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Hysteroscopic resection of fibroids

If you are considering having fibroid removal or have an operation planned, it is important to know all you can about it. This includes:

 

  • why you need this operation

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have fibroids in your uterus. These can cause a number of symptoms including:

 

  • pain
  • heavy periods, called menorrhagia
  • pressure on your bladder, bowel or spine.

 

 

Fibroids can cause miscarriages and problems when trying to become pregnant.

 

What are fibroids?

Fibroids are ball-like swellings in the wall of your uterus. They are created from an overgrowth of muscle fibres. You may have one or more fibroids. They are common, forming in three to four in 10 of all women (30-40%). Most fibroids do not cause problems and do not require treatment. They are benign but can sometimes be troublesome.

 

Fibroids can be:

 

  • serosal - just under the outside surface of the uterus
  • intra-mural - within the muscle wall of the uterus
  • submucous - just under the inside surface of the uterus.

 

Hysteroscopic resection of fibroids

 

For this operation you probably have submucous fibroids just below the lining inside your uterus.

 

What is the uterus?

To explain where your uterus is and what it does, the best place to begin is the vagina. Your vagina is a tube about five inches long. It runs from just in front of your rectum up into your pelvis. It is just behind your bladder. You can feel your bladder in your lower abdomen when it is full of urine.

 

At the top of your vagina is your uterus. It is about the size of your clenched fist. It is made of special thick muscle, but it is hollow inside with a special lining called the endometrium. The lowest part of your uterus, which juts into your vagina, is ‘the neck of the womb’, also called your cervix. Cervical smears are taken from the surface of your cervix.

 

The rest of your uterus is called the body. It thins out at the top to form two hollow tubes called the Fallopian tubes. You have a Fallopian tube on each side. These run sideways to end near your left or right ovary.

 

Your ovaries are slightly smaller than a golf ball. They lie deep in your pelvis just below your waist. Your ovaries make hormones and contain tiny eggs, which are too small to see with the naked eye.

 

What does the uterus do?

The uterus is where a baby normally develops during pregnancy. About once a month an egg in one of the ovaries grows and

breaks free from the ovary. It moves into the Fallopian tube and travels down the tube towards the uterus. At the same time, hormones make the endometrium thicker so that if the egg is fertilised by a sperm it can lodge in the uterus.

Hysteroscopic resection of fibroids 2

 

Often, the egg is not fertilised and it dies. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month. If the egg is fertilised it starts making extra hormones. These make the uterus and endometrium grow to take the developing baby.

 

What has gone wrong?

You have formed fibroids in the walls of your uterus, just under your endometrium. These swellings are a very common reason for heavy or painful periods. This is because they make the surface area of your endometrium larger than normal. The uneven surface of your endometrium over the fibroids can prevent a fertilised egg from lodging there properly. This can lead to infertility. The fibroids can also dislodge a growing baby. This can cause repeated miscarriages.

 

The aims

We remove the fibroids to make your uterus as normal as possible. The best method of removing the fibroids depends on their size, position and number.

 

In cases such as yours, where the fibroids are lying just under the endometrium, we do the operation using a special telescope, called a hysteroscope. We pass this through your vagina and cervix, into the body of your uterus. We pass instruments through the hysteroscope to remove the fibroids. We send the removed fibroid tissue to the laboratory for tests.

 

The benefits

We remove the fibroids to return the surface area of your uterus to a more normal size. This should make your periods less heavy and relieve your symptoms.

 

Removal of fibroids blocking your Fallopian tubes or cervix may cure infertility and reduce your chance of further miscarriages.

 

Are there any alternatives?

There are other ways of dealing with the fibroids.

 

  • Drug treatment - You can take drugs to make the fibroids smaller, but this is unlikely to be permanent and the fibroids may grow back.
  • Keyhole surgery - We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen. This is more commonly used for serosal or intra-mural fibroids.
  • Embolisation - This is a method of shrinking single fibroids by cutting off their blood supply. Under x-ray guidance we pass a fine tube, called a catheter, into an artery in your leg. We push it along to a position near the artery supplying blood to the fibroid. We inject tiny particles down the catheter to block the fibroid’s blood supply.
  • 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 will stop your bleeding problems permanently.

 

Discuss the pros and cons of each treatment with your gynaecologist.

 

What if you do nothing?

If you do nothing your period problem is likely to continue until you reach the menopause. The average age of the menopause is 51 years, but it may not start until you are 56. You need to consider if you can cope with your period problem until then.

 

If your bleeding is heavy you may become anaemic over time. Anaemia is when your blood does not contain enough oxygen-carrying, red blood cells for all your body’s needs.

 

Fibroids often slowly grow over years. They could become large enough to cause pressure symptoms as they push against your bladder or bowel.

 

Author: Dr David Hutchon F.R.C.O.G.  Consultant Gynaecologist.

© Dumas Ltd 2006

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