Most women don't even know that they have uterine fibroids. However, in some women, the presence of submucosal fibroids is quite symptomatic, particularly those who have either multiple or large subendometrial fibroids. Some typical symptoms are:
Unusually heavy or prolonged menstrual periods
Severe abdominal cramps during menstrual periods
Bleeding between menstrual periods
Large submucosal fibroids can cause some discomfort in the lower abdomen
Severe pain, if the stalk of the pedunculated submucosal fibroid twists or if the uterine fibroid outgrows its blood supplies
Do they cause infertility?
Submucosal fibroids are known to cause infertility in women of childbearing age. There are several ways in which submucosal fibroids can induce infertility. For instance, they can block the fallopian tube, thus preventing sperm from fertilizing the egg.
What happens to them in pregnancy ?
The presence of submucosal fibroids during pregnancy can lead to pregnancy complications. During the course of pregnancy, these fibroids will also grow in size, thereby decreasing the amount of space available for the baby to grow. As a result, either miscarriage or foetal congenital deformities can occur. Furthermore, submucosal fibroids can increase the chances of postpartum hemorrhage, obstructed labour and cesarean section.
What is hysteroscopy?
Hysteroscopy is a procedure that allows your doctor to look inside your uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be either diagnostic or operative.
What is diagnostic hysteroscopy?
Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes.
Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C)/or during infertility workup.to rule out uterine causes.
What is operative hysteroscopy?
Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can often be performed at the same time, avoiding the need for a second surgery.
When is operative hysteroscopy used?
Polyps and fibroids.
Thick endometrial lining, when suspecting cancer.
Missing copper t thread
Foreign body removal
Proximal Tubal cannulation for infertility.
What are the benefits of hysteroscopy?
Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:
Shorter hospital stay
Shorter recovery time
Less pain medication needed after surgery
Avoidance of hysterectomy
Possible avoidance of "open" abdominal surgery
How safe is hysteroscopy?
Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. With hysteroscopy, complications occur in less than 1 percent of cases
When should the procedure be performed?
Recommended to schedule hysteroscopy for the first week after your menstrual period. What type of anesthesia is used for hysteroscopy?-usually general anaesthesia
How long does it take?
The time to perform hysteroscopy can range from less than 5 minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time.
What can I expect after the procedure?-spotting/abdominal cramps?Will I have to stay in the hospital overnight?
Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, when operative procedure is performed stay might be recommended.
What Is a Hysteroscopic Myomectomy?
Hysteroscopic myomectomy is a technique that can be performed only if fibroids are within or bulging into the uterine cavity (submucosal)
How different it is from open surgery?
A myomectomy is a surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons.. This procedure is considered standard of care for removing fibroids and preserving the uterus.
Myomectomy has traditionally been performed through a large abdominal incision, however advances in technology have provided less invasive alternatives such as hysteroscopic and laparoscopic myomectomies. While this procedure is more invasive and time consuming for the surgeon, it affords patients the opportunity to remain fertile. A hysteroscopic myomectomy removes fibroids through the vagina.
How effective is the procedure?
When fibroids are the cause of infertility, pregnancy rates following hysreroscopic myomectomy have been about 50%. And when performed for heavy bleeding, nearly 90% of women have a return of normal menstrual flow.
Is pregnancy possible after this?-You can become pregnant after myomectomy,chances are more than 80%
What is Endometrial Ablation?
Endometrial ablation is an outpatient procedure used to stop or decrease bleeding from the uterus. The traditional method of performing endometrial ablation uses electrical energy passed into the uterine cavity at the end of a telescope in order to cauterize and destroy the lining of the uterus.
Endometrial ablation should only be performed for women who do not wish to have any, or any more, children. Because the lining cells of the uterus are destroyed, there is no place for a developing fetus to attach within the uterus.
Patients usually are sent home after the procedure and have minimal need for recovery. The hospital stay can last from 30 minutes to 2 hours and recovery time is generally 1-2 days. Generally only fibroids that are small and accessible through the cavity can be treated this way.
What is the medical management for fibroids?
Only small fibroids that are causing minimal to moderate symptoms and fibroids in women that are poor candidates for surgery because of their overall health.
Medications are useful in extremely anxious women who wish to avoid any type of surgery or radiologic intervention.
These medications are generally hormonal and consist of birth control pills, progestin-containing intrauterine devices (Mirena IUD), Depo Provera . .. Rarely androgen can be given to shrink fibroids and reduce their blood loss.
What is a resectoscope?
The resectoscope consists of a lit telescope and an electrically charged electrode (note: not a laser). The charged electrode can cut and cauterize tissue more effectively..
What is mirena?
Mirena is an intrauterine device approved by the FDA for use as birth control as well as to help relieve heavy bleeding in women suffer from heavy bleeding and pain caused by uterine fibroids.. Mirena works by releasing a steady dose of progestin, a hormone that provides relief of symptoms, but does not shrink tumors.
What could be the Side Effects of mirena?
Like all medications, Mirena has side effects. Common side effects include acne, back pain, breast pain, changes in menstrual bleeding, changes in sex drive, bleeding, cramping.
Can MIRENA Treat Heavy Bleeding from Fibroids?
Women who have a uterus with fibroids smaller than 12 weeks size and a normal size uterine cavity may get relief from heavy bleeding. One study showed that by 3 months, 85% of women returned to normal bleeding, and heavy bleeding and anemia were cured in virtually all women at the end of one year.