Update on Laparoscopic Myomectomy

FIBROIDS ARE TUMORS that arise within the muscle of the uterus forming round masses. Some women have single fibroids as large as a football, others have multiple ( up to 20 or more ) which vary in size from a peanut to golf balls and larger.

Fibroids are named according to their position in relation to the uterine muscle and cavity.

NO SYMPTOMS: Most fibroids up to the size of an orange(12 weeks pregnacy) cause no symptoms. Their mere presence is not a reason to treat them.

SUBMUCUS: They protrude into the uterine cavity and cause menstrual cramps, heavy periods, infertility and repeated miscarriages. The diagnosis is often missed as the uterus is not enlarged and unnecessary hysterectomies have been peformed for these. The diagnosis is made by hysterosonography or hysteroscopy.

INTRAMURAL: These fibroids are within the muscle of the uterus and can be very large. Because they enlarge the cavity of the uterus they can also cause heavy periods. The most common problem is PRESSURE symptoms on the bladder and rectum.

SUBSEROUS: These are external to the uterine muscle and are connected by a thin stalk. They are the least likely to be symptomatic and rarely need removal. TORSION (twisting) is a very rare complication.

DEGENERATION: Rarely there is liquifaction and bleeding within the center causing pain and fever. Infection may also occur. The most common occurrence is during pregnancy. Treatment is never surgery but conservative with fluids, pain medication and antibiotics.

Only submucus fibroids cause repeated miscarriages. Large intramural fibroids may be the cause of longstanding infertility if all other causes have been excluded.