Fibroid Treatment Options

Fibroid treatment options NOT involving hysterectomy

Myomectomy

This procedure is less invasive than hysterectomy because it removes just the fibroids while leaving the uterus intact and it is also performed far less frequently. There are three different types of myomectomies that surgeons perform for fibroid removal – vaginal myomectomy, laparoscopic myomectomy and abdominal myomectomy – and the selected procedure is dependent upon the type, size, and location of the fibroids.

• Vaginal myomectomy - can only be done if the patient has relatively small fibroids inside the cavity of her uterus and is most successful for fibroids that grow on a stalk. The doctor inserts a miniature camera via the patient's vagina and the uterus is filled with saline solution to expand the walls. Using another tool, the doctor shaves the fibroids away until they're at the same level as the uterus wall.
• Laparoscopic myomectomy - techniques also employ a camera to assist the doctor and operating room staff in the removal of fibroids. A video monitor shows a view of the patient's abdominal region and assists the doctor visually as he or she removes the fibroids in very small pieces. This is usually done with the help of a mechanical device called a morcellator, which chops fibroids into "morsels."
• Abdominal myomectomy - uses similar techniques as the vaginal and laparoscopic methods but provides the surgeon with a greater field of vision and allows the surgical staff more room to work. A woman can become pregnant after undergoing a myomectomy. Like any surgery, it carries with it the risk of bleeding, infection, or damage to surrounding organs. In 10 to 25 percent of cases, new fibroids eventually grow back.

Uterine Artery Embolization (UAE)

UAE, also known as uterine fibroid embolization (UFE), is a procedure that severely limits the blood supply to the uterus, creating an environment in which fibroids are unable to sustain themselves. During the procedure, the patient is under conscious sedation and a slender tube is inserted into the large artery near the groin. The catheter is guided into this artery using an x-ray procedure known as ateriogram or angiogeaphy, which helps to map which arteries are supplying blood to the fibroids. After the artery is identified, the surgeon releases tiny particles called polyvinyl alcohol (PVA). These particles are guided by the blood flow to their destination next to the fibroid, where they lodge and slow down the flow of blood to the uterus. This limited blood supply causes the degeneration of the fibroids. We have detailed visual images of this procedure in the NWHN Fibroids packet (pages 27-28 and pages 63-70).

Many women benefit from this procedure, but not all fibroids can be treated with UAE; the best candidates for the procedure are women who have fibroids causing heavy bleeding, have fibroids that are causing pain or pressure, do not wish to have a hysterectomy, and do not wish to have more children. Although pregnancy after UAE is possible in some cases, there is a higher risk of miscarriage and placenta problems, and researchers are currently looking into the effects of UAE on fertility. Other risks of this procedure include infection (which is rare and can usually be managed with antibiotics), damage to other organs and the formation of scar tissue.

UAE is a successful procedure in the majority of cases, and studies have shown that it reduces bleeding, urinary incontinence and abdominal enlargement in about 85 to 95 percent of women. Five years after treatment with UAE, more than 70 percent of women maintain symptom control (a percentage comparable to that of myomectomy). Longer-term studies have yet to be done, however, so there is limited data regarding fibroid recurrence over time. There is a small risk of premature menopause after UAE if PVA particles travel to the ovaries and block their blood supply. This risk is highest among women age 45 or older. Patients with a history of prior x-ray treatments, pelvic malignancy, chronic infections, or severe endometriosis should not undergo UAE. Furthermore, if you have inflammation of the tubes or lining of the uterus, this makes you more susceptible for an infection after UAE.

Endometrial Ablation

Endometrial ablation is where the lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding. But, a woman cannot have children after this surgery.

Endometrial ablation is not recommended for women who:

• Wish to become pregnant in the future
• Disorders of the uterus
• Have significant cramping with menstrual periods
• Have cancer of the uterus
• Were recently pregnant
• Are past menopause

Risks

Endometrial ablation risks may include:

• Perforation of the uterine wall
• Heat or cold damage to nearby organs
• Pain, bleeding or infection
   

Myolysis/Cryomyolysis

Myolysis is a laparoscopic procedure that can destroy uterine fibroids without surgically removing them. An electrified needle or laser is used to shrink and kill the fibroids and shrinks the blood vessels that support them. Although the uterus is not removed in this procedure, it becomes too weak to support a pregnancy. Cryomyolysis is a fairly experimental procedure that is very similar to myolysis except the needle destroys the fibroids by freezing rather than heat. The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.

Focused Ultrasound Surgery

This noninvasive, uterus-preserving treatment option involves the use of precisely focused high-frequency sound waves to destroy uterine fibroids. The procedure is performed while the woman is inside a magnetic resonance imaging (MRI) machine that provides very detailed information about the location of the fibroid. Initial results with this technology are promising, but its long-term safety and effectiveness are not yet known. It is also not widely available and may not be covered by your insurance. Risks include burns to the skin on your abdomen, severe discomfort during the procedure and heat damage to organs near the fibroids being treated. Focused ultrasound is not intended for women who wish to become pregnant in the future. Finally, like many other procedures used in the treatment of fibroids, this procedure may not permanently cure your fibroids and further treatment may be required. Further information on focused ultrasound can be found at http://mayoclinic.com/health/focused-ultrasound-surgery/MY00503/DSECTION....

Medications

If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.

Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.

Other drugs used to treat fibroids are "gonadotropin releasing hormone agonists" (GnRHa). The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pain. Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. This can be a big relief to women who have heavy bleeding. It also allows women with anemia to recover to a normal blood count. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.