Age 32 – After Hysteroscopic Myomectomy
This is the cervix of a 32 year old woman who has never given birth. She has a history of multiple fibroids (also called uterine myomas or leiomyomas), which are tumors made of smooth muscle cells and fibrous connective tissue that grow in the tissue of the uterus. They are almost always benign (non-cancerous). Often people with fibroids have no symptoms, but sometimes, they can cause heavy or painful periods, pain in the lower back or abdomen, increased need to urinate, constipation, or pain or discomfort during sex.
Her largest fibroid was submucosal and approximately 6 cm x 6 cm x 5 cm. Submucosal fibroids grow just under the endometrium, the innermost layer of muscle lining of the uterus and can bulge into the uterine cavity. Sometimes these types of fibroids include a stalk of tissue (called pedunculated fibroids).
She had a uterine fibroid embolization (UFE) to cut off blood supply to the fibroid so it would shrink. During UFE, a thin tube (catheter) is inserted through a blood vessel in the leg or wrist and guided by X-ray images to the blood vessels that feed the fibroids of the uterus. Tiny particles are injected to stop blood flow to the fibroids. Usually, after embolization, the fibroids shrink gradually over the next weeks.
For this woman, three months after her embolization, a necrotic (dead/disintegrating) fibroid that had detached from the endometrium and was sitting in the uterine cavity, causing pain, inflammation and persistent thick mucus discharge. She had the remaining fibroid removed hysteroscopically through an outpatient, in-office procedure.
During a hysteroscopy, the patient may receive local or general anesthesia to numb the pelvic area. The doctor opens the vagina with a speculum and then dilates the cervix using a series of slender rods increasing in diameter to open the os. Once dilated enough, they can use a hysteroscope (a thin, lighted, flexible tube & camera) to enter the uterus through vagina and into the cervix. After the uterus is expanded with gas or a solution, small instruments are inserted through the hysteroscope tube and used to remove the fibroid.
In these photos, there are clearly visible at least 4-6 injection sites where the paracervical block (local anesthesia) was administered at the start of the procedure to numb the cervix. Some dilation is still evident, as is bloody mucusy discharge associated with remnants of the disintegrating fibroid. Her cervix and vaginal walls are slightly swollen in these photos.