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Fibroid Treatments

Wait and Watch

If your fibroids are not causing any symptoms, or if the symptoms are minor, your doctor may recommend that you simply leave them alone, with periodic examinations to see whether or not they are growing.

Medication

If your symptoms involve menstrual irregularities, the doctor may suggest that you try taking birth control pills to regulate your periods. Although estrogen can cause fibroids to grow, low-estrogen birth control pills are available. If the pills can regulate your cycle, this may provide the relief you need. Of course, if you want to become pregnant, taking birth control pills is not an appropriate long-term solution for you.

For severe bleeding symptoms, some doctors may prescribe a drug treatment known as a GnRH (gonadotropin-releasing hormone) agonist. Lupron is one brand name for this kind of drug. Lupron works by decreasing your body’s estrogen production. This treatment leads to shrinkage of the uterus and fibroids. Unforuntately, the side effects can be unpleasant, including hot flashes, reduced libido, and vaginal dryness. This treatment also prevents pregnancy. Because long-term use of GnRH agonists can lead to bone loss, they are usually prescribed for only a few months. After the drug is discontinued, the fibroids will probably start growing again. For that reason, GnRH agonists are used mainly as a pre-surgical treatment. Because the drug is expensive and has side effects, it may be considered unnecessary or undesirable prior to surgery, especially if the fibroids are not very big. There is some concern that if small fibroids shrink too much, the surgeon will not be able to find and remove them. However, if the woman has severe anemia, this drug in combination with iron supplements can be very helpful in reducing or eliminating the anemia prior to surgery. The use of these drugs is controversial, so if they are recommended for you, make sure you understand exactly why and what your doctor expects.

Myomectomy

Myomectomy is a “conservative” surgery that removes the fibroids, leaving the uterus intact. This procedure is preferred by women who wish to become pregnant or who simply prefer to keep the uterus. There is a chance that after a myomectomy, the fibroids will grow back, although it may take a long time for this to happen. It is difficult to know how likely regrowth is, as various sources estimate that anywhere from 10% to 80% of women will experience a recurrence of fibroids after myomectomy.

In some cases, myomectomy may be performed by entering the uterus through the vagina. However, if the fibroids are too large and numerous to use this option, an incision will be made in the abdomen. This is usually a horizontal cut above the pelvic bone, below the “bikini line”.

After administering general anesthetic, the doctor will insert a catheter to keep the bladder drained during the surgery. A second catheter is used to stain the interior of the uterus with blue dye. Once the abdomen has been opened, the surgeon will locate the uterus and the fibroids. Each fibroid is injected with a drug called Pitressin. This cuts off the fibroid’s blood supply for about twenty minutes, giving the surgeon enough time to cut the fibroid out of the uterine wall. After removing the fibroids, the surgeon repairs the incisions in the uterus.

Hysterectomy

Hysterectomy is a “nonconservative” surgery that removes the uterus. With the uterus removed, you will not have any more periods, and you cannot become pregnant. Your fibroids will not grow back.

In the past, hysterectomy was often the only choice available to women whose fibroids caused serious symptoms. Hysterectomies are one of the most commonly-performed surgeries in the United States, the country which leads the world in hysterectomies. Many women’s health experts believe that a large number — perhaps even most — of hysterectomies are unnecessary. Only about 10% of hysterectomies are performed for life-threatening conditions such as cancer.

Because of this, the use of hysterectomy to treat fibroids is controversial. Many doctors understandably do not want to perform this procedure on women who may want to have children or on any young women. Other doctors still believe hysterectomy is the best choice, especially for women over 40 and those not interested in childbearing. Younger doctors are less likely to recommend hysterectomy than older doctors.

A doctor’s attitude may be that if you cannot or do not intend to become pregnant, your uterus is merely excess baggage. Many women agree. Removing the uterus can have many advantages. It eliminates the inconvenience of menstruation, the need for contraception, and the risk of uterine or cervical cancer. Many women who have had hysterectomies feel liberated sexually, personally and medically.

On the other hand, even if pregnancy is not in your plan, you may wish to keep your uterus. Some women find that the loss of the uterus makes sex less enjoyable, since they no longer experience uterine contractions. The vagina may be shortened, leading to discomfort during intercourse. Some researchers believe that removal of the uterus can lead to earlier menopause, even when the ovaries are left intact. Some women simply object to the removal of any organ unless absolutely necessary.

With a vaginal hysterectomy, the surgeon approaches the uterus through the vagina, and pulls it out. With an abdominal hysterectomy, the surgeon makes an incision (similar to that used for myomectomy) in the abdomen.

There are four basic kinds of hysterectomy:

Total hysterectomy: The uterus and cervix are removed. The fallopian tubes and ovaries are left intact. The ovaries will continue to produce hormones, possibly for as long as they would have without the hysterectomy.

Total hysterectomy with bilateral salpingo-oophorectomy: Total hysterectomy plus removal of the fallopian tubes and uterus. There are some variations on this which may include leaving one ovary or part of an ovary. For women over age 45, many doctors will recommend removal of the ovaries as part of the hysterectomy, even though the ovaries are still healthy. The doctor may feel that since the woman is near menopause anyway, this is not a great loss, and it will protect her against ovarian cancer. (Note, however, that ovarian cancer is not common in women who do not have a family history of ovarian cancer.) Removal of the ovaries results in instant menopause. Hormone replacement therapy (HRT) may be recommended.

Subtotal (partial, supracervical) hysterectomy: The body of the uterus is removed, but the cervix is left in place, and the vagina is not shortened. Because you still have a cervix, you will need to continue regular getting Pap tests. There is a small chance that you could have a recurrence of fibroids in connection with the cervix.

Radical hysterectomy: The uterus, ovaries, fallopian tubes, upper portion of the vagina, and the pelvic lymph nodes are all removed. (In some cases one or both ovaries may be left intact if they are not involved in the disease.) This kind of hysterectomy normally is done only if there is a serious disease, such as cancer, that warrants it. If your doctor is recommending a radical hysterectomy, find out why! And get a second opinion.

Other Treatments

Laparoscopic myomectomy: In laparoscopy, the doctors make a small incision and use a camera mounted on a tube to look around inside the abdomen. Additional small incisions are made in order to perform surgery. Laparoscopic surgery is appealing because it is often done on an “out patient” basis, meaning the patient goes home the same day, and because the scars are usually smaller than with more conventional surgeries. However, laparoscopy does have its own risks and limitations, and may not be suitable for all situations.

Hysteroscopic myomectomy: If the tumors are inside the uterine cavity and not deeply embedded in the wall, it may be possible to remove them using a hysteroscope, a tubular instrument inserted through the cervix. As with laparoscopy, this surgery usually allows the patient to return home the same day.

Embolization: This is promoted as a “non-surgical” technique and is performed by radiologists. However, it is invasive, and small incisions or punctures are necessary. Catheters inserted into the arteries are used to introduce material that will plug the blood vessels leading to the fibroids. The fibroids then die and wither. The patient may experience severe cramping for several days, a week, or more. It may take several months before symptoms improve. Currently, this technique is still considered experimental.

Myolysis: The tumors are destroyed with electrical current or a laser. They then die and shrink. This is still an experimental technique, and there is little information available.

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