If treating the symptoms of uterine fibroids is ineffective in bringing about relief and your Quality of Life is dwindling away, it may be time to move on to more aggressive methods of dealing with your uterine fibroids. It may be time to switch from Treating the Symptoms to Treating the Fibroids.
The more you know about uterine fibroids and your reproductive system, the better equipped you are to understand your treatment options and how to maintain and/or achieve a higher Quality of Life, regardless of the presence of this disease. Hysterectomy is certainly a treatment option. It isn't, necessarily, your only option.
There are a variety of treatment options for benign uterine fibroids which allow you to retain your uterus. These include:
Many women choose to do nothing and simply treat the symptoms since fibroids often shrink in size and become asymptomatic as a woman goes through menopause. The average age of menopause is 51. Can you watch & wait?
Myomectomy is a type of surgery that removes the fibroid without removing the uterus. For women over the age of 35, this procedure may provide adequate relief until the age of menopause when fibroids shrink naturally due to a decline in hormones.
There are numerous ways that doctors perform a myomectomy. The type, size and location of your fibroids determine which of the following myomectomies might be recommended:
Hysteroscopic Myomectomy involves the vaginal removal of submucosal fibroids through the use of a hysteroscope -- a thin telescope-like instrument that is inserted through the cervix and into the uterus.
Laparoscopic Myomectomy with Mini-Laparotomy allows for the removal of slightly larger subserosal fibroids than what the laparoscope alone can handle and generally includes a relatively small incision of 3 inches or less in the abdomen.
Uterine fibroid embolization (UFE, also known as uterine artery embolization UAE) 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.
Within minutes after the procedure the fibroids begin dying. Generally, but not always, there is an overnight stay in the hospital because many women feel intense abdominal cramping and pain. Pain from this procedure is usually controlled through the use of narcotics.
Because this is a non-surgical procedure, recovery is extremely fast and most women return to work within one week.
UFE works to stop the blood flow to all types of fibroids in the uterus. However, it is generally recommended that pedunculated submucosal fibroids and pedunculated subserosal fibroids be removed through hysteroscopy or laparoscopy first. Pedunculated submucosal fibroids that die and detach from the uterus as a result of UFE may be expelled from your body vaginally. If, however, you have detached submucosal fibroid material that is too large for your body to expel, it is extremely important that it be removed as quickly as possible through hysteroscopic resection to avoid serious infection potentially requiring hysterectomy.
As of September 1999, 4165 uterine artery embolization (UAE) procedures have been performed in the United States. Out of those initial 4,165 patients, 0 (zero) deaths and 25 complications resulting in additional surgery within 30 days of the procedure (<1%) were reported.
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.
Myolysis is only performed on subserosal fibroids that fit a certain size range.
A relatively new treatment that uses magnetic resonance image (MRI) guided focused ultrasound to target and super-heat the blood flowing within specifically targeted uterine fibroids. This, in turn, causes the blood to clot and prevents further blood flow to the individual tumor. Without a blood flow, the fibroid dies. While the tumors are not removed and don't totally disappear with this treatment, they do go through a cellular change that can be effective in treating the symptoms of uterine fibroids in women with a small number of tumors. Because the technology for this treatment is still relatively new and technical assessments for it's long-term effectiveness in treating uterine fibroids are limited, most insurance providers do not cover the cost of this procedure yet.
There are three primary forms of hysterectomy with the removal of the uterine fibroids AND the uterus.
Subtotal Hysterectomy involves only the removal of the uterus. The pelvic structural ligaments are not cut and the cervix is left in place. Fallopian tubes and ovaries may or may not be removed. This procedure is always done through the abdomen.
Total Hysterectomy involves removing both the body of the uterus and the cervix, which is the lower part of the uterus. It can sometimes be done through the vagina (vaginal hysterectomy); at other times, a surgical incision in the abdomen is preferable. For example, if you have large fibroid tumors, it is difficult to safely remove the uterus through the vagina. Vaginal hysterectomy, when it can be safely performed, generally involves fewer complications, a shorter recovery period and no visible scar.
In a total hysterectomy and bilateral (both sides) salpingo-oophorectomy, the ovaries and fallopian tubes are removed, along with the uterus and cervix.
There are a variety of surgical methods which a physician may use in performing a hysterectomy. It is extremely important to talk with your doctor about the kind of surgical method recommended for you.
In addition to the direct surgical risks, there may be longer-term physical and psychological effects, potentially including depression and loss of sexual pleasure. If the ovaries are removed along with the uterus prior to menopause, there is an increased risk of osteoporosis and heart disease as well.
In making a decision, you should consider that a hysterectomy is not reversible. After a hysterectomy, you will no longer be able to bear children and you will no longer menstruate.
A hysterectomy may be life-saving in the case of cancer. It can also relieve the symptoms of bleeding, discomfort, or uterine prolapse related to fibroids. However, you may find other treatment choices allowing you to retain your uterus more reasonable for the treatment of your benign uterine fibroids.
The surgical risks of hysterectomy and myomectomy include the risks of any major operation. You may have a fever during recovery. You may have a bladder infection or wound infection. A blood transfusion before surgery may be necessary because of anemia or during surgery for blood loss. Complications related to anesthesia may occur.
As with any major abdominal or pelvic operation, serious complications such as blood clots, severe infection, adhesions, postoperative (after surgery) hemorrhage, bowel obstruction or injury to the urinary tract can happen. Rarely, even death can occur. (Eleven women die for every 10,000 hysterectomies performed.)
The following questions may help you to begin a discussion with your physician about recommended treatment options for your uterine fibroids.