Fibroid Treatment Options
The treatment for fibroids is dependent on your symptoms and how they affect your life, the size of your fibroids, your age and your plans for future pregnancy.
As long as the fibroids do not cause any symptoms, no treatment is necessary. The fibroids could be monitored through yearly pelvic examinations and ultrasounds. Mild symptoms can be managed simply by taking over-the-counter or prescription pain medication. For more severe symptoms, you have several options both non-surgical and surgical.
Hormone Therapy includes the use of a medication called a GnRH (gonadotropin-releasing hormone) agonist. This medication shrinks the fibroid by blocking estrogen production. Treatment is short-term, usually no longer than 6 months, and the fibroids usually return after treatment is discontinued.
In addition, the side effects include those associated with menopause such as hot flashes, vaginal dryness, insomnia, irritability and depression. These drugs are generally used only when a does not desire conception in the near future. Learn more about drug therapies
Uterine Artery Embolization
Uterine artery embolization is one of the newest non-surgical approaches to treating fibroids, but long term results are still unknown. This procedure is performed in a radiological facility.
During an embolization, the radiologist uses X-ray images to guide a thin tube (catheter) through an artery in your leg to the arteries in your uterus that deliver blood to the fibroids. Once the catheter is in place, the doctor inserts tiny particles of plastic or springs into the uterine artery. Clots then form around the particles, blocking blood flow to the fibroid.
Without a blood supply, the fibroids shrink or disappear over time. The side effects include pain, bleeding, and possibly infection. This procedure is indicated for those who are not medically stable to have surgery. Its use in women of reproductive age requesting fertility is still questionable. Several cases have been report the uterus rupturing during a subsequent pregnancy after embolization.
Myomectomy is a uterine preservation surgical procedure to remove fibroids while leaving the uterus intact. It may be a good option for women who want to maintain their fertility. A traditional myomectomy is done through an incision in the abdomen which could be up and down (from the pubic bone to the umbilicus or belly button) or across the abdomen (bikini incision).
Recently, less invasive techniques have been developed which let you heal quicker, recovery time is shorter and produce minimal scarring. These include laparoscopic myomectomy (performed through tiny incisions in the abdomen) or hysteroscopic myomectomy (performed through the vagina and cervix with no incision).
These forms of surgery require special surgical skills and experience. Potential risks with any surgical procedure include infection, damage to vital organs and, in rare cases, perforation of the uterus.
Myomectomies could result in adhesions or scar tissue formation. Adhesions consist of scar tissue that develops internally at the site of surgery and can cause internal organs to bind to one another. Adhesions or scar tissue can cause pelvic pain and infertility.
Modern surgical techniques can help to reduce adhesions. Using meticulous surgical methods to minimize tissue trauma and selecting the appropriate suture material can reduce the formation of adhesions. Prior to the surgery being completed your surgeons can also place an adhesion barrier over the surgical site to keep organs from becoming joined. The barrier gradually dissolves as you heal.
Myolysis is an experimental procedure which destroys the fibroid by using a laser, electrical current or freezing during a laparoscopy. Currently, this procedure is experimental and is not standard of care offered to the general population.
A hysterectomy is reserved for those women who failed conservative management with medication and / or minimally invasive surgery and those who do not desire pregnancy. Traditional hysterectomy was considered a major invasive surgery requiring a several day stay in the hospital with up to 6 weeks of recovery.
In selected cases a hysterectomy can now be performed laparoscopically. This would reduce adhesion formation, post-operative pain, the hospital stay (to as short as an outpatient procedure), and reduce the recovery time to 1 week.
Fibroids are suspected when menstrual cycles are abnormal or when the uterus has an abnormal shape noted during a routine gynecological examination. In order to rule out other conditions that can be mistaken for fibroids; i.e. ovarian tumors, bowel masses or early pregnancy, several diagnostic tests could be performed.
Ultrasound uses high frequency sound waves to generate a picture of the pelvis and / or abdominal region. In cases where the fibroid could be in the uterine cavity a specialized ultrasound called sonohysterogram or saline infused sonography, can be used.
During this procedure a small amount of saltwater solution is placed in the uterine cavity through the vagina and cervix. This fluid distends the cavity and separates the walls. This enables the ultrasound to detect any lesions in the cavity; i.e. polyps, fibroids, or scar tissue. The ultrasound can be performed without anesthesia, and is an office procedure.
Magnetic Resonance Imaging (MRI)
An MRI is a procedure that uses magnets and radio waves to create an image of the uterus. This procedure is more time consuming and could cause more anxiety for the woman.
An HSG is performed a radiological facility by placing a catheter into the cervix. Through the catheter a special dye is injected into the uterine cavity. During this process, an X-ray of the inside of the uterus and fallopian tubes is taken.
This test allows the physician to actually visualize the dye as it goes into the uterus and exam the cavity and tubes while the test is performed. No anesthesia is used for this test and takes approximately 5 minute to set-up and complete.
Hysteroscopy is an outpatient surgical procedure that uses a thin, lighted telescope called a hysteroscope that is inserted into the uterus through the vagina and cervix to view the uterine cavity. Hysteroscopy is usually performed as an outpatient procedure using local or general anesthesia. If fibroids, polyp, or scarring are found, they can sometimes be removed during this procedure.
Laparoscopy is a procedure that uses a camera on a lighted telescope that is placed through a small abdominal incision, to view the uterus, ovaries and fallopian tubes. If a fibroid is encountered during a laparoscopy, size, placement in the pelvis, and location to nearby organs would determine if the fibroid is removed or if it is possible.