Fibroids, also known as myomas, are non-cancerous growths. They form within the muscular walls of the uterus. They typically affect women over 30, particularly those who have not had children. Fibroids can develop within the uterine wall (intramural), extend outside the uterus (subserous), or grow into the uterine cavity (submucous). Subserous fibroids generally remain symptom-free unless they exceed 5 cm. Intramural fibroids may lead to heavy menstrual bleeding, while submucous fibroids can cause irregular periods, heavy bleeding, and even infertility. A vaginal ultrasound can diagnose all three types. Treatment is not necessary unless symptoms appear. Surgery is the usual option for fibroid treatment in London.
What are Fibroids Really?
Fibroids are benign (non-cancerous) growths that develop in the uterine muscle, also called myomas or leiomyomas.
Extremely common, fibroids affect about 50% of women. While most fibroids remain small and symptom-free, around 40% of women with fibroids experience symptoms.
The exact cause of fibroids remains unknown. However, they are more prevalent in women without children and are particularly common among Afro-Caribbean women. Fibroids depend on oestrogen, which explains their growth during pregnancy and shrinkage after menopause.
How is fibroid managed?
Uterine fibroids affect up to 80 per cent of women of reproductive age. While many women experience no symptoms, others face significant issues, including abnormal uterine bleeding, pelvic pain, and symptoms like bladder and bowel dysfunction.
Some women prefer conservative fibroid management. Hormonal treatments, such as contraceptive pills, levonorgestrel intrauterine devices, and gonadotropin-releasing hormone analogues, can help alleviate heavy menstrual bleeding and anaemia. Uterine artery embolisation offers a non-surgical, uterus-sparing option, though it is less suitable for those planning future pregnancies.
For women wishing to maintain fertility, myomectomy is the standard treatment. However, by the time fibroids cause symptoms, they can be large and numerous, leading to complications such as heavy blood loss, scarring, and an increased likelihood of caesarean delivery in future pregnancies.
Balancing effective symptom relief with preserving fertility can be a challenge for women seeking fibroid treatment in London. Recently, radiofrequency ablation (RFA) has emerged as a less invasive, uterus-sparing option, offering a potential solution for those aiming to improve both symptoms and reproductive outcomes.
Fibroid Treatment in London
Fibroid treatment does not always require surgery. Here is an overview of the available options:
Conservative Options
- Hormonal Treatments
Doctors often prescribe Oral Contraceptive Pills to regulate menstruation. If breakthrough bleeding occurs, progesterone tablets may help stabilise the endometrium. GnRH analogues can also halt periods and shrink fibroids before surgery.
- Mirena Intrauterine System (IUS)
This hormonal IUD releases a small daily dose of progesterone (20 micrograms) into the uterus. It is highly effective in small to medium-sized fibroids that do not impact the uterine cavity. The Mirena lasts for 4 to 5 years and also serves as a reliable contraceptive method.
- Endometrial Ablation
This procedure replaces the uterine lining with scar tissue and is most effective when the uterine cavity is unaffected by submucous fibroids.
- Tranexamic Acid
These tablets can reduce heavy bleeding by about 50%. Anaemia can also be managed with haematinics and iron supplements.
- Uterine Artery Embolisation (UAE)
UAE blocks the blood supply to fibroids using silicon pellets, typically under short general anaesthesia or sedation. It reduces mass-related symptoms in 80% of cases and improves bleeding in 90% of cases. Risks include pain in the first few days, infection, vaginal discharge, and recurrence. Large fibroids extending above the umbilicus may not be suitable for this treatment. There is also a small risk of affecting the ovarian blood supply, potentially leading to early menopause. Gynaecologists generally recommend UAE for women in their forties who no longer plan to conceive.
- MRI-Guided Focused Ultrasound
Approved by the National Institute for Health and Care Excellence (NICE) for research settings, this newer treatment targets fibroids up to 10cm, reducing their volume by about 20%.
Surgical Options
- Hysteroscopic (Transcervical) Resection of Fibroids (TCRF)
This procedure, performed under general anaesthesia, involves inserting a hysteroscope through the cervix and removing submucous fibroids located within the uterine cavity using an electrical wire loop.
- Myomectomy
This surgery removes fibroids and can be done either through laparoscopy (keyhole surgery) or as an open abdominal procedure.
- Hysterectomy
Reserved for larger fibroids or when fertility is no longer a concern, hysterectomy can also be performed as a keyhole surgery in many cases.
If you are considering treatment for fibroids, consulting a private gynaecologist in London can help you explore these options and choose the most suitable approach for your needs.
Overview of Uterine-Sparing Treatments
Fibroid treatment generally follows two main approaches: fibroid removal (myomectomy surgery) and fibroid necrosis (Sonata).
Myomectomy can be done through various methods, including laparotomy (open surgery), laparoscopy (keyhole surgery), robot-assisted surgery, and hysteroscopy (fibroid removal via the vaginal route). The most suitable surgery depends on fibroid characteristics (size, number, and location) and the surgeon’s expertise.
Minimally invasive surgeries often result in better outcomes than open surgery, particularly in reduced blood loss, less postoperative pain, and shorter hospital stays. However, removing a fibroid located at the back of the uterus through keyhole surgery can present significant challenges for the surgeon.
When comparing open and keyhole procedures, there are no significant differences in fibroid recurrence or reproductive outcomes, such as live birth, miscarriage, or caesarean delivery rates. Keyhole surgery, however, typically takes longer to perform than open surgery.
Although myomectomy effectively alleviates abnormal uterine bleeding and pelvic pain, it is crucial to consider its impact on fertility. While the procedure enhances fertility, complications can arise, sometimes hindering this goal.
For example, if fibroid removal creates an opening in the uterine cavity, the risk of developing intrauterine adhesions, or Asherman’s syndrome, increases. Additionally, the surgery may raise the chance of uterine rupture during pregnancy and labour. There is also an elevated risk of the placenta attaching abnormally to scarred areas of the uterus after fibroid surgery.
Although these complications are rare, they can be severe. It is vital to remember that, like any surgery, the outcomes are not always predictable, and post-myomectomy complications can sometimes be catastrophic. Consulting a Top gynaecologist in London ensures the most informed and expert care throughout the treatment process.
FAQs
Q1) Can fibroids recur after removal?
Fibroids can return after surgery. A myomectomy usually provides relief for about five years before the fibroids may reappear, making the timing of surgery crucial.
Q2) How are fibroids treated?
Fibroid treatment varies depending on the case. Options range from supportive care to more invasive procedures like a hysterectomy. Factors such as age, fibroid size and location, fertility goals, symptoms, and personal preferences all play a role in deciding the best treatment.
Q3) Can diet and lifestyle changes help with fibroid symptoms?
Yes, diet and lifestyle changes can help manage fibroid symptoms. The Top Gynaecologists Clinic offers expert advice on regulating hormone levels through dietary adjustments, which can help slow fibroid growth.
Q4) How large do fibroids need to be for removal?
There is not a strict size requirement for fibroid removal. Surgery is typically recommended if a fibroid exceeds 6cm or if the uterus grows larger than it would be at 12 weeks of pregnancy. Smaller fibroids may still require removal if they cause severe symptoms, particularly if they are submucous.
Q5) Can one treatment option be recommended over others?
There is no single treatment that works for every woman with fibroids. Consulting with a Gynaecologist in London will help you consider various factors and choose the best treatment option tailored to your needs.
