Fibroids and their symptoms
Fibroids are non-cancerous, benign growths of the uterus that often appear during childbearing years. While some are harmless and can go undetected, 25% of cases require treatment as they cause painful and debilitating symptoms such as
- Feeling of discomfort, pain, heaviness or pressure in the abdomen, lower back and pelvic areas
- Feeling of pressure in the bladder and frequent urination
- Abnormal bleeding resulting in heavy & prolonged periods and anemia
- Vaginal bleeding other than menstruation
- Rectal pressure and constipation
- Inability to conceive or recurrent miscarriages
What treatment options preserve the womb?
Women affected by fibroids have 3 main treatment options. Two surgical treatments, a myomectomy or hysterectomy and a non-surgical treatment called uterine fibroid embolization. Myomectomy and uterine fibroid embolisation are the available treatments that maintain the integrity of the uterus which protects childbearing capabilities and enable you to start or grow your family. This is an important consideration when choosing a treatment option.
Myomectomy
A myomectomy is a surgery in which an incision in the abdomen is made under general anaesthesia and the fibroids are removed with the uterus left inside. This can be achieved through three methods; a hysteroscopy, laparoscopy and laparotomy. Unfortunately, myomectomies have a high recurrence rate of 50% within one year following the surgery. This happens because some fibroids cannot be seen or are still in the seedling stage during surgery and are therefore missed and can grow in future causing further complications.
Recovery time differs depending on the method used but can be anywhere from a few days to 6 weeks
Fibroid embolisation
Fibroid embolisation is the minimally invasive, non-surgical option in which an interventional radiologist uses a minimally invasive procedure to treat the symptoms of the fibroids. A small catheter is inserted through a tiny hole in the artery of the groin (femoral artery) or artery in the wrist (transradial approach for uterine fibroid embolisation). The position of the correct artery supplying the fibroids is located by injecting an iodine based solution which maps out the arteries. These images are then used as a map for the radiologist to gain access to the uterine arteries and inject small particles that will block the blood supply to the fibroids.The particles are harmless to the patient and the end result is fibroid death. A dead fibroid, with no blood supply will shrink and the symptoms resolve.
Embolisation is a recommended option for younger women, specifically to avoid repeat myomectomies but it also has the added benefit of not affecting the uterus. Patients who undergo uterine artery embolisation do not need to undergo general anaesthetic, and are rather provided with light sedation so that they remain awake and breathing on their own. The procedure itself is pain free and takes approximately 15-20 minutes.
Following embolisation, the patient is observed for 4 hours under direct nursing supervision and placed on a patient-controlled pain pump which allows the patient to manage their own pain control. The majority of patients are discharged the day after the procedure, with a follow-up visit scheduled for 6 weeks post procedure.
For information on other types of fibroid treatment, see here.