Treatments & Options
The size and location of your fibroids, along with your medical history, will determine the options available to you. No matter how old or young you are, you can be sure that in most cases you have more than one choice for a cure. Don't settle for less. You do not need a hysterectomy.
Every woman's situation is unique. It is important for each woman to get a complete evaluation and carefully review all of her options before deciding what treatment is best for her. The uterus is not a useless organ after the last pregnancy: it plays a preventive role in heart disease and supports other organs in the body. In the interest of preserving it, women have to know about alternatives and be aware of them.
Fibroids are the most common cause for hysterectomy. Improved surgical procedures minimize the risks and costs of a hysterectomy, but it remains a radical and unnecessary operation. Women who experience fibroid related symptoms are usually between 30 and 45 years old, and premenopausal. Only 15% of all hysterectomies are necessary.
Click on any of the links below for details on treatment options.
Remember that these procedures are skill dependent operations and should be performed by highly trained board certified physicians. The outlined treatment options are insurance covered.
There are several types of myomectomy, an operation that removes fibroids and leaves the reproductive organs completely intact, and mostly functional.
Myolysis is a controversial procedure. The fibroids are not removed, rather, the blood supply to the myoma is reduced by coagulation of the vessels (through electric coagulation, cryoscopy, or laser). This causes the fibroids to shrink in size. This treatment can cause adhesions, weakness in the uterine wall, or future uterine rupture during pregnancy. Potential cancer can be missed. This procedure is still being studied for thorough evaluation.
Magnetic Resonance Guided Focused Ultrasound
Magnetic Resonance Guided Focused Ultrasound (MRgFUS) has recently been used to treat Uterine Fibroids. Ultrasound waves target a specific region (fibroids) and damage the tissue at a focal point (necrosis). This shrinks but does not remove the fibroid; further surgery might be necessary.
MRgFUS does not require insertion of an instrument into the body; it is noninvasive. Results, however, of MRgFUS are inconsistent; it is not recommended for treatment of large or submucous fibroids and is contraindicated if pregnancy is desired.
Possible complications are bladder, bowel, and nerve injuries. (Non-target injuries.)
With or without removal of the ovaries, Hysterectomy is the most radical approach to the treatment of fibroids. In the absence of a cancerous condition a supra-cervical hysterectomy - which leaves the cervix in place - can be a better choice.
Process by which the blood flow to the uterus is interrupted. A catheter is inserted into the leg vein and follows it into the uterine artery. A chemical (poly-vinyl alcohol) is then injected into the uterine artery (process of embolization), which interrupts blood flow to both the womb and any fibroids within it. This is indented to cause myomas to shrink, stunt their source of nourishment, and prevent them from growing in the future.
Embolization is performed by an interventional radiologist. The evaluation for uterine artery embolization includes an ultrasonogram of the fibroids to determine their size and location. This procedure is not indicated for large fibroids (over 10cm.), pedunculated or submucous fibroids. Also, women who are considering pregnancy are not candidates for uterine artery embolization. Premature menopause, ovarian failure, and infection are infrequent complications.
Hormone therapy can slow fibroid growth before surgery
Yes, doing nothing is also an option and often a good recommendation if symptoms are not severe.