There are a number of treatment options for uterine fibroids. Normally, treatment is only considered if symptoms cause discomfort, health risks or the size and location of the fibroid affects fertility.
Watchful Waiting and Annual Pelvic Exam
When no symptoms are present, gynecologists often recommend "watchful waiting"or simply monitoring symptoms. For most women, this approach is all that will ever be required.
Nonprescription painkillers often provide adequate pain management. Because fibroid growth has been linked to certain hormones, hormone-blocking drugs can also offer relief by slowing abnormal growth rates and even shrinking the myoma.
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During abdominal myomectomy, fibroids are surgically removed from the uterus. Depending on the size and placement of the fibroids, abdominal myomectomy can be an outpatient laparoscopic surgery, robotic surgery or an open surgery requiring a one-to-three day stay in the hospital. Abdominal myomectomy is a major surgery that involves cutting out fibroids and stitching the uterus back together.
Abdominal myomectomy has become less invasive as laparoscopic techniques have been developed. Many patients previously treated with open surgery can now benefit from minimally invasive surgery. In general, the procedure is successful in controlling symptoms, but the more fibroids a patient has, the more challenging the surgery. In addition, fibroids may grow back in the future.
Hysteroscopic myomectomy is a procedure used to remove fibroids that enter the uterine cavity and cause menstrual bleeding abnormalities. The procedure is performed through the vagina as an outpatient surgery. Patients typically go home the day of surgery and are generally able to return to work the next day. Pain management rarely consists of more than mild over-the-counter painkillers.
Myomectomy is the procedure of choice in women wishing to preserve fertility as other uterine preserving techniques (uterine artery embolization and myolysis) may more adversely affect the integrity of the uterus and complicate future pregnancies.
A hysterectomy is the surgical removal of a woman's uterus. Typically performed by a gynecologist, a hysterectomy may be total (removing the entire uterus and cervix) or subtotal (leaving the cervix). In some cases, surgical removal of the ovaries (oophorectomy) is performed in conjunction with a hysterectomy.
Women who undergo hysterectomy with removal of both ovaries lose most of their ability to produce the hormones estrogen, progesterone and testosterone. As a result, they enter what is known as "surgical menopause" and will likely experience hot flashes, night sweats, and other menopausal symptoms. Women who undergo hysterectomy without removal of the ovaries will not experience menopausal symptoms, but their periods will stop and will no longer be able to sustain a pregnancy.
Hysterectomy can be performed abdominally, vaginally or laparoscopically. Abdominal hysterectomy, which has been the traditional surgical approach to women with symptomatic fibroids, requires a single long abdominal incision, and is associated with the longest hospital stay, recovery, and the highest complication rates. Less invasive approaches, including vaginal and laparoscopic hysterectomy, have shorter recovery times and lower complication rates. Some minimally invasive hysterectomies are now routinely performed as outpatient surgeries with patients returning to work in less than two weeks.
Uterine Artery Embolization (UAE)
A minimally invasive procedure, UAE may eliminate the need for surgical treatment. It is performed while the patient is conscious, but sedated. The procedure involves placing a small catheter into an artery in the groin and directing it to the blood supply of the fibroids.
Research has shown fibroid embolization to be at least 85 percent effective in reducing bleeding and alleviating pain. Many women have described significant change in their symptoms within days. Most patients find that UAE reduces or completely alleviates their symptoms.