management of uterine fibroids

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The Management of Fibroids
by
Jimi Odejinmi
Ukgynaecologist.com

FIBROIDS
The commonest benign growth of
the female genital tract

What are fibroids
• Fibroids are benign (non cancerous)
growths of the uterus (womb)
• They arise from single muscle cells
within the womb

How common are
fibroids?
• No fibroids are quite common
– Up to 30-40% of women have them
• They are 3 to 9 times commoner in black
women than Caucasians
– They tend to present at an earlier age in black
women
– They tend to be more numerous and more
symptomatic in black women at the time of
presentation

What causes
fibroids?
• No one knows what causes fibroids
• The womb is made up of muscle cells
and fibroids develop as a result of
enlargement of single muscle cells

What are the
symptoms
• Symptoms depend
– Location of fibroids
– Number of fibroids
– Size of fibroids

Fibroid locations
• Fibroids are categorised according to their
location
– Subserous
• Where most of the fibroid is located superficially
– Submucous
• Where most of the fibroid is located in the cavity of
the womb
– Intramural
• Where most of the fibroid is located within the
muscle of the womb
– Pedunculated
• Where the fibroid is attached to the womb by a stalk
containing blood vessels

Subserous
Submucous
Pedunculated
Intramural

WILL FIBROIDS INTERFERE
WITH MY ABILITY TO GET
PREGNANT
The majority of women with fibroids will get pregnancy and the
majority of women who get pregnant will have no problems.
However fibroids have been associated with
•Difficulties conceiving
•Miscarriage
•Degeneration and pain in pregnancy
•Preterm delivery
•Increased risk of placental separation (abruption)
•Obstructed labour
•Bleeding after delivery (postpartum hemorrhage)

Fibroids and fertility
• Not all fibroids impair fertility
• Fibroids most likely to impair fertility are
– submucous
• Distorting the cavity of the womb
– Intramural
• In the muscle of the womb distorting the cavity
• In women who have difficulty getting
pregnant removing fibroids from these
locations can improve chances of
pregnancy

What about
cancer?
• It is unlikely that fibroids become cancerous
particularly in young women
• In the older women the risk is estimated at
about 0.17%
• In one Australian study it is estimated at 1
in a million
• Rapid increase in size of fibroids however
usually alerts to the possibility of cancer

What treatment options
are available?
Options depend on a number of issues either
individually or in combination:
•Symptoms
•Desire for future fertility
•Number of fibroids
•Locations of fibroids
•Size of fibroids

Things to consider when thinking about
treatment
• Is treatment necessary?
– Only if you have symptoms
• if treatment is necessary
– Weigh up the risks against possible side
effects of treatment

TREATMENT OPTIONS FOR
SYMPTOMATIC FIBROIDS

DOING NOTHING?
For women who are not ready for intervention

WHAT HAPPENS IF I
DO NOTHING?

MEDICATION?
There is no medication that cures fibroids they only
make symptoms better
Medication may be appropriate for women who do
not want intervention or for shrinking fibroids prior
to surgery

What about
medication?

What types of
medication are there?

GNRH ANALOGUES?
These drugs induce false menopause and can shrink
fibroids by up to 30% in first 3 months. May be
advised for shrinking fibroids prior to surgery
Not suitable for long term use

Types of hormonal preparations

UTERINE ARTERY
EMBOLISATION
Procedure carried out by radiologists to reduce the
size and symptoms of fibroids
Suitability depends on
Desire to retain fertility
Age
Location of fibroids

What about Uterine artery
Embolisation?

What can I expect
from an embolisation

SURGERY
May be recommended for women with symptoms
from fibroids

If I want to have surgery,
what types are available?

MYOMECTOMY?
REMOVAL OF FIBROIDS INDIVIDIALLY TO RETAIN
WOMB AND REPRODUCTIVE POTENTIAL

What if I chose to have a
myomectomy?

What are the complications
of a myomectomy?
Incisions for laparoscopic
myomectomy

What are the advantages of
laparoscopic myomectomy

Am I a suitable candidate for
laparoscopic myomectomy?

Laparoscopic myomectomy images

HYSTEROSCOPIC
MYOMECTOMY
Suitable for selected women with fibroids in the cavity of the
womb

Am I suitable for a
Hysteroscopic myomectomy?

What could go wrong with
hysteroscopic myomectomy?

management of uterine fibroids

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