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Uterine fibroids are the most common benign neoplasms of the female reproductive tract with an estimated incidence of 25–30% at reproductive age . They are detected by ultrasound in about 70–80% of women by the age of menopause . About 30% of fibroids produce symptoms such as abnormal uterine bleeding (AUB) which may result in anaemia, pain or pressure effects on contiguous structures such as urinary incontinence, urinary frequency, urinary outflow obstruction, hydronephrosis, constipation and tenesmus. Fibroids may also be associated with subfertility, and with adverse pregnancy outcomes such as miscarriage and fetal malpresentation . The symptoms associated with fibroids are known to compromise quality of life .
Improved hysteroscopic technology has enabled clinicians not only to perform diagnostic outpatient hysteroscopy but also to treat uterine lesions. Bipolar diathermy electrodes have reduced the risk of fluid overload, allowing the excision of larger fibroids at a single setting and thus reducing the need for abdominal operations. Novel indications for hysteroscopy have become available, such as hysteroscopic tubal occlusion. Concomitant developments in hysteroscopic equipment and ultrasound technology have influenced how these tools are used in the diagnosis and treatment of intrauterine conditions.
The association between endometriosis and infertility is controversial, as endometriosis can be present in both fertile and infertile women. A review of the published studies showed that the prevalence of endometriosis was 4% in women with proven fertility undergoing laparoscopic sterilisation, whilst this figure was 13.5% in infertile population. Furthermore, this review demonstrated that endometriosis tends to be more advanced in infertile women, compared to women with proven fertility. A recent epidemiological study showed that endometriosis was associated with an age-adjusted two-fold increased risk of subsequent infertility, but only in women under the age of 35 years.