Ask the Doctor: Minimally Invasive Surgery for Endometriosis And Fibroids

April 01, 2020
Woman holding her stomach in pain

Here, doctors from GW Hospital discuss gynecologic issues that women may face, along with advanced treatment options available.

Abnormal Uterine Bleeding and Endometriosis

Catherine Z. WuCatherine Z. Wu, MD, is a board-certified and licensed Minimally Invasive Gynecological Surgeon and Associate Professor of Obstetrics and Gynecology. 

When is uterine bleeding considered abnormal, and what are some of the common causes? 

Abnormal uterine bleeding may occur when periods last beyond five days, come sooner than 21 days or later than 35 days. Bleeding is also considered abnormal if it is heavy or prolonged enough to cause anemia (a low blood count) or if it negatively impacts quality of life. There are many reasons why abnormal uterine bleeding can occur. Some of the most common noncancerous causes include: fibroids, adenomyosis, polyps, uterine infection, or ovulation irregularities. However, abnormal bleeding can also be caused by something much more dangerous, such as cancer.

When might minimally invasive surgery be recommended as a treatment option?

Abnormal uterine bleeding caused by fibroids, adenomyosis and polyps can be treated surgically. Depending on the condition causing the bleeding, the bleeding severity, and the patient’s fertility goals, options available include: hysterectomy (removal of the uterus), myomectomy (removal of fibroids), or polypectomy (removal of polyps). All these surgeries can be performed through minimally invasive methods at GW Hospital.

What are the advantages of minimally invasive surgery?

Benefits for patients can include smaller incisions, fewer complications, less pain and bleeding, reduced scarring and quicker recoveries. Minimally invasive surgery is a great option for all patients, including patients who want to preserve fertility to have children in the future.

“Many of our patients can go home the same day, resume normal activity (walking, eating regularly) within the first few days, and are able to return to work after two weeks." – Dr. Catherine Wu

What does surgery entail, and how can it help?

While previously these conditions were treated using open surgery with a single large incision, many of these problems can now be tackled using minimally invasive techniques. Laparoscopy and robotic surgery can use anywhere from two to four small keyhole incisions (around 0.5 cm to 1 cm in size, or less than half an inch each!), while other techniques, such as hysteroscopy or vaginal incision, require no visible incisions. For patients, this can mean faster recovery time, less pain, smaller scars and a shorter turnaround to feeling better!

What about endometriosis?

General signs of endometriosis can include painful periods, painful intercourse, difficulty getting pregnant and ovarian masses. While abnormal uterine bleeding can be a symptom of endometriosis, it is much less common. In addition, depending on where the endometriosis is located within the pelvis (or the body), it can also manifest with urinary or bowel symptoms. However, adenomyosis, a condition very similar to endometriosis, most commonly presents with heavy and painful periods.

Endometriosis can greatly impact a woman's quality of life and is often difficult to treat. If a patient fails to improve on medical management, there are surgical options available as well, such as removal of endometriosis or hysterectomy. Surgery for endometriosis can be especially challenging, which is why it is incredibly important to find a surgeon that specializes in this type of surgery to maximize removal of endometriosis and symptom relief, and to minimize the risk of injury. While surgery for endometriosis is considered technically challenging, it can (and should) be completed minimally invasively through small incisions.

Uterine Fibroids

Maria Victoria Vargas

Maria Victoria Vargas, MD, MS, FACOG, is a Minimally Invasive Gynecologic Surgeon and Assistant Professor of Minimally Invasive Gynecologic Surgery.

What are uterine fibroids, and what causes them?

Fibroids are non-cancerous growths of the uterus. They're actually the most common non-cancerous tumors in women of childbearing age. We don't know what causes them, but we know they have hormone receptors and that their growth is hormonally driven. 

When should women consider having them treated?

Women may need their fibroids treated when they develop symptoms such as heavy and painful periods, anemia, abdominal or pelvic pain/pressure, or infertility related to their fibroids. Many women experience relief of their symptoms with treatment. This can mean a significantly better quality of life and the ability to start a family if that’s the goal. Often, patients have fibroids but no symptoms. These fibroids don’t typically need treatment.

What treatment options are available?

Options for management include medications to help reduce symptoms, and surgical removal of fibroids, called a myomectomy. Myomectomy can often be completed minimally invasively using a laparoscopic or robotic surgical approach. It's also possible to remove fibroids vaginally when they are small enough and located within the womb. This procedure is called a hysteroscopic myomectomy. Fibroid radiofrequency ablation and uterine artery embolization are other minimally invasive options that may be recommended for women meeting very specific criteria. Minimally invasive surgery may help preserve fertility for women who want to have children in the future. Discuss the best treatment with your physician.

Gynecologic surgeons at GW Hospital perform hundreds of procedures each year and are fellowship trained in minimally invasive gynecologic surgery. To find a doctor at GW Hospital, call 1-888-4GW-DOCS or search online.

Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if minimally invasive surgery is right for you.