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Treatment options

Details the treatment options available to patients with uterine problems.

Management options for uterine problems

There are a number of treatment options available for patients with uterine problems and trying for a pregnancy. The Treatment options may include one of the following techniques: myomectomy, polypectomy, adhesiolysis, metroplasty and septoplasty depending upon the nature of womb problem.

Treatment options for uterine fibroids in women who wish to conceive

(1) Medical management

Women who suffer heavy painful periods may take Mefenamic acid pills three times a day commencing on day one of menstruation and Tranexamic acid pills three times a day commencing on day one of menstruation . Both medication do not affect fertility and are effective in reducing pain and bleeding in about 50% of patients.


(2) Myomectomy (removal of fibroids and conserving the womb)

Myomectomy is an operation to remove fibroids without removing the womb. Fibroids are removed and the womb is repaired. The surgery is recommended if the doctor thinks that fibroids are affecting the patients fertility (significantly distorting the uterine cavity) or the fibroid is large in size.

The procedure is carried out under general anaesthetic is can be performed by laparoscopy, laparotomy (open abdominal myomectomy).The incision will depend on the size and number of fibroids. a bikini line cut or midline. Some doctors gives an injection of GnRH agonist prior to surgery or pill to take daily called Ulipristal in order to shrink the fibroid and make surgery technically easier with less blood loss. There is a small but potential risks associated with myomectomy including risk of infection, bleeding, injury to pelvic organs, risk of scar rupture during labour, risk of adhesions formation which may affect fertility and also 1-2% risk of hystrectomy (removal of the womb) to control excessive bleeding. Moreover, the risk of recurrence as new fibroids develop over time and risk of blood clot in the leg or the lung.


(3) TCRF (transcervical resection of fibroid)

Thw surgery is performed in selected cases where the fibroid is projecting into the cavity of the womb, removal of the fibroid can be achieved by hysteroscopy. In this procedure, a hysteroscope is inserted through the vagina and into the womb through the cervix (neck of the womb). A small instrument with a specially designed tip is inserted through the hysteroscope and used to break the fibroids down into small pieces, which are then removed.

(4) Uterine artery embolisation (UAE)

UAE is a minimally invasive procedure where interruption of the blood supply to the womb is carried using embolic materials such as polyvinyle alcohol injected via a catheter, which is inserted via the femoral artery in the leg into the uterine artery. The procedure is performed under a local anaesthetic and sedation, usually require overnight stay in the hospital. UAE decreases the fibroid size by about 50% and reduce menstrual loss. Up to 90% of women report symptomatic relief following the procedure. UAE is not recommended for women who wish to preserve their fertility because of uncertainties about the safety of pregnancy after embolisation. Major complications of uterine artery embolisation are rare but minor complications are common inclouding pain, feeling sickness, vaginal discharge. The reintervention rate at two years is about 15%. It has been reported that UAE is associated with increased risk of miscarriages, preterm delivery, severe haemorrhage after delivery, increased rates of delivery by caesarean sections, and placenta accrete (morbid adherence of afterbirth). To date, over 200 pregnancies have been reported following uterine artery embolisation (Homer Fert Steril 2010). Furthermore, UAE is associated with an increased risk of premature menopause 3%.

Management of women who have a large endometrial polyp and wish to conceive

Endometrial Polypectomy  (removing the polyp)

This is usually a simple procedure done with the aid of a hysteroscope or by a D & C.


Management of women who have uterine adhesions (Asherman syndrome) and wish to conceive

Adhesiolysis (division of uterine adhesions)

This is a minor procedure, usually done using a hysteroscope. Antibiotics may be prescribed to diminish the chances of infection.

Management of women who have uterine septum and wish to conceive


A uterine septum is a congenital anomaly (present from birth) It is a fibro-muscular band that divide the inside of the womb, thus creating two cavities. The septum may be complete or incomplete. Uterine septum is more common in women with primary infertility and in women who have had recurrent miscarriages and preterm delivery. Metroplasty is surgical procedure to remove the septum with the aim of creating a normal uterine cavity. Metroplasty is commonly used for women who have had recurrent miscarriages or preterm delivery. However, its use in women with primary infertility is controversial. Metroplasty is performed under a general or spinal anaesthesia. It can be done abdominally or vaginally through an operative hysteroscope. Hysteroscopic approach is favoured as it reduces morbidity and shorten recovery period. The procedure may be performed under ultrasound or laparoscopic guydance.Unlike abdominal metroplasty, cesarean section is not mandatory for women who conceive after hysteroscopic metroplasty.

Division of septum

What are the treatment options for women who was born without uterus or whose uterus had been removed?

(1) Accepting the status que

(2) Surrogacy

(3) Adoption

(4) Uterine transplantation

Uterine transplantation is a novel treatment for absolute uterine factor infertility and is currently being performed under experimental protocols in a few medical centers worldwide. Brannstrom and colleagues from Sweden (2014) reported a series of 9 human uterine transplantations with live uterus donors. Most women who received the donor wombs were wither born without womb or had their womb removed (hysterectomy) because of cancer or massive haemorrhage following delivery. The majority of donors were mothers to the recipients. Uterine transplantation is a complex surgery and can takes up to 12 hours to perform with a team of vascular surgeons and gynecologists etc. Furthermore, the recipients need to take immunosuppresI've drugs to stop their body rejecting the donor uterus.

a 36 year old Swedeish mother has become the first woman in the world to give birth after receiving a womb transplant. She was born without uterus. The donor was a 61 year old live close friend. The pregnancy was conceived after IVF and replacing one frozen embryo. The baby was delivered by cesarean section at 31 weeks because the mother developed high blood pressure in pregnancy. Both mother and baby are OK. A second woman 34 years old who had her womb removed when she was treated for cancer aand had womb transplant gave birth To a baby boy boy by caesarean section and the baby weighed about 6 pound. The mother of the second patient donated her uterus. To date, there has been 20 live births from uterine transpalnts.

Who is more likely to need uterine transplant?

Women born without womb and have functioning ovaries (the incidence is one in 5000 woman). Women who had their womb removed after suffering form cancer. Women who had their wombs removed because of massive postpartum haemorrhage or severe infection (complications after birth). Women who had deformed wombs or have adhesions or scars (such as severe Asherman syndrome). Women who have suffered repeated miscarriages with no cause found.

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