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Uterine Fibroids Surgery

What are uterine fibroids and how are they diagnosed?

Uterine fibroids are muscular growths on or within the uterus that can contribute to infertility by impeding the embryo’s ability to properly implant. Uterine fibroids are almost always benign (noncancerous), and do not always cause symptoms. Because of this, many women who have fibroids are not aware of them.

It is estimated that anywhere from 20 to 80 percent of all women have fibroids by age 50, and they are present in 5 to 10 percent of women with infertility. They tend to shrink and diminish once a woman reaches menopause.

Treatment for fibroids is considered only if they cause symptoms or are suspected to be causing infertility. Symptoms may include irregular bleeding, painful periods, abdominal pain, bladder or bowel pressure, or pregnancy complications. In addition, women with fibroids are much more likely to need a cesarean section delivery, and fibroids can sometimes cause preterm birth.

If fibroids are suspected, a doctor may be able to confirm their presence during a routine pelvic exam. Sometimes imaging tests such as an ultrasound or magnetic resonance imaging (MRI) may be needed. The doctor might also perform a procedure called a hysteroscopy, in which a thin tube is inserted vaginally to view the inside of the uterus. Laparoscopic surgery may also be used to confirm the presence of fibroids. The method used completely depends on location of the fibroid(s).

Uterine fibroids surgery at a glance
  • Uterine fibroids can be removed from the uterus using one or more surgical techniques.
  • Uterine fibroids are growths of muscle on and/or within the uterus, or womb, and are one of the most common uterine issue that may cause infertility.
  • The decision to pursue fibroid surgery as a treatment method depends on the severity of symptoms as well as the patient’s desire to get pregnant in the future.
  • If the patient wishes to preserve her fertility, myomectomy to remove fibroids but preserve the uterus is the treatment of choice.
  • Hysterectomy (complete removal of the uterus) should be reserved for women with significant symptoms who do not wish to conceive in the future.
  • Surgical methods include laparotomy (open surgery) and minimally invasive laparoscopic surgery.

How are fibroids treated?

The best method of treating symptomatic fibroids depends on their size, location, and the patient’s desire to get pregnant, both immediately after treatment and long-term. Nonsurgical treatment options include:

  • Over-the-counter pain medications
  • Gonadotropin-releasing hormone agonists (GnRHa) such as Lupron, which can reduce the size of fibroids
  • Certain birth control medications, which can control heavy bleeding
  • Mirena IUD (intrauterine device), which can control heavy bleeding

Birth control medications and IUDs prevent pregnancy and are only appropriate considerations for women who aren’t trying to get pregnant. In addition, placement of an IUD may be difficult because fibroids can deform the uterine cavity. If the medical treatment methods described above fail or fibroids are severe enough to compromise a successful pregnancy and birth, a doctor may recommend fibroid surgery.

Fibroid surgery options

Myomectomy

Myomectomy is the surgical removal of uterine fibroids with the intention of leaving the uterus intact so future pregnancy may be possible. This may be performed using a larger incision (laparotomy) across the abdomen. Myomectomy can also be done laparoscopically using small, minimally invasive “portal” incisions. Women & Infants Fertility Center surgeons also perform robotic laparoscopic myomectomies, in which a robotic arm is used for precision control and improved access to the fibroids.

Hysteroscopic myomectomy

When hysteroscopy is used for the removal of fibroids, it is called a hystereroscopic myomectomy, and a specially designed hysteroscope called a resectoscope is used. The resectoscope uses electrical energy to cut away the fibroids. Hysteroscopy is a surgical option for fibroids located within the uterine cavity.

Hysterectomy

A hysterectomy is the surgical removal of the uterus. This may be an option for women experiencing severe fibroid symptoms and who do not wish to get pregnant in the future. A hysterectomy eliminates the possibility of pregnancy, but can offer a total resolution of symptoms without the risk of recurrence. Women & Infants Hospital offers comprehensive surgical services for women requiring a hysterectomy.

Prognosis and recurrence

Following myomectomy, there is a chance that uterine fibroids will grow back over time. The risk for uterine fibroid recurrence increases the younger (and further from menopause) a patient is. A study published in 2014 found that following laparoscopic myomectomy, fibroids returned for 4.9 percent of women after two years and for 21.4 percent of women after five years. These percentages were higher among women in the 30 to 40 age range, as well as for those who were treated for more than one fibroid.