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Uterine Fibroids & Polyps

Uterine Fibroid and polyps are growths of muscle and fibrous tissue in the uterus which are usually not cancerous and often cause problems with heavy bleeding, difficulties in conceiving or recurrent miscarriages. Fibroids and polyps are diagnosed with the help of examination, ultrasound scan, MRI and CT scan. If they need to be treated they are mainly removed by surgery but there are non-surgical treatments too.

Although we are using fibroids and polyps together, there is a difference, and that lies in their origins. Fibroids are tumours of uterine muscle tissue, while polyps are tumours of the uterine lining.

Women often do not know if they have fibroids or polyps as only 1 in 3 women show symptoms, these are:

  • Bleeding – Both fibroids and polyps can cause heavy bleeding as well as bleeding between periods and at times bleeding after sex.
  • Pain – Fibroids can cause cramping and discomfort whereas polyps usually cause no pain.
  • Enlarged Uterus – Polyps are generally too small but fibroids that have grown large can cause a uterus to become bigger than normal size.
  • Lower back pain and pelvic pain
  • Frequent urination
  • Constipation
  • Pain or discomfort during and after sex

The treatment of fibroids and polyps will depend first on what symptoms they cause. So if Fibroids with no bleeding or pain,they may not need to be treated unless fibroids are large in size (over 12 weeks pregnancy size uterus) or grow fast that can feel even from stomach.

If fibroids or polyps cause symptoms we have described above they would not need to be treated to control the bothersome symptoms patients experience.

The type of surgery that is recommended would depend on the size of fibroids, the location of the fibroid as well as number of fibroids with the women’s desire for future pregnancies and the symptoms that the fibroids are causing.

For example, a small fibroid that is inside of the uterine cavity that is causing irregular menstrual bleeding, Infertility or sometimes bleeding during and after sex, would be treated with hysteroscopy method for resection of the fibroid. Hysteroscopy is a procedure we perform from vagina and through the cervix with the usage of a little telescope that is inserted into the uterus. The uterine cavity is expanded with normal saline and fibroid is resected in small pieces and sent to the lab for further investigation. Few patients are daignosed with large fibroids, or multiple fibroids in the uterus, who has pain or heavy menstrual flow can choose to have the procedure to remove the fibroids. If they do not wish to have children in the future, then it will be a hysterectomy and if they wish to have children in the future it would be a myomectomy thats removing just fibroids and saving the uterus. Myomectomy or hysterectomy can either be done through laparotomy, just like caesarean section type of cut or laparoscopy (keyhole) surgery it depend on the size and the number of fibroids if its not too big.

The non-surgical way of managing fibroids is by uterine artery embolization. This procedure is done by a radiologist in a special setting and the meaning of the procedure is to block the blood supply to the fibroids, which will then lead to shrinkage of the fibroids. But not all fibroids and not all patients are suitable for this procedure and the doctor will be able to advise for whom this procedure is suitable.

The special procedure preparation would be advised individually to each patient overall.

Before general anaesthesia, we advise the patient not to eat or drink for six hours prior. The procedure is performed in the operating room. It can be either a day procedure if it’s a hysteroscopy and sometimes patients have to stay overnight if it is laparoscopy (keyhole) surgery. Patients who undergo laparotomy will generally stay in the hospital for 2 nights after the surgery. There will be no pain as you will be asleep during the procedure, the anaesthetist will see you before the surgery to discuss anaesthesia and advise on what type of anaesthesia you will recieve.

The duration of the procedure would depend on what type of procedure we’re performing also size and number of fibroids and also any previous surgery or any other comorbidities that are involved.

After the procedure, we would advise patient to take time off work for anything from one to two weeks for laparoscopy and hysteroscopy procedures for laparotomy four to six weeks after the procedure. Pain levels are moderate and usually controlled well with oral medications.

The possible complications involve infection, wound infection and bleeding. Quite often patient develop bladder infections and more rare and significant risks such as clots that may occur. We usually go into detail about any type of complications during preoperative counselling.

For the procedure through the abdomen such as laparotomy or laparoscopy(Keyhole), there will be a small scar involved. It takes four to six weeks to recover from the laparotomy and one to two week from laparoscopy (Keyhole) surgery.

Patient should see the results within the first period, the blood loss during the period should be lighter. The success rate of the procedure is quite high. If someone’s having a hysterectomy for uterine fibroids, it is definite that the fibroids will not come back because the uterus is removed and there will be no further bleeding. If someone is having a myomectomy just removal of fibroids and not the uterus, the fibroids can be there in future in life after some years. However the success of this procedure is still high, and the overall risks is very low.