Fibroids are only treated if they cause symptoms. The symptoms caused by fibroids are in the most part related to where they are in relation to the cavity of the womb. Those inside the cavity of the womb are called submucous fibroids and can be responsible for:

1. Heavy menstrual bleeding
2. Problems with fertility

Ultrasound is the commonest way to diagnose these fibroids, this is best-performed transvaginally. This investigation only takes a few minutes and the results are given at the end of the procedure.

Sometimes saline sonography is used, this is where the cavity of the womb is distended with fluid to allow the contour of the uterine cavity to be visualized and determine the relationship between the fibroid and the uterine cavity.

Another investigation that is sometimes used is a diagnostic hysteroscopy usually performed in the outpatient setting.

After these investigations you and your gynaecologist will be in a good position to discuss treatment suited to your needs. This often depends on whether your family is complete or whether fertility is an issue. Another important consideration is how close you are to the menopause.

For the majority of these fibroids the treatment of choice is Hysteroscopic resection.

If you are close to the menopause and the reason for having the operation is for heavy periods your gynaecologist may advise that you have an endometrial ablation/ resection at the same time. This is where the lining of the womb is either removed or treated with “heat therapy” to destroy it.  In this sort of situation women who have only the fibroid removed have an 84% chance of success compared to nearly 97% of women who had both procedures

Hysteroscopic resection of Fibroids is usually performed under general anaesthetic, and is a day case procedure. The majority of women are able to return to work within a few days if not the day afterwards.

The success of this procedure depends on the number and size of the fibroids and the amount of fibroid in the cavity in relation to the muscle of the womb.

Hysteroscopic fibroid resection (part II)

Continuing our discussion about resection of submucous fibroids.

One of the determinants of success of this procedure depends and size of the amount of fibroid in the cavity of in relation to the muscle of the womb.

A simple classification used is:

Type 0= where all the fibroid is in the cavity of the womb

Type I = where most of the cavity is within the cavity of the womb and some within the muscle

Type II = where most of the fibroid is within the muscle of the womb and a little projecting into the cavity.

(Type 0 fibroids are generally easier to remove than type II)



Other factors that determine success are:

1.     The size of the fibroids and uterus and

2.     The number of fibroids.

In a recent scientific study women with a normal sized womb and no more than 2 fibroids were projected to need additional surgery less than 10% of the time within 5years compared to women who had an enlarged womb and 3 or more fibroids where the risk increased to 35%.

If your gynaecologist feels that your fibroids are too large you may be advised have some medication to shrink the fibroids. The commonest medication used in a GnrH analogue. This may help make the procedure easier and help reduce some complications, reducing the fibroid size by up to 30% after 2-3 injections, reducing the operating time and reducing the amount of fluid absorbed into the body.

The commonest complication of this procedure is tearing of the cervix at the time of entry into the womb. For this reason your surgeon may advise that your cervix be prepared before the operation. Commonly the night before or a few hours before the procedure you may be advised to insert a tablet or two of Misoprostol, which is a tablet that makes the neck of the womb softer and easier to dilate for the procedure.

Another complication that surgeons encounter is fluid overload. This happens when the fluid used to distend the uterus for the operation is absorbed into the body. Special fluid monitoring systems are available to help avoid this complication to ensure that the amount of fluid that goes in is what comes out. Surgeons generally stop the procedure if they notice that the fluid “lost” is more than 1000mls.

Bleeding can also be a complication of this type of surgery and in most cases is put right either by the use of medication or the use of compression during the procedure. Only in extreme cases would a hysterectomy be necessary in cases of intractable bleeding as a life saving measure. The risk of this is generally put at 1:10,000.

If bleeding is encountered or the fibroid found to be too big for some women a

2-stage procedure may be necessary. This is where the procedure is stopped and completion surgery scheduled for another time.

If you have been advised to have a Hysteroscopic resection of your fibroid discuss these issues with your doctor. You should ask whether

1. Cervical preparation is necessary and whether is will be used in your case?
2.  What measures will be taken to avoid fluid overload?
1. Will a special pump be used to monitor fluid?
3. What their success and complication rates are.