www.ukgynaecologist.comwww.ukgynaecologist.comWhat are fibroids• Fibroids are benign (non cancerous)growths of the uterus (womb)• They arise from single muscle cellswithin the womb
www.ukgynaecologist.comwww.ukgynaecologist.comHow common arefibroids?• No fibroids are quite common– Up to 30-40% of women have them• They are 3 to 9 times commoner in blackwomen than Caucasians– They tend to present at an earlier age in blackwomen– They tend to be more numerous and moresymptomatic in black women at the time ofpresentation
www.ukgynaecologist.comwww.ukgynaecologist.comWhat causesfibroids?• No one knows what causes fibroids• The womb is made up of muscle cellsand fibroids develop as a result ofenlargement of single muscle cells
www.ukgynaecologist.comwww.ukgynaecologist.comWhat are thesymptoms• Symptoms depend– Location of fibroids– Number of fibroids– Size of fibroids
www.ukgynaecologist.comwww.ukgynaecologist.comFibroid locations• Fibroids are categorised according to theirlocation– Subserous• Where most of the fibroid is located superficially– Submucous• Where most of the fibroid is located in the cavity ofthe womb– Intramural• Where most of the fibroid is located within themuscle of the womb– Pedunculated• Where the fibroid is attached to the womb by a stalkcontaining blood vessels
www.ukgynaecologist.comwww.ukgynaecologist.comWILL FIBROIDS INTERFEREWITH MY ABILITY TO GETPREGNANTThe majority of women with fibroids will get pregnancy and themajority of women who get pregnant will have no problems.However fibroids have been associated with•Difficulties conceiving•Miscarriage•Degeneration and pain in pregnancy•Preterm delivery•Increased risk of placental separation (abruption)•Obstructed labour•Bleeding after delivery (postpartum hemorrhage)
www.ukgynaecologist.comwww.ukgynaecologist.comFibroids and fertility• Not all fibroids impair fertility• Fibroids most likely to impair fertility are– submucous• Distorting the cavity of the womb– Intramural• In the muscle of the womb distorting the cavity• In women who have difficulty gettingpregnant removing fibroids from theselocations can improve chances ofpregnancy
www.ukgynaecologist.comwww.ukgynaecologist.comWhat aboutcancer?• It is unlikely that fibroids become cancerousparticularly in young women• In the older women the risk is estimated atabout 0.17%• In one Australian study it is estimated at 1in a million• Rapid increase in size of fibroids howeverusually alerts to the possibility of cancer
www.ukgynaecologist.comwww.ukgynaecologist.comWhat treatment optionsare available?Options depend on a number of issues eitherindividually or in combination:•Symptoms•Desire for future fertility•Number of fibroids•Locations of fibroids•Size of fibroids
www.ukgynaecologist.comwww.ukgynaecologist.comThings to consider when thinking abouttreatment• Is treatment necessary?– Only if you have symptoms• if treatment is necessary– Weigh up the risks against possible sideeffects of treatment
www.ukgynaecologist.comwww.ukgynaecologist.comDOING NOTHING?For women who are not ready for intervention
www.ukgynaecologist.comwww.ukgynaecologist.comWHAT HAPPENS IF IDO NOTHING?
www.ukgynaecologist.comwww.ukgynaecologist.comMEDICATION?There is no medication that cures fibroids they onlymake symptoms betterMedication may be appropriate for women who donot want intervention or for shrinking fibroids priorto surgery
www.ukgynaecologist.comwww.ukgynaecologist.comWhat types ofmedication are there?
www.ukgynaecologist.comwww.ukgynaecologist.comGNRH ANALOGUES?These drugs induce false menopause and can shrinkfibroids by up to 30% in first 3 months. May beadvised for shrinking fibroids prior to surgeryNot suitable for long term use
www.ukgynaecologist.comwww.ukgynaecologist.comTypes of hormonal preparations
www.ukgynaecologist.comwww.ukgynaecologist.comUTERINE ARTERYEMBOLISATIONProcedure carried out by radiologists to reduce thesize and symptoms of fibroidsSuitability depends onDesire to retain fertilityAgeLocation of fibroids
www.ukgynaecologist.comwww.ukgynaecologist.comWhat about Uterine arteryEmbolisation?
www.ukgynaecologist.comwww.ukgynaecologist.comWhat can I expectfrom an embolisation
www.ukgynaecologist.comwww.ukgynaecologist.comSURGERYMay be recommended for women with symptomsfrom fibroids
www.ukgynaecologist.comwww.ukgynaecologist.comIf I want to have surgery,what types are available?
www.ukgynaecologist.comwww.ukgynaecologist.comMYOMECTOMY?REMOVAL OF FIBROIDS INDIVIDIALLY TO RETAINWOMB AND REPRODUCTIVE POTENTIAL
www.ukgynaecologist.comwww.ukgynaecologist.comWhat if I chose to have amyomectomy?
www.ukgynaecologist.comwww.ukgynaecologist.comWhat are the complicationsof a myomectomy?Incisions for laparoscopicmyomectomy
www.ukgynaecologist.comwww.ukgynaecologist.comWhat are the advantages oflaparoscopic myomectomy
www.ukgynaecologist.comwww.ukgynaecologist.comAm I a suitable candidate forlaparoscopic myomectomy?