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Options For Women With Fibroids. by Happy (f): 8:04pm on November 4
Fibroids are non-cancerous growths of the muscle of the uterus that occur in women during their reproductive years.

One in five women has fibroids and black women are two to three times more likely to have them compared to their white counterparts, research shows.

Depending on the size, location and nature of symptoms caused by the fibroids, there are different treatment options. For women who want to avoid open surgery or have risks resulting from surgical complications, a history of keloid scars (an overgrowth of scar tissue), blood clots, they may opt for uterine fibroid embolisation (UFE).

Dr Timona Obura, the vice chair, department of obstetrics and gynaecology at Aga Khan University Hospital and consultant hysteroscopic and laparoscopic surgeon says UFE is well established internationally as a proven treatment.

Where is the procedure carried out?

The procedure is carried out in a catheter laboratory in a hospital. Patients are admitted before the treatment and spend one night in the ward afterwards and are discharged the following morning.

Does the patient require any prior preparation?

After a full gynaecological review and discussion of the treatment options with the doctor, magnetic resonance imaging (MRI) and ultrasound scans are done to define the size and location of fibroids and assess the likely response to treatment.

What does the procedure entail

This is a painless operation and therefore a full anaesthetic is unnecessary. After the patient is given a sedative and local anaesthetic, a tiny nick in the skin is made to allow a very fine catheter to be passed into a blood vessel. The catheter tip is moved along the blood vessels until the uterine arteries are reached. A substance is then injected to block the uterine arteries. All this is followed on an X-ray screen by a radiologist.

What post-operative care is required?

Embolisation has the advantage of a shorter recovery time. Following the procedure, the patient rests in the ward overnight. Some painkillers are usually given during the night in the hospital, followed by tablets for two to seven days after discharge. It is possible to resume normal activity within two weeks.

Can a woman still conceive after this procedure?

After the procedure, a woman should wait for six months before attempting to conceive.

It also effective in reducing excessive menstrual blood loss in women with anaemia.

Embolisation is also used to shrink fibroids to reduce pressure symptoms.

Apart from UFE what are the other methods of treating fibroids?

— Abdominal hysterectomy is where fibroids are removed through an incision in the lower abdomen. It is sometimes recommended for patients who have completed childbearing and have large fibroids.

— Vaginal hysterectomy is where the fibroids are removed through the vagina. This may be suggested for patients with ‘medium size’ fibroids and have also completed childbearing.

—Open myomectomy is the removal of uterine plus the fibroids. It is a suitable option for large symptomatic fibroids in a patient aiming to preserve the potential for childbearing.

—Laparoscopic myomectomy is removal of fibroids that are mainly outside the uterus through keyhole surgery. A small incision is made that is about 0.5cm to 1.5cm through the abdominal wall and a surgeon cuts out the fibroids into small pieces. Patients recover faster than those who have had open myomectomy.

—Laparoscopic hysterectomy is where the entire uterus is removed via small surgical incisions equivalent to those of laparoscopic myomectomy.

—A hysteroscopic fibroid resection is a technique which uses a telescope inside the uterus to remove fibroids that are protruding into the cavity of the uterus.

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