Hysteroscopic Management of Fibroids

FIBROIDS ARE common benign tumours of the uterus and are very prevalent in Caribbean women.

They can be asymptomatic or symptomatic; if symptomatic, they usually present with menorrhagia (heavy menses), dysmenorrhea, urinary frequency due to pressure symptoms.

Submucosal fibroid after

Fibroids can be pedunculated, serosal, myometrial, submucosal and cervical.

Pedunculated fibroids are fibroids which are found on the surface of the uterus and just ‘dangle’. Serosal fibroids are found on the surface of the uterus.

Myometrial fibroids are found in the muscle of the uterus.

Submucosal fibroids are in the lining of the uterus (uterine cavity) and cervical fibroids are found in the cervix.

Fibroids when symptomatic, present mainly with heavy menstrual bleeding and or dysmenorrhea.

The main causes would be submucosal and myometrial fibroids, this is because they increase the surface area of the endometrium.

This article looks at the hysteroscopic treatment/ management (camera in the womb) of submucosal and myometrial fibroids whose symptoms are heavy menses.

When one has submucosal fibroids, treatments like northisterone or mirena coil will not be as effective in the long term, because the uterine cavity is irregular and the surface area of the endometrial cavity is increased. The only effective treatment of the submucosal fibroids would be by endometrial resection to remove them thus preserving the uterus.

Endometrial resection is a hysteroscopic technique where the submucosal fibroid is removed under direct vision by a resectoscope; alternatively one can use a tissue removal system to remove the fibroid or fibroids.

The advantages of this include: 1. It is specific for the medical problem (submucosal fibroid) avoiding a hysterectomy.

2. Done as a daycase which means a quicker recovery when compared to hysterectomy 3. Can be done as an outpatient,

the advantage is no general anaesthetic or theatre costs 4. Cost effective when compared to hysterectomy.

5. Uterus is conserved.

If one has fibroids in the muscle of the uterus and doesn’t want any more children, endometrial ablation is a viable alternative.

Endometrial ablation is a technique where the lining of the womb is destroyed by thermal means via a balloon, or by radiofrequency, and can be done as an outpatient or inpatient.

The advantages include: 1. High amenorrhea rates 2. Less pain 3. Quicker recovery 4. Faster return to normality 5. Minimal complications, if any, when compared to hysterectomy 6. Higher satisfaction rate In conclusion, treatment of submucosal and myometrial fibroids has specific treatments tailored for them and general hysterectomy is not the only answer, the advantages of resection include preserving fertility, the uterus and a quicker recovery. The advantages of ablation include preservation of the uterus, quicker recovery and high satisfaction rates.

Article is done by Dr John Barker Bsc MBBS MRCOG Dip (Risk Management). Obstetrician/ Gynaecologist at Arnos Vale Medical Center His special interests include Endometriosis, Gynaecological Oncology, Alternatives to hysterectomy, out-patient hysteroscopy, high risk obstetrics.