Treating Uterine Fibroids: More Options, More Choices
]]>Uterine fibroids]]> —benign tumors that grow in the uterus—affect one out of every five women over the age of 35, and 40% of African-American women over 40. For many years, the only treatment available was hysterectomy, i.e. removal of the uterus. But today, women seeking relief from fibroids have treatment options that spare the uterus.
What Are Fibroids?
Uterine fibroids are noncancerous tumors that grow in the uterus during the childbearing years. They can appear on the inside or the outside lining of the uterus, or within the muscle wall. They usually begin from a single muscle cell that continues to grow. The rate at which they grow is unpredictable. Most remain small, but fibroids can range in size from that of a pea to that of a grapefruit. Many women with fibroids have more than one.
Fibroids are the most common reason for ]]>hysterectomy]]> in premenopausal women, according to the Society of Cardiovascular and Interventional Radiology. Of the 600,000 hysterectomies performed annually in the United States, one-third are due to fibroids.
In many cases, women with fibroids experience no symptoms at all, while others may experience significant symptoms. These can include:
- Pelvic pain and pressure
- Heavy, prolonged menstrual periods and/or unusual monthly bleeding
- Increased clots in menstrual flow
- Increased cramping during periods
- Pain during sexual intercourse
- Frequent urge to urinate (caused by pressure on the bladder)
- Constipation and bloating (caused by pressure on the bowel)
- Abnormally enlarged abdomen
Whether or not fibroids require treatment depends on how many fibroids there are, how large they are, where they are located, and whether they are causing symptoms.
Treatment options include no treatment (living with your fibroids and their symptoms), surgical removal of fibroids without removing the uterus (myomectomy), uterine artery embolization, focused ultrasound treatment, and surgical removal of the uterus.
Drug Therapy–Hormone Therapy
Hormone therapy involves taking a gonadotropin-releasing hormone (GnRH) agonist, which shrinks uterine fibroids by blocking hormone production by the ovaries. Commonly used GnRH agonists include Lupron and Viadur. Use of these drugs is always temporary – 3-6 months. There are only two approved reasons to use these drugs for fibroids: to reduce the size fo the uterus in order to make it possible to do a vaginal hysterectomy rather than an abdominal procedure; or to prevent blood loss during the pre-op period in order to avoid needing a transfusion at the time of planned surgery. However, this treatment can induce premature menopause-like symptoms including hot flashes, mood swings, headaches, vaginal dryness, and bone loss.
Common surgical procedures include:
]]> Myomectomy ]]> —the surgical removal of fibroids without removing the uterus. There are a variety of ways myomectomy can be performed, depending on where the fibroids are located and how large they are. Common methods of myomectomy include:
- Abdominal Myomectomy —a large incision is made in the abdomen to cut out the fibroids.
- Laparoscopic Myomectomy —a few, very small incisions are made in the abdominal area and a small fiberoptic tube is used to remove the fibroids.
- Hysteroscopic Myomectomy —a tube called a hysteroscope is inserted into the vagina and through the cervix to remove the fibroids.
In about 10% of cases treated with myomectomy, the fibroid tumors will return.
]]>Hysterectomy]]> —the surgical removal of the entire uterus including the fibroids. While hysterectomy is a complete cure for fibroids, it is not appropriate for everyone, particularly women who wish to have children. If the ovaries are removed along with the uterus, menopause will follow. It is not necessary in all cases to remove the ovaries as well as the uterus.
Uterine Fibroid Embolization —this procedure blocks the blood supply that nourishes the fibroid tumors, causing them to shrink.
A physician specialist called an interventional radiologist does the procedure. A tiny incision is made in the groin. A small tube (catheter) is passed through this incision and into the blood vessels that supply the fibroids with blood. This catheter feeds tiny sand-sized plastic particles into the blood vessels, thereby blocking the blood supply to the fibroids. Without blood, the fibroids eventually shrink. Many women report uterine cramping for hours to days after the procedure.
It can take several weeks for the fibroids to shrink, but symptom relief often comes much sooner. Eighty-five percent of women who have undergone this procedure report relief from symptoms. Long-term follow up is not yet available to determine if the fibroid tumors will grow back.
MR Guided Focused Ultrasound Surgery
MR guided Focused Ultrasound Surgery is an outpatient procedure using high doses of focused ultrasound waves (HIFU) to destroy uterine fibroids, without affecting any of the other tissues around the fibroid. This energy of these ultrasound waves is much higher than the ultrasound used in a diagnostic study. The procedure is conducted in a magnetic resonance imaging (MRI) scanner which helps the physician "see" inside the body to pinpoint, guide, and continuously monitor the effects of the treatment.
Choosing a Treatment
No single treatment option is best for all women. Many factors influence which choice is right for you, including: age, medical history, symptoms, and the number and location of fibroids. If you have fibroids, talk to your doctor about your options, and weigh all the risks and benefits of each before making your decision.
American College of Obstetricians and Gynecologists
National Uterine Fibroids Foundation
Society of Interventional Radiology
The Canadian Women's Health Network
The Society of Obstetricians and Gynaecologists of Canada
The American Academy of Family Physicians. Uterine fibroid embolization: a new way to treat fibroids. Am Fam Physician . 2000.
Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ . Accessed February 27, 2006.
National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus . Accessed February 27, 2006.
Last reviewed May 2008 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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