Fibroids and Polyps diagram.

Fibroids & Polyps

Fibroid and polyps are growths made up of muscle and fibrous tissue in the uterus which are usually not cancerous and often cause problems with bleeding, difficulties falling pregnant or recurrent miscarriages. Fibroids and polyps are diagnosed on examination, ultrasound and hysteroscopy. If they need to be treated they are usually removed surgically but there are non-surgical treatments too.

Although we are using fibroids and polyps together, there is a difference, and that lies in their origins. Fibroids are tumours of uterine muscle tissue, while polyps are tumours of the uterine lining. It is always a worry when we hear the word tumour from our doctor but when it’s a fibroid or polyps tumour, experts assure us there is little to fear.

Uterine Fibroids

Uterine fibroids are masses of tissue that can vary in number and size, from one growth to many, ranging from very small to large, and are often seen in women between their 30s and 40s. A family history of fibroids can be a cause but it is not always passed on. Overall these tumours are quite common and are seen in about 70% of all women by the time they reach 50.

Uterine Polyps

Polyps are small growths that look similar to a skin tag and are found on the uterine lining. They are generally seen in women who have had children and can be rather common. While there is no definitive cause, they are usually brought on by hormone levels and develop in response to oestrogen circulating in the blood. Although they are rarely cancerous, they should be looked at by your gynaecologist.

Women often do not know that they have fibroids or polyps as only 1 in 3 women show symptoms, these are: 

  • Bleeding – Both fibroids and polyps can cause heavy bleeding as well as bleeding between periods and at times bleeding after sex.
  • Pain – Fibroids can cause cramping and discomfort whereas polyps usually cause no pain.
  • Enlarged Uterus – Polyps are generally too small but fibroids that have grown large can cause a uterus to become bigger than normal.
  • Lower back pain
  • A frequent need to urinate
  • Constipation
  • Pain or discomfort during sex

Fibroids and polyps are diagnosed on examination and confirmed by ultrasound and hysteroscopy. If they need to be treated they are usually removed surgically, although there are non-surgical treatments too.

The treatment of fibroids and polyps will depend first on what symptoms they cause. If someone has no symptoms or doesn’t know that they have them, they may not need to be treated, unless fibroids are large (over 12 weeks) or grow fast.

If fibroids or polyps cause any of the symptoms described above, they would need to be treated to control the bothersome symptoms and the patient’s experience.

The type of surgery that is recommended would depend on the size of fibroids, the location of the fibroid and the woman’s desire for future pregnancies and the symptoms that the fibroids are causing.

For example, a small fibroid that is inside of the uterine cavity that is causing irregular bleeding, or infertility or sometimes bleeding after sex, would be treated with hysteroscopy and resection of the fibroid. Hysteroscopy is a procedure we perform through the vagina with the usage of a little telescope that is inserted into the uterus. The uterine cavity is expanded with normal saline and a fibroid is resected in small pieces and sent to the lab for investigation. Someone who has large fibroids, or multiple fibroids in the uterus and has pain or heavy menstrual flow can choose to have the procedure to remove the fibroids. If they do not wish to have children in the future, it would be a hysterectomy and if they wish to have children in the future it would be a myomectomy. Myomectomy or hysterectomy can either be done through laparotomy (cut on the abdomen), caesarean section type of cut or keyhole surgery, if the size of fibroids is not too big.

The non-surgical way of managing fibroids is by uterine artery embolization. This procedure is done by a radiologist in a special setting and the procedure is done to block the blood supply to the fibroids, which will then lead to shrinkage of the fibroids. But not all fibroids and not all patients are suitable for this procedure and the doctor will be able to advise for whom this procedure is suitable.

The special procedure preparation would be advised individually to each patient overall.

Before general anaesthesia, we advise the patient not to eat or drink for six hours prior. The procedure done is performed in the operating room. It can be either a day procedure if it’s a hysteroscopy and on occasions, patients have to stay overnight if it is keyhole surgery. Patients who undergo laparotomy will generally stay in the hospital for 2 nights after the surgery. There will be no pain as you will be asleep during the procedure, the anaesthetist will see you before the surgery to discuss anaesthesia and advise on what type of anaesthesia you will have.

The duration of the procedure would depend on what type of procedure we’re performing and what size the fibroids are and any previous surgery or any other comorbidities that are involved.

Read more about hysterectomy here…

Read more about hysteroscopy here

After the procedure, we would advise women to take time off work for anything from one to two weeks to four to six weeks after a laparotomy. Pain levels are moderate and usually controlled well with oral medications.

The possible complications involve infection, wound infection and bleeding. Quite often women develop bladder infections and more rare and significant risks such as clots that may occur. We go into detail about any type of complications during preoperative counselling.

For the procedure through the tummy such as laparotomy or laparoscopy, there will be a little scar involved. It takes four to six weeks to recover from the laparotomy and two to three weeks from laparoscopy.

You should see your results within the first period, the blood loss during the period should be lighter. The success rate of the procedure is quite high. If someone’s having a hysterectomy for uterine fibroids, it is definite that the fibroids will not come back because the uterus is removed and there will be no further bleeding. If someone is having a myomectomy just removal of fibroids and not the uterus, the fibroids may come back later in life. However the success of this procedure is still high, and the overall risks are low.

We can provide the quotation for the procedure. Generally, the cost of surgery would depend on the size and location of the fibroid, the procedure we perform, previous surgical history and potential for complications and your weight. 

Hysteroscopic Polypectomy

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