BACKGROUND

Deciding on removing a Fibroid (also called Leiomyoma) through a surgical operation (Myomectomy) can often be a difficult decision, especially in a country like Nigeria where there is an abundance of stories related to poor outcomes after surgery and in some cases, fatality. This may not be unrelated to the ease with which poorly trained personnel can provide this surgery. You come across patients with distorted uterine cavities unsuited for conception or blocked fallopian tubes after a previous Myomectomy. These are complications that can occur, but it is obviously too common. The general notion is therefore that of fear. Most women would not want surgery based on what they learn from interactions with others. But this has to change. There are good reason why a Myomectomy is perhaps the best option and it entirely crucial to be careful when selecting centres for your surgery. Skill and expertise is essential. A good guide is the reproductive successes of those who have had surgery in those centres. Below are some of the factors we take into consideration when faced with a uterine Fibroid.

Size is IMPORTANT

One of the important reasons we offer a Myomectomy is size, which is measured in comparison with the size of a pregnancy. Once it is up to 16 weeks (4 months) and above, one should be considering a Myomectomy. For women in the reproductive age bracket, it is likely to continue to grow and beyond the size, surgery is likely to be difficult in terms of reconstructing the uterus. The size and level of uterine distortion is greater. It is also likely to cause more symptoms like abdominal pain, compression of the bladder with frequent micturition and a feeling of incomplete emptying of urine and a block of draining tubes of the kidneys which can in prolonged cases lead to kidney problems. The bigger the fibroid, the more likely it will affect the contour of the uterus and disturb a pregnancy. Recurrent miscarriage are not uncommon.

Location can be detrimental

At times, the size is not enormous, but it is located where fertility is easily compromised. When they are sited close to the fallopian tubes, they can disrupt sperm migrations towards the egg (ovum). For this to really affect fertility, the two tubes needs to have a fibroid located close to them. Some are located within the uterine (Intra-cavitary Fibloid). Also a cervical location can have adverse effects on fertility by preventing sperm passage into the uterus to the fallopian tubes where fertilization takes place.

Associated symptoms

The bigger the fibroid, the larger the cavity of the uterus (endometrial) becomes and this can precipitate excessive menstrual loss, often enough to require blood transfusion over time. Those located within the cavity of the uterus are also prone to this effect (Submucuos Fibroid). And in some instances, there is repeated pregnancy failures because of this location. Removal is advised. For individuals considering IVF treatment, the presence of a sizeable Fibroid indicates a Myomectomy.

The key to a successful Myomectomy is to always remember that future fertility is the goal. Removing the Fibroids is importantly, but what is of greater value is to reconstruct the uterine in a way that allows for subsequent successful reproductive function. Myomectomy can be done commonly through an open abdominal surgery (Laparotomy – Open Myomectomy), Pin-hole surgery through the abdomen (Laparoscopic Myomectomy), through the Vaginal route (Hysteroscopic Myomectomy) and by interventional radiotherapy where the blood flow to the Fibroid is blocked, allowing it to shrink. In our environment, open Myomectomy, because delays in deciding to operate allows for a bigger size at presentation. Medical treatment are effective in selected cased. Non-steroidal anti-inflammatory drugs like Ibuprofen can help manage pain and reduce menstrual loss. While Gonadotropin releasing hormone antagonist like Goserelin (Zoladex) can shrink fibroid and can be used in older women close to menopause.

When faced with the presence of uterine Fibroid, expert evaluation is essential. The prognosis and the need for surgery should be carefully evaluated. Most women with Uterine Fibroid would not have a need for surgery, because often the size in inconsequential or the location is not prone to any difficulty.

NB: An expert in gynecology will anchor responses to comments.

Additional health info.

The apprehension related to Myomectomy (Fibroid operation) is real and often not out of place. Outcome in out environment can be poor if surgery is not properly done. But size matters a lot and appropriate and timely evaluation is ideal. In young women, it will continue to grow and delays paradoxically increase the risk of surgery.

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