Under The Knife

Now we're going to look at the surgical options for fibroid treatment. Women often turn to surgery if medical management hasn't worked, they are looking to correct infertility or they want to put an end to their fibroids once and for all.

Hysterectomy - This is complete removal of the uterus and the definitive (final) treatment for fibroids. Forty percent of all hysterectomies are performed because of fibroids, so this is a very common treatment. Of course this is only an option for women who don't want to have any more children. There are several different ways this surgery scan be done. With an abdominal hysterectomy the uterus is removed through a larger incision in the belly. A laparoscopic hysterectomy uses a camera through smaller incisions to complete the surgery. The procedure can also be done vaginally which results in no scars and usually a faster recovery. However, this cannot be done if the fibroids are very large. It's important to remember that a hysterectomy is a major surgery and will require a stay in the hospital no matter how it's done.

Myomectomy - This is a surgery where individual fibroids are removed while keeping the uterus intact. It's a good option for women who are trying to overcome infertility from their fibroids or those who want relief from symptoms but still want the option of having kids. Just like hysterectomies, there are many ways a myomectomy can be done including abdominally or laparoscopically. There is also the option of doing it with a hysteroscope or a camera that goes into the uterus. This is especially effective on those tricky submucosal fibroids that cause so many problems.

For any woman considering treatment for her fibroids it's important to consult a doctor. In order to make the best decision they will often need to get an ultrasound or MRI to get a better picture of the fibroids.

To Treat or Not to Treat - That is the Question

Admittedly up to this point we've talked about bad stuff - what puts you at risk, what can go wrong? Today we'll start looking at what can be done about fibroids. For most women the answer is: nothing. The majority of women have no symptoms from their fibroids and really don't need to do anything about them.  Doctors often call this "expectant management" or "watchful waiting," meaning we'll wait and see if anything happens. With fibroids this means getting a yearly gynecological exam and telling your doctor if anything changes. For those women who do have symptoms from fibroids or have concerns about getting pregnant because of the location of their fibroids there are options. Today we're going to look at the non-surgical methods.

Hormones - Hormones in a variety of forms have been shown to help with fibroid symptoms, especially heavy bleeding. They do not seem to decrease the size of fibroids. The hormones like estrogen and progesterone can be given in a lot of different ways. The most common is oral contraceptives or birth control pills but there are also IUDs, implants and injections. There are also drugs that affect the level of hormones in your body. One type of these know as gonadotropin-releasing hormone agonists (quite the mouthful!) has been shown to be the most effective at decreased the size of fibroids. Sadly, this drug is not recommended for long term use and is usually only given before surgery.

NSAIDs - Non-steroidal anti-inflammatory drugs are a fancy name for medicines we all have in our cabinet - ibuprofen, Motrin, Aleve. Since pain is one of the most common symptoms of fibroids, these drugs can be very helpful in their management.

Uterine artery embolization (UAE) - UAE is one of the newer treatments for fibroids. While it is a procedure, it's not a surgery - in fact a radiologist does it! The goal of UAE is to stop the blood flow to the fibroids. This is done by injecting little plastic particles into the arteries that send blood to the uterus. 

This procedure is very successful at shrinking the fibroids (up to 65%) and up to 85% of women report less symptoms. 

Fibroids and Pregnancy

A lot of women worry about if their fibroids will affect their pregnancy. The clearest answer is - maybe. First off, fibroids can cause some women to have trouble getting pregnant in the first place. As much as 2% of all infertility can be traced back to fibroids. The fibroids that are usually to blame are the ones that sit inside the cavity of the uterus (check out the picture from the first post.) Contrary to what you might think, bigger fibroids are not always worse.

Once a woman is pregnant there are a couple of ways her fibroids can affect her. Since fibroids have been found to respond to hormones like estrogen it's often thought that they will get bigger during pregnancy. However, this actually hasn't been shown! Most fibroids don't change at all during pregnancy and some even get smaller. Despite this, there can be complications during pregnancy. The most common is pain. There have also been some studies to show that fibroids can increase the risk of a miscarriage. Again this is only really a concern if the fibroid is what doctors call submucosal or right underneath the inner lining of the uterus. Women with fibroids may also experience some bleeding before they deliver and can be at risk for preterm labor and birth. They also tend to have more caesarean sections. So what can be done? Are women with fibroids doomed to have a difficult pregnancy? Of course not! Check back next time when we discuss treatment options!