Fibroids, also known as leiomyomas, are benign tumors originating from uterine tissue. They can vary greatly in size and number, and they are classified according to location: subserosal, submucosal, intramural, pedunculated, or combined. Symptoms and treatment options are affected by the size, number, and location of the leiomyomas. The incidence of uterine fibroids is unknown. Since fibroids are very common and most of the time they do not cause bothersome symptoms, they go undetected. However, some studies report leiomyomas in greater than 50% of women age 50 years. While the majority of women usually have no symptoms, 1 in 4 women end up with symptoms severe enough to require treatment. Symptomatic patients may experience heavy bleeding, irregular bleeding, painful periods, as well as pelvic pressure and urinary frequency from an enlarged uterus. Usually premenopausal women are the patients who seek out treatment. This is because when menopause occurs and estrogen production declines, fibroids usually shrink and abnormal bleeding significantly improves. However, a minority of postmenopausal women will still be symptomatic and seek out treatment.
If conservative options are unsuccessful, contraindicated, or not desired, then surgery is offered. For patients with fibroid tumors who wish to keep their childbearing potential (they want to have children), a Myomectomy is a possible option. A Myomectomy is a surgical procedure which removes only the fibroid tumors from the uterus. If incisions are made into the uterine wall, then they are closed with sutures, and the uterus is left intact. If a major incision is made into the uterine wall, this will heal forming a scar and usually a Cesarean Section is recommended for future deliveries if the patient becomes pregnant.
There are a variety of ways this procedure can be performed and the approach depends on the number, location and size of the fibroids, as well as the surgeon’s level of skill and comfort. A Hysteroscopic Myomectomy involves placing a hysteroscope into the uterus via the vaginal canal and removing small submucosal fibroids. An Abdominal Myomectomy involves making an incision in abdominal wall and removing the fibroids through this incision. This is the standard of care for intramural and subserosal fibroids, especially large fibroids. Patients stay in the hospital for 2-3 days. A Laparoscopic or Robotic Myomectomy, removes intramural and subserosal fibroids laparoscopically from the uterus. They require a highly skilled surgeon specializing in minimally invasive surgery. The advantages of a laparoscopic procedure are many. Patients usually go home the same day, the recovery time is faster and less painful, and the cosmetic outcome is better. Most of our cases here at AMIGS are performed laparoscopically or robotically.
Read the full discussion of Abnormal Uterine Bleeding and treatment options.