It is well documented that there is a risk of developing intrauterine scar tissue following any trauma to the uterine cavity. This includes fibroid resection causing pain, infertility and Asherman’s Syndrome diagnosis.
Uterine fibroids or myomas are benign tumours of the uterus made up of smooth muscle. They are very common in women between 25 –45 years. Fibroids may occur on the inside of the womb (submucosal fibroids), in the muscle wall (intramural fibroids) or grow to the outside of the womb (subserosal fibroids). They may vary in size from being very small to very large. Fibroid growth is caused by hormones produced by the ovaries.
Many women with fibroids do not have symptoms. Symptoms usually depend on the size, number and location of the fibroids in the womb.
Fibroids can cause heavy menstrual bleeding. As a result some women develop anaemia (low blood iron), causing weakness and tiredness. Fibroids can also cause painful periods and lower abdominal (pelvic) pain.
They may also cause abdominal swelling or lump. They may cause pressure symptoms like lower back pain or pelvic discomfort as well as urinary frequency and/or constipation. Fibroids may be present in about 5-10% of women who have infertility and may be the only factor causing infertility in 1-2% of infertile patients.
This is specialist surgery and should be done by an experienced surgeon doing it on a regular basis.
Transcervical Resection of Fibroids is used to remove fibroids that occur on the inside of the uterus (submucosalfibroids). It is usually performed under a general anaesthetic as a day case. The neck of the womb is stretched using dilators. Fluid is then passed into the cavity of the womb to distend it and allow a clear view.
Using a special telescope and a resectoscope, an electrical current is passed through a cutting loop attached to the resectoscope and the fibroid is shaved off the womb.
Hystereoscopic removal of fibroids can cause adhesions, especially if the fibroids are on opposite sides of the uterus. The average reported incidence is around 10% – 20% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids.
In this instance, two opposing fibroids in the cavity should not be operated on in one procedure. The two cut edges will stick together sealing the uterus closed. Functional integrity of the uterus is as important as tumour removal or symptoms relief.
Other risks include heavy bleeding, infection or perforation of the uterus (making a hole in the womb). If there is a perforation of the uterus, an additional procedures such as laparoscopy (keyhole surgery) or laparotomy (open surgery) is needed to fix the damage caused.
There is a risk of excessive fluid absorption from the fluid used to distend the womb during the procedure (1-5%). Fluid balance should be monitored during the procedure to reduce this risk.
Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of adhesions.
If you think you may have a claim following Fibroid Resection Causing Pain Infertility and Asherman’s then call us in confidence to discuss your issue. We are happy to talk through what has happened and advise you on a potential claim. If you want to make an Ashermans Claim Call us for FREE on 0800 470 2009 or email Dr Victoria Handley at vhandley@handleylaw.co.uk