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Other Fibroid Treatments

There are multiple surgical and non-surgical treatment options available for women with symptoms caused by their fibroids. All of these options have advantages, disadvantages, and potential risks or side effects associated with them. Depending on the size, number, location and blood supply of the fibroid tumors, certain treatment options may be more favorable for one patient than another. Discussing the potential options with your doctor is important in determining which option is best for you. Generally speaking, the larger the fibroids and uterus become, the fewer treatment options that are available. Once a uterus reaches a certain size, usually about the size of a 6 month pregnancy, the only option is traditional open surgery. The following are brief descriptions of other uterine fibroid treatment options:

  • Hysterectomy:A large percentage of the approximately half a million hysterectomies performed in the United States each year are due to fibroid tumors. During a hysterectomy, the uterus is removed either through an open surgical incision in the lower abdomen/pelvis area or through the vagina. Vaginal hysterectomies, however, are usually not an option for larger fibroids. Hysterectomy is considered major surgery and requires general anesthesia. It also requires a three or four day stay in the hospital and is associated with an average recovery time of approximately four to six weeks. Hysterectomy is the most common current therapy for women who have fibroids and remains the mainstay of treatment.

  • Myomectomy: Like hysterectomy, traditional myomectomy is an open surgical procedure that requires general anesthesia and is associated with a four to six week average recovery time. During a myomectomy, fibroids are removed from the uterus, but the uterus itself is left behind, thus preserving the women's fertility. Myomectomy is successful in controlling symptoms caused by fibroid tumors approximately 80% of the time. As a general rule, however, the more fibroids that are present, the less successful myomectomy is. Additionally, fibroids grow back after myomectomy in a significant percentage of cases and uterine scarring as a result of the surgery may lead to a greater incidence of infertility.

  • Laparoscopic Procedures: Laparoscopic procedures offer a less invasive way to perform surgery through small puncture holes made the abdomen. These procedures minimize the size of the surgical scar and are usually less painful than open surgery. Hospital stay and recovery time are significantly shorter than traditional open surgical procedures, though general anesthesia is usually still required. Laparoscopic techniques can be used to remove fibroids that are visible on the outside of the uterus (laparoscopic myomectomy). Like open myomectomy, and any other uterine sparing procedure, the fibroids may reoccur following the surgery. Hysterectomy can also be peformed through a laparoscope, usually referred to as Laparoscopic Supracervical Hysterectomy, and is becoming a more popular option than traditional open hysterectomy. Laparscopic myomectomies have been limited recently by removal morcelators (devices which chopped up the fibroid inside the body before removal) from the market. Like many less invasive treatment options, the size of the uterus and fibroids can limit a patient's ability to be treated in this way.

  • Hysteroscopic Procedures: Hysteroscopic procedures are preformed by some gynecologists by inserting tiny instruments through the vagina and cervix and into the inner lining of the uterus (the endometrial cavity). Using a flexible fiber optic camera (hysteroscope), the doctor can remove or otherwise treat fibroids visible on the inner lining of the uterus. Since this procedure does not require an incision, the recovery time and hospitalization are significantly shorter than with open surgical procedures such as hysterectomy and myomectomy and there is no surgical scar. Many times, hysteroscopic procedures are performed on an outpatient basis. Like laparoscopy, general anesthesia is usually required for hysteroscopy and the size of the uterus and/or fibroids can be limiting. Neither hysteroscopic nor laparoscopic procedures allow for the simultaneous treatment of fibroids both inside and outside the uterus at once.

  • Endometrial Ablation: The inner lining of the uterus is called the endometrium. It is this lining that is sloughed each month as a result of menstrual flow during a woman's period. A variety of techniques are used to destroy this lining so that no bleeding occurs at the time a period is expected. Destruction of the endometrial lining can be achieved using a hysteroscope to cut away and cauterize the lining or by applying heat to the endometrium using a variety of techniques. This procedure can reduce heavy bleeding as a result of fibroids but its effects are often temporary. Endometrial ablation cannot be performed in women who still desire fertility.

  • Robotic Surgery: Surgery for fibroids and other conditions can now be performed by robots remotely controlled by specially trained physicians, usually gynecologists, through small puncture holes in the abdomen. These procedures are similar to laparoscopic surgery and minimize the surgical scar, post-operative pain and recovery time but usually require general anesthesia. Robotic hysterectomy and myomectomy are becoming more common and more widely available. Like many less invasive surgical treatment options, the size of the uterus and fibroids can limit a patient's candidacy for robotic procedures.

  • Myolysis: Myolysis involves destroying fibroids within the uterus without removing them. Two forms of myolysis are currently being performed, myomacoagulation and cryomyolysis. Myomacoagulation is a laparoscopically guided procedure in which heat is applied to each fibroid. This heat kills the fibroid tissue and as the fibroid dies, it shrinks in size and is incapable of further growth. This technique is often used alone or in combination with laparoscopic myomectomy. Cryomyolysis uses a probe to freeze the fibroids thus causing death and shrinkage of the tumors. Variations of myolysis have also recently been performed by interventional radiologists using ultrasound, CAT scan, or MRI guidance and a heating or cooling probe inserted through the skin.

  • Drug Therapy: Drug therapy is usually tried first in women with symptomatic uterine fibroids. This area is ever expanding and may one day provide the ultimate non-invasive treatment of option for fibroids. Drug therapy might include the use of non-steroidal anti-inflammatory agents such are ibuprofen or Motrin, birth control pills, or hormone therapy. In some patients, symptoms are controlled with drug therapy and no additional therapy is required. Many hormone therapies, however, have significant side effects when used over a long period of time, and are therefore most often used temporarily. Fibroids are usually very sensitive to homone levels. They tend to grow in response to high estrogen levels and shrink in response to the absence of estrogen. This is why fibroids tend to increase in size during pregnancy and decrease in size after menopause.

    One group of drugs being used to treat the symptoms caused by fibroids are known as GnRH analogs (such as Lupron) which are administered by an injection and work to reduce the level of estrogen in the body. The result is generally a reduction in blood flow to the fibroids and decrease in size of the fibroids. These drugs are often used prior to surgery to reduce the size of the fibroids in an attempt to make the surgery safer and easier. This therapy, however, is associated with multiple side effects that simulate menopause and is considered temporary since fibroid symptoms often reoccur when the therapy is discontinued and the fibroids usually regrow to their original size in four to six months. Newer drug therapies are constantly being investigated through clinical trials.