There are mainly 4 types of fibroids that develop at different locations in and on the uterus.

• Intramural fibroids: These are the most common type of fibroids which prominently appear within the muscle lining (endometrium) of the uterus.
• Sub-mucosal fibroids: These type of fibroids form in the inner lining (myometrium) of the uterus and may extend into the uterine cavity. These are not as common as other type of fibroids but may cause heavy menstrual bleeding and trouble in conceiving when developed.
• Sub-serosal fibroids:These type of fibroids appear close to the outside of the uterus-partly in the myometrium and partly outside.
• Pedunculated fibroids:When submucosal or subserosal fibroids develops a slender base that supports the tumour, they are called pedunculated fibroids.

Uterine fibroids can result in developing two different types of uterine conditions which can be catheterized under as:

A. Cancerous uterine conditions

B. Noncancerous uterine conditions

Most of the growths in uterus are typically non-cancerous in origin. Some of the most common non-cancerous conditions are:

• Fibroids
• Endometriosis and endometrial hyperplasia
• Severe menstrual pain and ovarian cysts
• Uterine prolapse
• Pelvic inflammatory disease

Treatment for Fibroids can be classified in two ways:

• Medical Management:
  • GnRH agonists, Progestin, oral contraceptive pills, androgenic agents and anti-estrogens
• Surgical Management:
  • Myomectomy:This procedure is for removal of fibroids but conserves the uterus. There are different techniques of performing myomectomy like Hysteroscopic, laparoscopic and open myomectomy.
  • Uterine Artery Embolization/Uterine Fibroid Embolization (UAE/UFE):The blood flow to the uterus and/or fibroid is blocked, leading to necrosis and a gradual shrinkage of the fibroid.
  • Hysterectomyis one of the options which involves complete or partial removal of uterus and the fibroid. It can be done the conventional way or minimally invasive way.

Treatment of fibroids depends on the age of the patient, her medical condition and obstetric history, size and type of fibroid. The common criteria associated with selection of treatment also depend on the symptoms like:

• Excess and prolonged menstrual bleeding
• Pain in the abdomen and lower back
• Painful intercourse
• Frequent urination or constipation

Myomectomy

• Laparoscopic myomectomy removes intramural tumours viz., tumours that are deep inside the uterus wall or sub-serosal which lie outside the uterus. A very small incision gives access to the laparoscope and surgical tools making it a minimally invasive procedure.
• Hysteroscopic myomectomy technique removes fibroids that are sub-mucosal with the help of a small camera called hysteroscope to pass through cervix into the uterus in order to excise and remove the fibroids.
• Open myomectomy is the traditional method with incision large enough to remove the fibroids. This technique is used when other less invasive methods are not an option.

Hysterectomy

• Laparoscopic Hysterectomy: The patient is anesthetised. Small incisions of about a centimetre are made on the lower abdomen. The abdomen is then filled with carbon dioxide and a small camera with laparoscope and small instruments are introduced and operated. The gas is later removed and incisions are closed.
• Vaginal Hysterectomy: The procedure is performed through the vagina. Both vaginal and Laparoscopic hysterectomy are for situations where the uterus is not too large in size.
• Abdominal Hysterectomy: This is the traditional horizontal incisions to remove the uterus and fibroids when it is too large for minimally invasive methods.

Uterine Artery Embolization (UAE)

The procedure is done by an interventional radiologist. The patient is sedated and a needle is inserted into the leg and a catheter is connected to the artery and x-ray is taken. Particles of polyvinyl alcohol are injected that block the arterial supply for the fibroid. Thus, the uterine arteries are embolized and the blood supply to the fibroids is cut off, so that the fibroids shrink and disintegrate. The patient has to remain in bed for 6 hours with the leg straight. Pain can be managed with medicines after the procedure.

Recovery time for laparoscopic and all minimally invasive procedures require an overnight stay in the hospital. Uterine Artery Embolization procedure involves overnight stay at the hospital but total recovery will happen in 7 to 10 days. Vaginal hysterectomy usually takes 24 hours stay at the hospital. Mild pain persists for approximately for 10 days. Whereas with abdominal hysterectomy, it takes 3 to 4 days of hospital stay and total recovery needs 4- 6 weeks.

85% to 90% of the patients have significant resolution of symptoms such as pain, heavy bleeding etc. Hysterectomy is a permanent treatment where uterus is taken out and there are no chances of having fibroids after that. The flip side is that the woman cannot get pregnant after hysterectomy. Myomectomy has good results with resolution of all symptoms. Chances of recurrence of fibroids have to be consulted with the doctor.

Minimally invasive techniques require only an overnight stay or a 24 hour stay. But traditional surgeries like abdominal myomectomy and open hysterectomy require longer hospital stay and recovery time. It depends on the type of treatment procedure.