Whether you are current trying for or planning a future pregnancy
  • General health - Medications, smear tests and medical history.

AssessmentShow [+]Hide [-]

Diagnosis may first be made by vaginal or sometimes abdominal examination but normally an ultrasound scan is needed to confirm this.

Occasionally we may also request a specialist Magnetic Resonance Scan (MRI) if needed. An ultrasound can be done by a simple abdominal examination scan (similar to an assessment in later pregnancy), although a more accurate assessment of fibroids, in terms of position, number and size, is normally best achieved with a vaginal (internal) scan. The scan itself is painless but some women find any internal examination uncomfortable and can opt for an abdominal scan. Scans in our clinics are done in a clean environment with an emphasis on respect, dignity and privacy. After your scan you can discuss it along with a management plan with your doctor.

You can take the “360 degree tour” to see our facilities.

The aim of a scan is to document the following:

  • Features that confirm a fibroid rather than something else
  • Number of fibroids
  • Size of fibroid(s)
  • Position of fibroid(s)
  • Other abnormalities that may need to be considered as part of management such as endometrial (womb cavity lining) polyps or ovarian cysts

ManagementShow [+]Hide [-]

The care of women found to have fibroid(s) is a balance between the impact on a woman’s wellbeing and the effect or outcome of treatment.

Most fibroids don’t actually require treatment and will even shrink after the menopause. For those women that need treatment there are a variety of medicines, simple interventions and more advanced surgical options to choose from. Some are intended to preserve or even enhance fertility. The Women’s Health Unit at the Royal Victoria Infirmary in Newcastle is one of a few if not the only centre in the north of england that can offer a full and comprehensive range of management options:

1. Medicines – Simple treatments include iron tablets to help anaemia, tranexamic acid tablets to help reduce blood loss and hormonal methods such as the simple contraceptive pill or progesterone only contraception. Your doctor will explain these and consider with you if you an option would be suitable. There are a number of therapies that have an “anti” – hormonal effect. Gonadotrophin Releasing Hormone injections (Zoladex®, Prostap®) reduce hormonal (oestrogen and progesterone) production and shrink fibroids as do Progesterone only Receptor Modulators (Ullipristal Acetate). Whilst these are very effective, their use is only short-term (3-6 months) and usually reserved for women in preparation for surgery.

Mirena System2. Progesterone Intra-Uterine Device /The Mirena® ”Coil” – This is one of the simplest and most commonly used treatments for heavy periods. It reduces or stops bleeding in most women, although it can take a few months to establish itself. It is a very secure contraceptive but is easily removed with no impact on long-term fertility. Unfortunately it is often less effective with fibroids that sit within or distort the uterine cavity. A scan can be requested to check this. Even so a Mirena system may be worth trying first as it is a simple first line treatment.

 

3. Myomectomy and Fibroid Resection – For some women fibroid(s) may be removed leaving them with an intact uterus (womb) Fibroid resectionand ovaries. This depends on their size, number and position as well as the indication for treatment (fertility, heavy bleeding or pain). Small fibroids (up to 4cm) that sit inside the uterine cavity may be removed through the cervix as part of a small surgical operation using a vaginal approach (Trans-Cervical Fibroid Resection) This can be done in the clinic with local anaesthetic or sedation or as a short procedure under general anaesthetic. We still offer endometrial ablation (Novasure®/Thermachoice®) for some women with heavy menstrual bleeding and fibroids, providing the womb cavity is relatively unaffected by the fibroids. Larger fibroids may be removed with surgery through the abdominal wall, either laparoscopically (key hole surgery) or with a laparotomy (open surgery). This is called myomectomy and is a procedure we are very familiar with in the Women’s Health Surgical Centre in Newcastle. When there are a large number of fibroids, then myomectomy becomes more difficult and other treatment options may be more suitable. Find out more on our Endometrial ablation page.

4. Selective Uterine Artery Embolisation - This is a procedure which is used to identify blood vessels that “feed” fibroids and to block these vessels. In Newcastle there is a wealth of experience and research into this Interventional Radiology Procedure. It is effective in reducing bleeding and symptoms of fibroids and is done under a local anaesthetic with the woman awake. Some women experience cramping pain in the first 24 hours and we often keep them overnight for monitoring and pain control. Suitable women include:

  1. Known fibroid related menstrual problems and symptoms
  2. At least 1 larger fibroid (usually 5-10cm)
  3. Family complete (this procedure can be used as second line management of fibroids for women still wishing to conceive but there still remains some uncertainty regarding the impact of this procedure on future pregnancies. Usually it is only considered when other options have been discussed and/or tried. Complete information is given in the National Institute for Website.

5. Hysterectomy – Sometimes the only option for management of fibroids is a hysterectomy. Da Vinci Robot surgeryThis is a complete treatment of fibroids. In Newcastle we have a team of specialist surgeon’s skilled in laparoscopic (keyhole) surgery and nearly all hysterectomies are done laparoscopically (including the advanced da Vinci Si robot as the surgical interface). Most women go home same day or after 1 over-night stay in hospital with the aim of returning to normal life within 6 to 8 weeks. Occasionally the size of fibroid(s) is simply too great so that open surgery is needed with a slight delay in recovery compared to laparoscopic surgery. A hysterectomy can be tailored to a women’s preferred choice, either removing or retaining the ovaries, tubes and/or cervix. These surgical options will have an impact on a woman’s well-being in the menopause. This will be discussed prior to surgery. You can get further information on our hysterectomy webpage.

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