Frequently, fibroids can be managed by procedures designed to treat the symptoms fibroids cause. There are many medications that can treat symptoms adequately. Sometimes, surgery is indicated.

Surgical Options

Minimally Invasive Procedures

More Invasive Procedures

Most Invasive Procedures

Minimally Invasive Procedures

Dilation and Curettage (D&C)

If abnormal bleeding is your primary concern, you may undergo a procedure called a dilation and curettage (D&C). The cervix is dilated wide enough to introduce a curved blade that scrapes out the lining of the uterus. The entire procedure takes about ten minutes and can be done under local anesthesia. The two main reasons for this procedure are:

  • To obtain a sample of endometrial tissue for examination to rule out endometrial cancer
  • To reduce the thickness of the endometrium, which may cure the excessive bleeding

This may be done with a diagnostic hysteroscopy. Combining these procedures lets the doctor make a definite diagnosis by visual observation through the scope.

Rare complications include:

  • Perforation of the uterus
  • Bleeding

Uterine Artery Embolization

Uterine fibroid embolization (UFE)—also known as uterine artery embolization (UAE)—is performed by an interventional radiologist (IR). The procedure is designed to cut off the blood flow to fibroids and essentially “kill” them off by cutting their lifeline.

The radiologist will thread a catheter into an artery in your groin and guide it into the uterus. The catheter will be threaded with the aide of dye and x-rays ; the IR will know when the catheter is positioned in the artery that feeds the uterus. Then he or she will inject small particles to block the blood supply feeding the fibroids. The procedure is about an hour. You might be asked to stay overnight in the hospital because there may be additional pain after the procedure.

Myolysis and Cryohemolysis

Myolysis is a procedure that shrinks the fibroids, using a directed heat source. Several devices can be used that employ high frequency electrical current or lasers to cauterize (burn) the blood supply to the fibroids. The devices are usually inserted through very small incisions and guided by a laparoscope. As an alternative, cryohemolysis utilizes liquid nitrogen to freeze the fibroids.

The fibroids remain in place and are not surgically removed. Without a blood supply, the fibroids shrink. Myolysis and cryohemolysis are performed only on fibroids of certain sizes near the surface of the uterus.

Focused Ultrasound Surgery

In this procedure, you will be inside an MRI machine, which allows your doctors to view your uterus and the rest of your abdominal anatomy. Focused sound waves are applied to destroy the fibroids, while leaving your uterus completely intact. This procedure may take several hours to complete.

More Invasive Procedures

Myomectomy

Myomectomy is the surgical removal of fibroids without removing the uterus and, unlike hysterectomy, can preserve fertility. There are a variety of ways myomectomy can be performed, depending on where the fibroids are located and how large they are. The fibroid tumors will return in about 10 percent of cases.

  • Laparotomy (Abdominal Myomectomy) —This technique uses a surgical entry into the abdomen. Once inside, the surgeon has direct access to the uterus and can remove fibroids on the surface and in the body of the uterus.
  • Laparoscopic Myomectomy —Some fibroids are small and accessible enough to be removed through small incisions near the navel using a laparoscope€”a thin telescope with a light.
  • Laparoscopic Myomectomy With Mini-Laparotomy —Larger fibroids on the surface of the uterus may be removed through a slightly larger incision (3 inches or less) using a combination of standard surgical techniques and a laparoscope.
  • Laparoscopic Assisted Vaginal Myomectomy (LAVM) —Some fibroids can be reached through the vagina, using a similar combination of standard surgery and a laparoscope.
  • Hysteroscopic Myomectomy —Fibroids that arise from the inside of the uterus may be reached using a different but similar instrument, a hysteroscope, which is inserted through the vagina and cervix.
  • Endometrial Ablation —This procedure applies heat to the uterine lining, thus destroying it and preventing further abnormal bleeding. It is only effective against fibroids that are within the uterine lining.

Most Invasive Procedures

Hysterectomy

  • Subtotal Hysterectomy (cervix is left in place)
  • Total Hysterectomy (uterus and cervix are removed)
    • Abdominal
    • Vaginal

The oldest approach to the problem of fibroids is to remove the uterus. This is referred to as a hysterectomy. There are different types of this procedure, which include:

A subtotal hysterectomy has been rarely done because the remaining cervix can still cause problems, like cancer. However, if the woman has a history of normal pap smears, and wants to keep her cervix for vaginal support and perceived maintenance of sexual pleasure, she and her surgeon may consider this procedure. Risks and benefits should be thoroughly discussed, especially if removal of the cervix is anticipated to make the surgery considerably more difficult.

A total hysterectomy is performed either through the abdomen or, if the uterus is small enough, through the vagina. A vaginal approach may be combined with a repair of weakened and stretched tissues in the vaginal walls. It involves fewer complications, a shorter recovery period and no visible scar. Retention or removal of the tubes and ovaries will depend upon the woman’s age and desires.

All of these procedures require sterile operating room conditions, whether they are performed in a radiology suite, an outpatient center, or an acute care hospital. The choice of facility will depend upon the type and extent of the procedure and your overall health.

Pregnancy is impossible after a hysterectomy. If you have a myomectomy, you may have perfectly normal pregnancies. But after myomectomy, there may be an increased chance of a caesarian birth due to weakening of the uterine muscle.

When to Contact Your Doctor

Contact your doctor if any of the following occur after your procedure:

  • Bleeding
  • Fever and other signs of infection
  • Pain that is not treated by pain relievers
  • Inability to urinate
  • Abdominal swelling