Treatment of Fibroids – Is hysterectomy an ultimate option?

Fibroids are benign (non cancerous) growths of tissues inside and around the uterus. What causes fibroids? Not known! There are different types of fibroids depending on the place (in/on the uterus) where they grow. You can read about ‘types of fibroids’ in one of our previous articles.

Common symptoms of fibroids:

1. Heavy menstrual bleeding
2. Pain in lower abdomen
3. Spotting/bleeding during non menstrual days
4. Problem emptying your bladder. (This can result in frequent urination)

What are the treatment options in women suffering from fibroids?

Some women where the fibroids are small, symptoms may not show up and they may be found during an examination of other problems. In others, symptoms do show up and following are the two options to treat fibroids:

1. Myomectomy
2. Hysterectomy

Myomectomy procedure involves removal of fibroids. Once the fibroids are removed, they won’t grow back but there is a possibility of fibroids growing in different region.  Myomectomy gets rid of the symptoms in about 90% of women. 33% of women who undergo Myomectomy will need another surgery, typically in next 5 years as the fibroids return, in different places.  Hysterectomy is a procedure where the uterus is removed, giving no possibility of fibroids re-growth.

Which surgery is best for fibroids removal?

The type of surgery that is preferred by your gynaecologist depends on certain factors:

1. The location and size of fibroids
2. The number of fibroids
3. If you have to plan to get pregnant in future
4. If you don’t want to have children but still want to retain uterus for any other reason.

There are different types of Myomectomy and Hysterectomy procedures that are used for fibroids removal.

Types of Myomectomy:

1. Hysteroscopy
2. Abdominal Myomectomy
3. Laparoscopic Myomectomy

Types of hysterectomy for fibroids removal:

1. Laparotomy or Abdominal Hysterectomy
2. Vaginal Hysterectomy
3. Laparoscopic hysterectomy

Myomectomy procedures to remove fibroids

Hysteroscopy

Hysteroscopy is done when there are less number of fibroids and when they are smaller in size. The fibroids should be ‘inside’ the uterus. A liquid/solution is pumped into the uterus. A long thin tube with camera and light is inserted into the uterus through the vagina and the fibroids are broken. The broken pieces of fibroids come out through the vagina along with the fluid that was filled.  This is done like a day care procedure. Healing is faster.

Abdominal Myomectomy or Laparotomy

Laparotomy is a traditional way of making an incision in the lower belly region to remove the fibroids. This procedure is adopted when the fibroids are larger in size. You will have to stay in the hospital for 3 days or so after which you will be allowed to go home.

Healing takes a little time, may be around 2 to 6 weeks.

Laparoscopic Myomectomy

This is an advanced procedure and Dr. Deepa Ganesh is one of the expert gynaecologists in Chennai in performing surgeries using laparoscope and also using robotic technology.

Two small incisions are made on the belly. Through one incision, a tube with a camera is inserted and through another incision, a tool to remove the fibroids is inserted. The doctor cuts and removes the fibroids by seeing them on a television screen. Laparoscopic Myomectomy is relatively a painless procedure with minimal blood less and also heals quickly compared to abdominal Myomectomy.  You may have to stay in hospital for a day or two based on your doctor’s advice.

Hysterectomy procedures to remove fibroids

Vaginal Hysterectomy

When the fibroids are smaller, vaginal hysterectomy may be performed. The uterus is removed through the vagina.  When the fibroids are large, it may not be possible to remove them through the vaginal opening. Since no incisions are made, you will be able to get back to your normal life very quickly.

Abdominal Hysterectomy

Abdominal hysterectomy is adopted when the fibroids are large in size. A cut is made in the lower belly and the uterus and fibroids are removed.  Healing may take anywhere between 2 to 6 weeks.

Laparoscopic Hysterectomy

The uterus (and the fibroids) is removed using a laparoscope. This procedure needs small incisions to be made around the belly through which small/large fibroids can be removed and the uterus is also removed. Ovaries and cervix are usually preserved so that you won’t have any problem with hormone generation.  This procedure is also done robotically. We are proud to say that Dr. Deepa Ganesh is one among the first gynecologists in all of South India to perform robotic hysterectomy using CMR Versius Robotic System.

Read more on laparoscopic hysterectomy.

What is Endometrial Ablation?

Endometrium is the inner lining of the uterus. Endometrial ablation is a minimally invasive procedure where the endometrium is destroyed surgically. This procedure is suitable when all the fibroids are inside the uterus and when the person is not expecting to get pregnant in future.

The destruction of the endometrium is done by any of the following technologies:

1. Using Electric current
2. A balloon filled with heated liquid
3. High energy radio waves
4. A cold probe (that freezes and destroys the fibroids and the uterus lining)
5. Heated fluid.

In short, hysterectomy is an ultimate treatment procedure for removal of fibroids with minimal incisions, blood loss and quick healing. Talk to Dr. Deepa Ganesh, if you are suffering from heavy menstrual bleeding, spotting and/or any other symptoms of fibroids that we have mentioned above regarding the problem and treatment.

References:

1. https://journals.lww.com/co-obgyn/Abstract/2013/08000/The_long_term_outcomes_of_endometrial_ablation_in.12.aspx
2. https://www.mayoclinic.org/tests-procedures/myomectomy/about/pac-20384710