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GEMS for "Gynaecology Endoscopy Maternity Menopause Surgery"

Management of fibroids

Fibroids are non-cancerous (benign) tumors that grow from the muscle layers of the uterus (womb). They are also known as myomas, or fibromyomas. Fibroids are growths of smooth muscle and fibrous tissue and can vary in size, from that of a bean to as large as a melon.

Fibroids affect at least 20% of all women at sometime during their life. Women aged between 30 and 50 are the most likely to develop them. Overweight and obese women are at significantly higher risk of developing fibroids, compared to women of normal weight.
Fibroids may cause heavy periods or menorrahgia, abdominal pain, premature birth, labor problems, miscarriages and infertility

There are four types of fibroids :
1. Intramural: These are located in the wall of the uterus and are the most common.
2. Subserosal fibroids: These are outside the wall of the uterus. They can develop into large fibroids.
3. Submucosal fibroids: These are located in the muscle beneath the lining of the uterus wall.
4. Cervical fibroids: These are located in the neck of the womb (the cervix).

Most women have no symptoms. That is why most patients with fibroids do not know they have them. When symptoms do develop, they may include heavy painful periods, anemia , backache, discomfort in the lower abdomen (especially if fibroids are large), painful sex and swelling in the lower abdomen (especially if fibroids are large).

Diagnosis of fibroids
In most cases, the symptoms of fibroids are rarely felt and the patient does not know she has them. They are usually discovered during a vaginal examination by an ultrasound or a trans-vaginal scan. Hysteroscopy or a laparoscopy may also be done. During this procedure, if necessary, a biopsy can be taken of the lining of the uterus for further examination.

Treatment of fibroids
If the woman has no symptoms and the fibroids are not affecting her day-to-day life she may receive no treatment at all. Even women who have heavy periods and whose lives are not badly affected by this symptom may also opt for no treatment. During the menopause symptoms will usually become less apparent, or disappear altogether as the fibroids usually shrink at this stage of a woman's life.

When treatment is necessary it may be in the form of medication. And when medications have not worked, the patient may be advised to undergo surgery. The following surgical procedures may be considered:

Hysterectomy - removing the uterus. This is only ever considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes considered as an option to stop recurrences of fibroids. Hysterectomies have two possible side-effects: 1. Reduced libido. 2. Early menopause.

Myomectomy -the fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant (as opposed to a hysterectomy). Women with large and /or many fibroids, as well as those whose fibroids are located in particular parts of the uterus may not be able to benefit from this procedure.

Endometrial ablation - this involves removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus. This procedure is considered as an effective alternative to a hysterectomy. UAE (Uterine Artery Embolization) - this treatment stops the fibroid from getting its blood supply. UAE is generally used for women with large fibroids. UAEs effectively shrink the fibroid. A chemical is injected through a catheter into a blood vessel in the leg - it is guided by X-ray scans.