Should you surgically remove your uterine fibroids?

Uterine fibroids are a common concern in women of fertile age. They can cause multiple bleeding and pain-related symptoms as well as harm different aspects of a woman’s life.

Mr Mahantesh Karoshi is a consultant gynaecologist and specialist in the management of fibroids. He provides you with a brief guide to help you in deciding if surgery is the right path for you.

How common are uterine fibroids?

The incidence of uterine fibroids by age 35 is approximately 60 per cent among Afro-Caribbean women, increasing to over 80 per cent by the age of 50.

Caucasian women have an incidence of 40 per cent by the age of 35, and almost 70 per cent by age 50.

Should all women have uterine fibroids surgically removed?

There are two important rules when it comes to uterine fibroid removal:

1. Not all fibroids need surgical removal

2. Women who undergo a surgical procedure for fibroids usually suffer from either one or a combination of the following:

• Heavy menstrual bleeding.
• Bleeding between periods.
• Pain or pressure in the belly.
• Frequent urination.
• Trouble emptying the bladder.

What are the types of fibroid surgery?

There are two types of fibroid procedures: myomectomy and hysteroscopy. Which one a person undergo depends on:

• The size of the fibroids.
• The number of fibroids.
• Where the fibroids are located in the womb.
• Whether a woman wants to have children in the future.

What is myomectomy?

In myomectomy, fibroids are removed surgically to relieve bleeding and other symptoms. This surgery is an option if the affected woman would like to have children in the future, or if the woman wants to keep her uterus for another reason.

About 80 per cent of women who undergo the surgical removal of fibroids experience relief from their symptoms or see their symptoms reduced. The fibroids won’t grow back after surgery, but women may develop new fibroids.

Up to one in three women who undergo fibroid surgery will need a repeat procedure within five years because they grow new fibroids. The recurrence of fibroids also depends on the woman's age at the time of surgery. It’s less likely in a woman’s late forties and more likely in their late twenties.

This surgery can be done in one of three ways , depending on the number, size, and location of the fibroids.

1. Hysteroscopy

Hysteroscopy is more effective for women with smaller and fewer fibroids. This procedure can also remove fibroids that have grown into the inside of the uterus.

During the procedure, the doctor inserts a long, thin, telescope with a light through the vagina and cervix into the uterus. The fluid is injected into the uterus to expand it and help doctors see the fibroids.

Then, the surgeon uses a device to cut the fibroids. The fibroid pieces wash out with the fluid that was used to fill the uterus. With hysteroscopy, a woman may go home the same day of the surgery.

2. Abdominal myomectomy

This procedure, also known as a laparotomy, is better for large fibroids, but it leaves a bigger scar than the other two types of myomectomy. For this procedure, the surgeon makes a cut in the belly and removes the fibroids.

After abdominal myomectomy, patients typically stay in the hospital for two to three days. Complete recovery takes two to six weeks.

3. Laparoscopy

Laparoscopy is used for women who have smaller and fewer fibroids . During laparoscopy, the surgeon makes a few small cuts in the belly. A telescope is inserted into one of the openings to help the doctor to see inside of the pelvis and around the uterus. A tool is inserted into the other opening to remove the fibroids.

Surgeons may then cut fibroids into small pieces before removing them.

What is a hysterectomy?

A hysterectomy removes a part of the uterus or the entire uterus. This procedure may be an option if a woman has lots of fibroids, if they’re large, and/or a woman is not planning to have children in the future.

The surgeon may leave the ovaries and cervix in place. The woman will continue to produce female hormones.

Hysterectomy is the only surgery that cures uterine fibroids and fully relieves their symptoms. However, women will no longer be able to have children.

The management of fibroids is one of Mr Mahantesh Karoshi’s areas of professional expertise. Click here to learn how he can help you.