Treatment options associated with uterine fibroids.
If you and your healthcare provider determine that you have uterine fibroids, it is a good idea to discuss the various treatment options available for fibroids, including uterine fibroid embolization (UFE).
Non-invasive treatment options:
- Watchful Waiting
If your fibroids do not cause symptoms, there is no need to treat them. Your doctor can best manage your care and can continue to monitor your fibroids for growth.
- Hormone Treatment
Medications for fibroids target hormones that regulate a woman’s menstrual cycle and help treat symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. The possible side effects of using these medications are similar to the symptoms experienced during and after menopause and include: weight gain, hot flashes, vaginal dryness, mood swings, changes in metabolism, and infertility. In most cases, once hormone therapy stops, fibroids tend to grow back and can reach their original size. This often occurs if hormone therapy is not accompanied by another treatment.
- High-Intensity Focused Ultrasound Surgery (HIFU or MRgFUS)
During the treatment, magnetic resonance images are used to help a doctor examine fibroids and surrounding organs in 3-D. High-intensity focused ultrasound waves are then used to heat an area of the fibroid, causing cell death. Pulses of ultrasound energy are also applied repeatedly to treat the fibroid. The procedure takes three to four hours. Patients report abdominal pain, cramping, and nausea throughout the procedure. A few days after the procedure, patients report feeling cramps as well as shoulder and back pain. Most women are able to return to work within one to two days following the surgery.
Less invasive treatment options:
- Uterine Fibroid Embolization (UFE)
The UFE procedure, also known as uterine artery embolization (UAE), begins with a tiny incision in the groin area or wrist. Using specialized X-ray equipment, an Interventional Radiologist (IR) passes a catheter (small tube) into the incision to the uterine artery and guides it near the location of the fibroid tumor. When the IR has reached the location of the fibroids, embolic material (small particles) is injected through the catheter and into the blood vessels feeding the fibroid, cutting off its supply of oxygenated blood. This shrinks the fibroid. The embolic material remains permanently in the blood vessels at the fibroid site. The catheter is then moved to the other side of the uterus, usually using the same incision. Once the IR has completed embolization of the uterine artery on both sides, the catheter is removed. The entire UFE treatment typically lasts less than one hour and is typically an outpatient procedure. Recovery typically takes less than one week.
- Endometrial Ablation
This procedure destroys the endometrium (the lining of the uterus) with the goal of reducing menstrual flow. In some women, menstrual flow may completely stop. No incisions are needed for endometrial ablation, as a physician inserts a slender tool through the cervix. The tools used for this procedure vary depending on the method used. Some types of endometrial ablation use extreme cold, while others depend on heated fluids, microwave energy, or high-energy radio frequencies. This procedure can only be used to treat submucosal fibroids that are less than one inch in diameter.
Surgical treatments options:
- Surgical myomectomy treatments
A myomectomy is the surgical removal of fibroids in the uterus. This treatment is recommended for women who want to become pregnant. There are different types of myomectomy procedures, including:
- Hysteroscopic Myomectomy
In this procedure a long, thin scope with a camera and light is passed through the vagina and cervix into the uterus. No incision is needed. Submucosal or intracavitary fibroids can be resected or removed using a wire loop or similar device. Patients are usually sent home following the procedure. The hospital stay is generally under two hours, and recovery time is one or two days. Usually only small fibroids accessible through the cavity can be treated this way.
- Laparoscopic Myomectomy
The laparoscope is a slender telescope inserted through the navel (belly button) to view the pelvic and abdominal organs. Two or three half-inch incisions are made below the pubic hairline and instruments are passed through these incisions to perform the surgery. Next, a small scissors-like instrument is used to open the thin covering of the uterus, where the fibroid is found and removed. After the fibroid is removed from the uterus, it is brought out of the abdominal cavity. This is done by cutting the fibroid into small pieces. The pieces are then removed through one of the incisions. Most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be required. Patients can usually walk on the day of surgery, drive in about a week, and return to normal activity within two weeks.
- Robotic-assisted Myomectomy
During this procedure, a surgeon sits at a special console with hand and foot controls that move robotic arms during the operation. With the assistance of the robot, the surgeon injects medication into the fibroids to decrease overall bleeding and makes an incision in the uterus. The surgeon then removes the fibroid(s) from the surrounding uterine tissue. Once the fibroid has been removed, the surgeon cuts the fibroid into smaller pieces inside the abdomen, and removes the fibroid pieces through the incision. Patients typically go home the same day of the procedure and most patients resume normal activities within two weeks.
- Abdominal Myomectomy
The operation begins with a surgeon entering the pelvic cavity through one or two incisions. Depending on the size and location of the fibroid, a vertical or horizontal incision is made. For large fibroids or fibroids that are located in a ligament between the uterus and pelvic wall, a vertical incision is required. The incision is made from the middle of the abdomen that extends below the navel (belly button). In other cases, a horizontal bikini-line incision is made that runs about an inch above the pubic bone. The procedure usually requires a hospital stay of two to three days. Recovery takes four to six weeks.
