Submucosal fibroids: when should they be removed?

Submucosal fibroids in women can result in infertility issues as the presence of these fibroids unfortunately makes it all but impossible for sperm to be able to implant itself in the uterus.

On hand to inform us when women should have these nuisance-causing fibroids removed is revered women’s health expert and consultant gynaecologist, Mr Mahantesh Karoshi.

When is surgical removal of submucosal fibroids required?

Women who are troubled by fibroids which project into the cavity of the womb usually experience heavy menstrual bleeding, which can, in turn, lead to intractable bleeding, flooding, as well as passing of large blood clots.

Can fibroids cause infertility problems?

There is enough scientific evidence to suggest that fibroids can indeed cause the following infertility-related problems:

• they may act like a contraceptive
• failure of the fertilised egg to implant
• miscarriages
• fibroids also secrete certain chemicals which are not conducive to pregnancy

Which fibroids are recommended to be removed?

If the resection of the fibroid is mainly for subfertility purposes, then, due to the fact that the resected area of the fibroid is considered as a freshly open wound, in order to prevent adhesion of the two uterine walls (front and back), a copper intrauterine device is inserted for up to three months. Doing so will prevent intrauterine adhesion formation such as Asherman’s syndrome.

Up to 3cms-sized fibroids that project into the womb cavity can be shaved off in one sitting. If there is more than one fibroid that projects into the womb cavity, then the patient may require two-stage procedures, i.e., to remove the first one and then after a few weeks the second one.

If the fibroid is too big, then half can be shaved first and then the remaining will be shaved off in the next procedure. If the fibroid is 6-7cms and is projecting into the womb cavity, then it is preferable to remove it through either an open approach or a keyhole approach.

Some patients may require a hysteroscopy to demonstrate normal womb cavity after such major surgery at the time of removal of the copper intrauterine device.

How are fibroids located in the womb? What technique is used?

Fibroid mapping, a technique used to correctly and accurately locate fibroids in the womb, is usually carried out by an experienced sonographer, through an MRI scan or as an outpatient diagnostic hysteroscopy (a thin telescope which is 2mm in size) which is inserted into the womb cavity under local anaesthesia to plan the appropriateness of the shaving procedure or whether the given patient benefits more from open or keyhole surgery.

Are hormonal injections used when identifying or removing fibroids?

Occasionally, temporary shrinkage of the fibroid is considered to reduce blood loss during surgery. Usually, this measure involves administration of hormonal injections, referred to as GnRH analogues.

Mr Mahantesh Karoshi is a highly esteemed and skilled London-based consultant gynaecologist who specialises in women’s health. Check out his Top Doctors profile today to book an appointment with him if you feel as though you may require surgical removal of fibroids.