B. Myomectomy – EXplanation
myomectomy.
Endometrial ablation is a very good option to decrease menorrhagia however the
procedure involves using electrical currents or heated water to destroy the endometrium
which could result in infertility. This procedure is therefore NOT recommended for
women who still want children. It is also important to note that endometrial ablation is
not used in patients with large fibroids. It is primarily used in patients with heavy
menstrual bleedings due to endometrial hyperplasia without fibroids, but it can also be
used to treat small submucosal fibroids.
Uterine artery embolisation (UAE) is an alternative procedure to a hysterectomy or
myomectomy for treating fibroids. It is performed by radiologist and involves embolizing
the uterine arteries to shrink the fibroids. It is recommended for women with large
fibroids however it is not recommended if the woman is trying to conceive as it reduces
blood to the uterus significantly.
The levonorgestrel intrauterine system (LNG-IUS) is a small, plastic, t-shaped device
placed in your uterus that slowly releases progestogen. It also acts as a contraceptive
and thus should not be used for a woman trying to conceive.
GnRH analogues essentially shrink the fibroids however they would grow back once the
medication is stopped. Its primary use is so that it is easier to remove the fibroids during
surgery.As GnRH analogues inhibit ovulation, it would prevent pregnancy from
occurring. This would be a suitable option given that it was combined with a
myomectomy.
It is also important to note that if she does decide to go for a myomectomy, she would
need to be counselled of the risk of uterine rupture in the future if she would become
pregnant especially during labour. Her obstetrician would need to weigh the risk and
benefits of a normal delivery and consider a caesarean section due to the risk of a
uterine rupture.
FIBROID LOCATIONS
Submucosal fibroids
- Are located beneath the endometrium and bulge into the uterine cavity
Intramural fibroids
- Are located within the muscular uterine wall
- Most common type of fibroid
Subserosal fibroids
- Located on the external surface of the uterus and project to the outside of the uterus.
