2 The condition, current treatments and procedure

2 The condition, current treatments and procedure

The condition

2.1 Uterine fibroids (also known as uterine leiomyomas or myomas) are benign tumours of the uterus. They can be asymptomatic or cause symptoms including heavy periods or bleeding between periods. They can be associated with fertility problems and miscarriage.

Current treatments

2.2 Treatment depends on whether the fibroids cause symptoms, and if the person would like to become pregnant in the future. For symptomatic fibroids, treatment options include medication, interventional radiology and surgery. Interventional radiology treatments include uterine artery embolisation and MRI-guided focused ultrasound. Surgery includes hysterectomy, myomectomy, endometrial ablation techniques and myolysis.

2.3 This procedure is used for submucosal fibroids, which develop in the muscle layer beneath the inner lining of the uterus and grow into the uterine cavity. This includes pedunculated fibroids, which are attached to the uterus with a narrow stalk of tissue.

The procedure

2.4 Hysteroscopic mechanical tissue removal (hysteroscopic morcellation) aims to remove submucosal uterine fibroids under visual guidance using a hysteroscope inserted into the uterus through the cervix. It is intended to reduce the risk of traumatic injury to the uterus associated with traditional procedures. An intended advantage of the procedure over thermal ablation techniques is avoiding the risk of thermal injury.

2.5 The procedure may be done under local, regional, or general anaesthesia, typically as a day-case procedure. A hysteroscope is inserted into the uterus through the cervix and saline is pumped thorough a small channel in the hysteroscope to distend the uterus. A morcellator is passed through the hysteroscope and used to cut and simultaneously aspirate the morcellated fibroid tissue. The aspirated tissue can be collected for histological analysis.

2.6 Different devices are available for this procedure.

  • National Institute for Health and Care Excellence (NICE)