Dr Abri de Bruin

Welcome! Please see this website as an educational reference for patients. My practice strives to offer comprehensive and individualized care in minimal access surgery, endometriosis and infertility.

1. What is a fibroid?

A non cancerous growth of the muscle fibers of the uterus.


2. What does it look like?

See Images below.


3. Where do they occur?

They can occur in the following parts of the uterus:

1. inside the cavity

2. inside the wall of the uterus, but pressing into the cavity

3. inside the wall of the uterus, not affecting the cavity

4. inside the wall of the uterus pressing outside the uterus wall

5. on the outside wall of the uterus

6. other areas are much less frequent, but it can occur in the cervic, broad ligament, paracytic fibroids any place inside the abdomen, and in the braod ligament

What are the symptoms?

This depends on the location of the fibroid.

  • If the cavity is affected 
    • abnormal bleeding, or heavy periods
    • pain or heavy periods

 

  • If the cavity is not affected
    • pain or heavy periods
    • Pressure symptoms, depending if the fibroid is pressing on the bladder or the rectum
    • Painful intercourse if the fibroid is posterior

4. How is it diagnosed?

  • by clinical examination if they are big
  • by trans-vaginal ultrasound or abdominal ultrasound

5. What are the risks of leaving them?

  • increase in size with subsequent increase in symptoms

6. What are the risks of removing them?

  •  all the atandard surgery and anaesthetic risks are relevant to any surgery procedures
  • bleeding at the time of the surgery.  This can usually be managed, but in severe cases when the bleeding cannot be controlled, a hysterectomy might be the only option to control the bleeding
  • a haematoma at the line of the sutures in the uterus, with a subsequent poor tension in the suture line and a higher risk of rupture during normal delivery
  • following a laparoscopic or laparotomy myomectomy, the patient should preferably deliver via caesarean section
  • a patient should not conceive within 3 months following removal of fibroids
  • a possible rupture of the scar at the time of delivery - that is why a caesarean saction is advised

7. What is the treatment?

The treatment depends on a few factors:

  1. Severity of symptoms - pain / bleeding / pressure symptoms
  2. If there is associated infertility - laparoscopic or hysteroscopic removal

  3. The age of the patient - after completion of family rather a hysterectomy, when still desiring fertility - laparoscopic removal

  4. the size of the fibroids - laparoscopy or laparotomy

  5. the number of the fibroids - laparoscopy or laparotomy

  6. the position of the fibroids - inside the cavity or affecting the cavity - hysteroscopic removal, otherwise laparoscopic or open surgery to remove them

 

There are 2 main options:

1. Medical treatment

2. Surgical treatment

 

1. Medical treatment

when

  • usually when there is no fertility wish
  • with multiple small fibroids
  • in patients prior to surgery to decrease the size and to decrease the blood supply of the fibroid and bleeding during surgery

what

  • GnRH-analogues are most commonly used 

2. Surgical treatment

Ultimate surgery for fibroids: A hysterectomy

Surgery to remove the current fibroids:

  • The aim is to remove as complete as possible fibroids and as many as possible.
  • Again the indication is important - pain vs bleeding vs infertility
  • Certain criteria exist for the removal of fibroids via laparoscopy and some are as follows:
    • The skill of the surgeon and especially skill in suturing
    • Number and size of the fibroids
      • Usually a guideline of 15cm is used
      • 1 of 15cm, 2 of 7.5cm etc.

3. Alternative treatment options

  • Uterine artery embolisation
  • This can be done by skilled radiologists, but care should be taken when doing this in women still desiring fertility

Is there a chance that they can be a cancer?

  • Yes, these tumours are then called lyomyosarcomas
  • They are very rare
  • There are certain pointers to make one think that a fibroid can be a cancer, and one always look at these
Pedunculated

Pedunculated

Intra-mural

Intra-mural

Intra mural and pedunculated

Intra mural and pedunculated

Cutting open the surface of the uterus to get to the intra-mural fibroid

Cutting open the surface of the uterus to get to the intra-mural fibroid


PROPERTY OF DR ABRI DE BRUIN 2015