2. Pearl Woman’s Hospital
Uterine Fibroids
Pearl Woman’s Hospital
Dr.P.L.KANANI

3. Uterine Fibroids Benign tumours (leiomyomata) of uterine smooth muscle
Common – 25% of women in a lifetime
Usually multiple
Various sizes
Genetic predisposition
more common in black races
More common in the obese
Less common in smokers
More common in nulliparas
Accounts for ~30% of hysterectomies

4. Fibroid Locations Subserous Submucous (~5% of all fibroids) Intramural
Project from the uterus into the peritoneal cavity
Sometimes pedunculated
Least likely to cause symptoms
Submucous (~5% of all fibroids)
Project into the uterine cavity
Most likely to cause symptoms
Intramural
Most common
Usually multiple

5. Intramural & Submucous Fibroids

6. Subserous Fibroid at Laparoscopy

7. Fibroids’ Natural History
Oestrogen-dependent tumours that grow slowly:
Whilst cycling premenopausal
Probably whilst on COC
When taking E2 HRT
Will regress with menopause
Response to progestin-only contraception is uncertain
Malignant change rare <1:1000

8. Investigation of Fibroids
Ultrasound
Frequently misdiagnosed with this modality
“Multiple small fibroids” is usually irrelevant
Heterogenous echolucency is normal in a parous uterus
Adenomyosis can look the same
Size and location important
Can be a “contraction wave” in pregnancy
MRI better than CT Imaging
Laparoscopy and Hysteroscopy
Saline hysterography
Useful for pedunculated submucous fibroids

9. Investigating a Submucous Fibroid

10. Investigating a Submucous Fibroid

11. Treatment Options for Fibroids
Hysterectomy
If the uterus is >10w size
Or symptoms that are due to the fibroids
Rapid growth
Abdominal or vaginal
Myomectomy
Best for single fibroid in a young woman
~50% come to hysterectomy within 5 years?
Hysteroscopic resection
Uterine artery embolisation (UAE)
Medical options
GnRH analogue
Mirena

12. NICE Recommendations for Uterine Fibroids
For patients with heavy menstrual bleeding and fibroids >3 cm size (and especially those with pelvic pain or other symptoms) then…
Hysterectomy, Uterine artery embolisation (UAE) and myomectomy should all be offered
Myomectomy recommended if fertility is desired
Hysteroscopic resection of the entire fibroid with endometrial resection is appropriate if the fibroid (s) are submucous
Pre treatment with GnRH analogue for 3 - 4m is worthwhile before hysterectomy and myomectomy
Reduces uterine size and makes surgery easier
Better HB pre op and less bleeding
But GnRH analogues are contraindicated before UAE

13. Fibroids and Infertility
In most women the association is result and not cause
It is said that ≈3% of infertility is due to fibroids
Most infertility specialists will recommend removal of any fibroid with >50% of its surface in the uterine cavity
The results from removal of a single submucous fibroid can be dramatic
And there is evidence that removal of intramural fibroids >5 cm diam will enhance fertility with IVF

14. Fibroids and Pregnancy
In most women there is no effect
80% remain unchanged in size
Rarely rapid growth and red degeneration
Increased risk of bleeding and threatened preterm delivery
But most deliver at term
Fibroid in the lower segment can interfere with vaginal birth
Myomectomy at the time of Caesarean is not wise
30% require emergency hysterectomy

15. 24 wks size fibroid uterus

16. LAP MYOMECTOMY IN CASE OF ANTERIOR WALL FIBROID

17. LAP MYOMECTOMY IN CASE OF POSTERIOR WALL FIBROID

18. LAP MYOMECTOMY IN CASE OF BROAD LIGAMENT WALL FIBROID

19. LAP MYOMECTOMY IN CASE OF IN MULTIPLE FIBROID

20. S M FIBROID … OPERATIVE RESECTOSCOPE

21. S M fibroid … inversion of uterus .

22. TLH IN MULTIPLE FIBROID

23. TLH IN C/O 32 WKS SIZE UTERUS

24. BIG SM FIBROID REMOVAL With Hystroscopic Morcellotor

25. Thank You