Not all fibroids require treatment, particularly if they are not causing any problems. However, fibroids that are symptomatic can be treated in several different ways depending on the symptoms, age of the patient and the desire for future pregnancy.
These options include:
- Surgical removal (‘myomectomy’)
- Medical treatment
Open surgery (Laparotomy)
If fibroids are large and need to be removed, extracting them through an abdominal incision (laparotomy) may be the most successful way of preserving the uterus and future fertility.
Using microsurgical techniques enables the patient to recover much faster and significantly reduces the risk of a patient requiring a subsequent hysterectomy – a very rare event occurring in less than 1% of our patients. Microsurgical methods also reduce post operative pain and improve the chances of a spontaneous pregnancy.
Transcervical resection of fibroids (TCRF)
If the fibroids are predominantly located within the uterine cavity, these can be resected using a special ‘keyhole’ surgical technique called transcervical resection of fibroids, leaving no scars on the abdomen. The procedure involves inserting a small camera with a special cutting instrument through the vagina into the cervix. The uterine cavity is then distended with special fluid and the fibroids can be carefully resected away. This is the optimal treatment for the type of fibroids which are distorting the cavity. TCRF is performed as a day case procedure under general anaesthetic.
Some fibroids can be removed by a type of keyhole surgery which involves shredding the fibroids while they are still inside the patient’s abdomen before they are removed through small incisions. Although fibroids can be removed adequately using this method, the repair of the uterus is less effective than with other procedures. This can result in significantly more postoperative adhesions than with correctly performed open microsurgery. However, if subsequent fertility is not a priority then the resultant adhesions may not present such a problem.
Medical treatment of fibroids
It is possible to shrink fibroids using drugs to suppress a patient’s production of oestrogen, as it is this hormone which fibroids need to grow in the first place.
Although this can be a reasonable treatment to achieve up to 50% shrinkage of the fibroids, unfortunately it can only ever be a temporary measure. When the effect of the drugs wears off, the fibroids can re-grow to their previous size quite quickly.
This treatment is sometimes used before transcervical resection of fibroids to allow the surgeon a better view inside the uterine cavity. It can also be given prior to open surgery in order to shrink the fibroids to help reduce blood loss, and in some cases to allow for a ‘bikini line’ incision rather than the larger ‘up and down’ incision below the umbilicus.