- Surgical hysterectomy treatments
A hysterectomy is a surgical operation to removal all or part of the uterus. There are different types of hysterectomy procedures, including:
- Vaginal Hysterectomy
This procedure is most often used in cases of uterine prolapse, or when vaginal repairs are necessary for related conditions. During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes, and upper vagina, as well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vaginal opening. If a patient’s uterus is enlarged, a vaginal hysterectomy may not be possible.
- Laparoscope-assisted Vaginal Hysterectomy (LAVH)
LAVH uses a laparoscope (a thin, flexible tube containing a video camera) to guide the removal of the uterus and/or fallopian tubes and ovaries through the vagina. During LAVH, several small incisions are made in the abdominal wall through which slender metal tubes known as “trocars” are inserted to provide passage for a laparoscope and other microsurgical tools. Next, the uterus is detached from other structures in the pelvis using the laparoscopic tools. The fallopian tubes and ovaries are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina. LAVH typically requires a one to three day hospital stay. Complete recovery time is usually four weeks.
- Robotic-assisted Laparoscopic Hysterectomy
During a robotic-assisted laparoscopic hysterectomy, a surgeon controls the movements of robotic arms from a computer station in the operating room. Three or four small incisions are made near the belly button. Gas may be pumped into the belly to distend it and give the surgeon a better view and more room to work. The laparoscope is inserted the abdomen, while other surgical instruments are inserted through the other incisions. The uterus will be cut into small pieces that can be removed through the small incisions. Depending on the reasons for a patient’s hysterectomy, the entire uterus may be removed or just the part above the cervix. The fallopian tubes and ovaries attached to the uterus may also be removed. Most people stay in the hospital for a few days. Complete recovery may take anywhere from a few weeks to a few months.
- Abdominal Hysterectomy
The uterus is removed through the abdomen via a surgical incision about six to eight inches long. The incision can be made either vertically, from the navel down to the pubic bone, or horizontally, along the top of the pubic hairline. The tissues connecting the uterus to blood vessels and other structures in the pelvis are then carefully cut away. The uterus is removed, along with any other structures such as the ovaries, fallopian tubes, and cervix, depending on each patient’s situation. Abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be longer. The recovery period is usually about six to eight weeks.
Look beyond hysterectomy and discover UFE.
A highly effective, minimally invasive procedure, UFE typically takes less than an hour to perform. Clinically proven to reduce the major symptoms of uterine fibroids, UFE has become one of the most successful alternatives to hysterectomy procedures.
Various factors, including the presence of symptoms, uterine size, fibroid number and location, patient age, proximity to menopause, and obstetric intentions influence the decision to treat symptomatic woman.
Hysterectomy is the removal of the uterus and it provides the cure for symptomatic fibroids however, fertility is lost with hysterectomy. With todays advanced non-surgical techniques, there is no reason why a woman must undergo a hysterectomy for all kind of fibroid disease. Of course hysterectomy is an important treatment for other disease including cancer, but shouldn’t be the first line treatment for all kind of fibroids.
Myomectomy is removal of fibroid while preserving the uterus. It is used to be the only alternative surgery to hysterectomy in women desirous of further childbearing. Interestingly, both myomectomy and hysterectomy share similar morbidity in terms of abdominal incision, operative time, blood loss, and hospital stay. Moreover, following myomectomy, adhesion formation may compromise future fertility, especially if microsurgical principles are not used and bleeding is not properly controlled.
- Minimally Invasive techniques
Traditional surgery entails general anesthesia, long hospital stay and recovery periods, and disruption at work and home. This drive for less invasive forms of therapy and the need to reduce health care costs have led to the development of alternative to the traditional surgical approaches. These alternatives include:
- Laparoscopic Myomectomy involves removing pedunculated subserosal fibroids through the navel and abdomen with the use of a laparoscope — a thin tube-like instrument with a light. It’s ideal for woman with a small number of subserosal or intramural fibroids in whom the uterus is small enough to allow the insertion of a laparoscope in order to obtain an appropriate view of the operating field.
- Myolysis involves surgical instruments that are inserted through a laparoscopic incision in the abdomen (usually your navel) and a high frequency electrical current that is sent to the fibroid. The electrical current causes the blood vessels to vaso-constrict (become very small or close down) and this basically cuts off the blood flow to the fibroids. The fibroids remain in place and are not surgically removed. Without a blood supply, the fibroids eventually die and shrink. However, Myolysis is only performed on subserosal fibroids that fit a certain size range.
- Hysteroscopic Myomectomy involves the vaginal removal of submucosal fibroids through the use of a hysteroscope, which is a thin telescope-like instrument that is inserted through the cervix and into the uterus. This procedure is mainly indicated for patients with submucosal fibroids.
- Endometrial ablation: For women who have completed childbearing and for whom bleeding is the primary problem, endometrial ablation may give relief by including laser, thermal energy, physical resection, or cryotherapy balloon.
- Uterine artery embolization (UAE) or uterine fibroid embolization (UFE).Among all of the minimal invasive techniques and by comparing their specific indications, UFE is the most novel technique for the treatment of fibroids. UFE is a minimally-invasive, non-surgical procedure performed by an interventional radiologist (IR). This procedure involves placing a catheter into the artery and guiding it to the uterus. Small particles are then injected into the artery. The particles block the blood supply feeding the fibroids. The whole procedure only takes about an hour.