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What are fibroids?

As many as 30% of women have fibroids, benign (non-cancerous) growths that develop within the uterus.

Genetically based and not associated with exercise or diet. Equal opportunity condition but some races are more predisposed to it. A rogue muscle produces collagen which then hardens to become a ball.

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Subserosal fibroid would not cause heavy bleeding but bulk symptom needs to urinate frequently.

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Fibroids removed during myomectomy - Hard white rubbery masses. What symptoms do fibroids cause?

Heavy bleeding every month their period are heavy every hour needs to change some needs to be given transfusion due to anaemia.
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Fibroid is denser so blocks off more sound waves and appears darker.

Bladder pressed so feels urge to urinate frequently.

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Options for Treatment Depends on the symptoms. If no symptoms, no necessity for intervention since fibroids are not cancerous.

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First line of treatment: 1. Birth control pills

but problem is they dont necessarily work. 2. GnRH agonist

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 Problem is it cannot be used long-term because it can cause osteoporosis. Not suitable for use in > 45 year old women damage to bone strength. Women do not enjoy being on this medication because it can cause hot flashes and vaginal dryness No point to use it for short term because fibroids comes back to the same size as before. Usually used on those who are considering surgery and wants to relief the symptoms in the meantime

3. Progestin in IUD

To date, no effective medical treatment for fibroids per se. Some compounds are on investigation but there are complications associated with the medication so not on the horizon just yet.

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Surgical treatment

Myomectomy remove fibroids only or Hysterectomy remove the uterus as well. Abdominal myomectomy

Standard operation for those who wants to have children in the future.

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Done in the operating room, about 45 minutes. An instrument goes into a hysteroscope to shave off the fibroids.

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Laparoscopy more challenging However these days, people used a robot which allows the surgeon to put in the many stitches needed more effectively and with less complications.

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Hysterectomy

Hysterectomy is a very common surgery 2nd most common after caesarian. But jury is out if it is an over-prescribed procedure.

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Although 1 in 3 women in the US would have had a hysterectomy, the number is decreasing each year as other options become available.

A partial or supercervical hysterectomy leaves the cervix intact. No statistical evidence of any advantages of leaving the cervix eg decreasing prolapsed etc in the short term. Long term still no data.

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Hysterectomy means taking out only the uterus and not necessarily ovaries and the fallopian tubes. Ovaries can stay and the woman can go into menopause when the time comes.

Advantage no marks. But uterus must not be too large. Can be a very nice option.

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A machine (morcellator) can come in and cut the uterus into smaller sections and sucked it out.

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Pros and Cons of Myomectomy and Hysterectomy

About 10% will go on to have new fibroids developing.

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No change in hormone levels because ovary is left intact.

Some evidence of increased risk for incontinence or pelvic relaxation in 10, 20 or 30 years in the future.

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Blocks the arteries feeding the fibroids it does likely have an impact on pregnancy. Higher miscarriage rates and inability to conceive. Should be reserved for people who have finished childbirth. Along with that there is some pain patients typically stay 1 day in the hospital and take pain killers for about 10 days. It is like giving a heart attack to the fibroids.

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Where the sound waves are focused into a point (the size of a rice grain), it generates a lot of heat which kills the fibroid cells. Usually the centres of the fibroids are killed off. Over time the FDA has allowed for more of the fibroids to be treated. The jury is still out on how effective this treatment is.
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Hysterectomy 4-6 weeks for abdominal hysterectomy but if laparoscopy, recovery period is 2 4 weeks. Most definitive option is hysterectomy but other options are viable particularly if you want to consider childbirth, retaining the uterus etc.

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