Myomectomy in infertile Jamaican women

Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital

Fibroids are the most common benign tumours of the pelvis in women, with a prevalence estimated at 20-50%. They are more common towards the end of the reproductive years. There is a racial preponderance, being more common in black than white women. This may relate to the aetiology, which is still poorly understood. Generally, fibroids do not cause symptoms but some sufferers do complain about pressure symptoms, abnormal vaginal bleeding and infertility. For these reasons, myomectomy is often resorted to after failure of medical interventions on the premise that it brings about improvement/cure of symptoms and enhancement of fertility. However, the evidence for these indications for surgery is hazy. An analysis of the 109 medical records of symptomatic patients who had myomectomy over a 5-year period at a tertiary centre revealed the following. Single-symptom presentation in 41 (38%), menorrhagia in 20 (18%) being the most common. Only 52 (48%) patients had medical treatment of one form or another before myomectomy. Additional operative findings included pelvic adhesions, evidence of PID and endometriosis. Thirty-four (31%) had an estimated blood loss 500 ml and 23 of these patients needed blood transfusion. There were four cases of unscheduled hysterectomies due to uncontrollable bleeding. Pyrexia was the most common (38%) postoperative complication followed by superficial wound infection in 5%. We observed improvement of symptoms, assessed over a range of 2-24 months, in 34 cases (68%) in patients without fertility symptoms who accounted for 50 of these women. The symptomatic benefit was less (36%) in the 'infertility group'. Following an observation period of over 12-36 months, 17 patients in the 'infertility group' were lost to follow-up. Two (14%) of the 14 patients who attempted in vitro fertilisation (IVF) were successful. In the non-IVF group, 13 (46%) of the 28 achieved natural conception. These results suggest that symptomatic improvement and fertility enhancement may be possible in some patients with fibroids. In view of the risks and potential failure of treatment associated with myomectomy these results, yet again, support the fact that patients should be properly counselled before embarking on myomectomy and we strongly advocate local data to form the basis of the advice given during the consultation rather than what obtains in the literature.

Uterine fibromyomata: presentation and management in northern Nigeria

A study of uterine fibromyomata at the Ahmadu Bello University Teaching Hospital, Zaria indicates that the condition occurs in 7.8% of new gynecology cases. Infertility 87.2%, menstrual disturbance 70.4%, in association with chronic pelvic inflammatory disease 43.4%, anemia 25.0% and hypertension 25.5% were the commonest presentations. Total abdominal hysterectomy was commonly performed due to the high rate of chronic pelvic inflammatory disease. Post-operative morbidity was due to pyrexia in 28.6%, hemorrhage in 7.1% and wound infection in 6.6% of the series.

Management of uterine fibroids at the University of Benin Teaching Hospital

One hundred and eighty cases of uterine fibroids out of the two hundred treated in a gynaecological unit in a 7-year period are reviewed. The incidence of uterine fibroids among gynaecological conditions was 3.2% and it accounted for 3.6% of the operations. The peak age incidence was at 31-40 years (46%). Twenty per cent of those affected were grand multiparae. The commonest clinical features were abdominal swelling, infertility, abdominal pain, menorrhagia and dysmenorrhoea. Most of the patients were treated surgically with myomectomy (68%), mainly on account of the low parity and age. There was increased morbidity among those who had hysterectomy; 2 deaths occurred in this group. We have advocated liberal use of myomectomy , with its preservation of menstrual and reproductive function.