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Open myomectomy

If you are considering having a fibroids operation or have a fibroids 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 when treating fibroids, 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 effects on your bladder, bowel or spine.
  • Problems with becoming pregnant.
  • Miscarriages.

 

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.
Open myomectomy

 

For this operation you probably have serosal or perhaps intra-mural fibroids.

 

The clinical name for a fibroid is a myoma. Removal of fibroids is therefore called a myomectomy.

 

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.

Open myomectomy 2

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.

 

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?

Fibroids have formed in the wall of your uterus. They can make the surface area of your endometrium much larger than normal. This often causes heavy and painful bleeding during periods.

 

The surface of your endometrium can become uneven over the fibroids. This may prevent a fertilised egg from lodging in your endometrium where it would develop into a baby. This can lead to infertility. Fibroids can also dislodge a growing baby causing a miscarriage.

 

As fibroids become larger they can cause pressure symptoms. They often press against the bladder causing it to feel full but they may put pressure on other structures such as the bowel and spine.

 

Sometimes fibroids outgrow their blood supply. The fibroid may then become soft as it degenerates. Oddly, this can cause bleeding into the fibroid that is usually painful.

 

The aims

The aim of a myomectomy is to make your uterus as normal as possible by removing the fibroids. The best method of removal depends on the size, position and number of fibroids. For this operation we remove the fibroids through a cut in your lower abdomen. Ask your doctors why an open myomectomy is the best method for you.

 

The benefits

Removing the fibroids will make your uterus as close to normal as possible. It will reduce the surface area of your endometrium. This should make your periods less heavy and relieve your symptoms. If the fibroids are blocking your Fallopian tubes or cervix then removal may cure infertility or reduce your chance of further miscarriages.

 

An open operation also allows your surgeon to directly examine the other structures within your lower abdomen.

 

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.
  • Hysteroscopic resection - We can remove submucous fibroids lying just beneath your endometrium using a special telescope, called a hysteroscope. We pass this into your uterus through your vagina. There is another leaflet within this series covering hysteroscopic resection of fibroids.
  • Keyhole surgery - We can sometimes remove smaller fibroids using keyhole instruments passed through tiny cuts in your abdomen. This is called a laparoscopic myomectomy.
  • 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 would be a certain way of dealing with the problem.

 

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

 

What if you do nothing?

Heavy and painful periods will not usually improve until they stop when 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.

 

If your fibroids are causing pressure symptoms, then these will usually get worse as the fibroids grow over the years.

 

If you do nothing you may miss the chance to prevent miscarriages and cure infertility.

 

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

© Dumas Ltd 2006

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