Uterine fibroids are non-cancerous tumours in the uterus. Most women have them at some point in their lives. The Department of Obstetrics & Gynaecology at Singapore General Hospital shares what surgical treatment methods are available.
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Treatment options for uterine fibroids
If uterine fibroids are not causing you any problems, your doctor will often recommend leaving them alone to avoid any risks from unnecessary treatment. Your doctor may then wish to monitor their size with further scans, several times a year at most, to see how quickly they are increasing in size.
If treatment is suggested, the best approach depends on whether the woman needs to retain her fertility, as well as on the location and size of the fibroids.
Hysterectomy (surgical removal of the womb)
If the woman doesn’t plan on bearing children, the womb can be removed entirely (hysterectomy). This is often a good option because removing only the fibroids (myomectomy) has a much greater risk of surgical complications.
When wombs have reached around the size of a four to five month pregnancy, open surgery with a bikini line incision is generally recommended. Some much larger cases will need a midline vertical incision in the tummy to remove the womb.
Smaller wombs than this may be amenable to minimally invasive “keyhole” surgery. This can lessen post-operative pain, shorten the hospital stay and allow a faster return to normal activities.
The other main advantage of removing the entire womb (hysterectomy) is that the fibroids will not return again, as they may do with all of the other options.
Removal of uterine fibroids
For women wishing to retain their fertility or who absolutely do not wish to have a hysterectomy, fibroids can be removed by two different types of surgery:
Removal of fibroids through the abdomen (myomectomy)
In myomectomy an incision is made in the surface of the womb and the fibroids are removed. This can be done by open or keyhole surgery. However, not all cases are suitable to be done by keyhole surgery, e.g. if the womb is too large or the number of fibroids too many.
More recently “keyhole” robotic surgery has made it easier for the surgeon to remove fibroids and to stitch up the womb incisions. Robotic keyhole surgery may thus be an option for women who would otherwise only be offered open surgery.
In myomectomy there is also a significant risk of blood loss, blood transfusion and internal scar tissue forming between the incision in the womb and the bowel, fallopian tubes, ovaries and bladder. Such internal scar tissue can cause further pain and fertility problems after the surgery.
Removal of fibroids through the cervix (trans cervical fibroid resection)
Smaller fibroids pressing into the cavity of the womb causing bleeding or fertility problems can be treated using a special operating telescope passed into the vagina and through the cervix.
For women who wish to retain their fertility but absolutely do not wish to have surgery, there are other options available. Read on to find out about non-surgical options for treating uterine fibroids.