Myoma (Fibroid) Surgery

A fibroid found incidentally in a woman with no complaints often needs nothing more than observation. The reason to treat is what the fibroid is doing, not that it is there.

When Fibroids Cause Problems

• Heavy or prolonged menstrual bleeding, sometimes leading to anaemia
• Pelvic pressure, an enlarging abdomen or discomfort during intercourse
• Frequent urination or difficulty emptying the bladder when a fibroid presses on it
• Difficulty conceiving or recurrent pregnancy loss, depending on where the fibroid sits

Position matters more than size in many cases. A small fibroid protruding into the uterine cavity can cause more bleeding and more difficulty with conception than a considerably larger one growing outward from the wall.

Assessment

Ultrasound is the first step and usually answers the main questions: how many fibroids, where they sit and how large they are. MRI is added when the anatomy is complex, when surgery is being planned, or when imaging features are not straightforward.

Treatment Options

• Observation where symptoms are absent or mild, with periodic review
• Medical treatment aimed at controlling bleeding
• Hysteroscopic removal for fibroids inside the uterine cavity, with no abdominal incision
• Myomectomy, removal of the fibroids with the uterus preserved, performed laparoscopically or as open surgery depending on number, size and position
• Hysterectomy, removal of the uterus, for patients who have completed their family and whose symptoms justify it

Where the uterus is to be preserved, laparoscopic and robotic surgery is often suitable. The method is chosen after the fibroids have been mapped, not in advance.

Fibroids and Pregnancy

Many women with fibroids conceive and carry a pregnancy without difficulty. Whether a fibroid interferes depends chiefly on where it sits: one that distorts the uterine cavity is more likely to affect implantation or cause bleeding than one growing outward from the wall.

Where surgery is considered before a planned pregnancy, the discussion covers not only removal but also healing of the uterine wall and how that affects later delivery. This is a decision made together, with the imaging in front of you.

Fibroids and Cancer

Fibroids are benign and do not turn into cancer. Very rarely a mass that was assumed to be a fibroid turns out on pathology to be a different tumour, which is one reason rapid growth, growth after menopause or unusual imaging features are taken seriously and assessed rather than simply watched.

For an assessment, see the contact page. This page is general information and does not replace an examination. Decisions about your own treatment can only be made after assessment.