Uterine fibroids are benign tumors which more often grow in women of childbearing years. While these fibroids rarely, if ever, cause cancer they can cause significant disruption in a woman’s life because of the symptoms. Physicians estimate that between 20 and 50% of women have uterine fibroids by only a small number of those are plagued by symptoms. In fact, most women discover this condition incidentally during an annual pelvic examination.
But, for the women who do suffer from symptoms that significantly impact their life discovering the treatment option that works best for their condition is a high priority. Most women, approximately 75%, manage to live with their fibroid tumors fairly well and never have any symptoms. Even some women who have fairly large fibroids aren’t even aware of their presence.
The bad news is that the majority of women who are more likely to develop fibroids are in their childbearing years at a time when they are trying to become pregnant. This means that the traditional treatment, surgical removal of the uterus, is less and less acceptable. Fortunately there are now other options and still more alternative treatments being developed.
Fibroids are not usually treated unless they begin to grow rapidly, cause serious pain or discomfort or are interfering with the ability to become pregnant. Women who have significantly heavy menstrual flow and large blood clots will also be primary candidates for treatment. This is because significant blood loss will often result in anemia which effects other bodily systems.
When problems caused by the fibroids are severe enough to require treatment it may be necessary to not only removes the tumors but also the uterus. The factors which are important when considering the treatment options available will include the woman’s age, whether her family is completed and the type of symptoms she is experiencing. It is also important to remember that women who develop fibroids are likely to develop them again once the primary tumors have been removed. The likelihood of a recurrence depends upon the woman’s age, race and how much of her tumors were removed during the procedure.
For these reasons women who have completed their childbearing and families often choose to have a hysterectomy or complete removal of the uterus which means these tumors will not return. A hysterectomy will leave the ovaries intact which means that a woman does not automatically face menopause immediately after the surgery. The decision to preserve or remove the ovaries will depend upon the woman’s age at the time of surgery. Currently surgeons recommend to preserve normal and healthy ovaries in women who are younger than 45.
A myomectomy is a type of gynecological surgery for a woman who continues to hope to become pregnant by for home the presence of fibroids makes the pregnancy and possible. During this procedure each of the tumors are removed separately without damaging or disturbing the uterus. Most women find this procedure is successful no matter how numerous or big the fibroids are or where they are located.
During the procedure the surgeon attempts to remove as many tumors as possible while making as few surgical incisions as possible. Sometimes removal of the tumors through the vagina are considered but in most cases surgeons must make an abdominal incision.
The possibility of a significant blood loss during either a hysterectomy or myomectomy is a consideration. During a myomectomy the fibroids are removed one at a time and surgery can take several hours longer than a hysterectomy. A second, or even a third, myomectomy is an option if the tumors return but multiple surgeries can lead to other problems including scarring of the uterus which decreases the ability to become pregnant or a bowel blockage.
Alternative methods of treatment include hormonal therapy using drugs to block the production of estrogen. Because fibroids are dependent on the hormone estrogen to grow and maintain their size by blocking estrogen day will shrink. The most common drug used in this procedure is Lupron, also in combination with other uterine fibroids treatments. Shrinkage is usually only temporary and because the drug is associated with menopause like symptoms such as hot flashes, mood swings, insomnia and premature bone loss this treatment is usually only considered for women who have large tumors prior to undergoing a myomectomy to preserve her fertility.
An endometrial ablation and resection is an out patient procedure during which a gynecologist uses a scope through the surtax into the uterine cavity to burn and scrape the lining of the uterus. The removal of the lining will stop the bleeding but not all the uterine fibroids can be removed with this technique. It is a technique which is less invasive and has a shorter recovery time than a hysterectomy but ultimately causes permanent infertility as well.
Focused ultrasound therapy is used to obliterate tumors by focusing high-intensity ultrasound beams on the growth does raising the temperature enough to destroy them. This treatment is usually guided by magnetic resonance image as which is a scanner that allows the Interventional Radiologist to see the location of the fibroids, which ones have been treated and monitor the temperature of the body.
This technology is limited to symptomatic women who are also not interested in becoming pregnant again and has few and smaller fibroids. Women who have larger fibroids or multiple smaller ones are more difficult to treat using focused ultrasonic therapy. Because this is a new technology the long-term effects of this therapy are not yet clear.
There is also a new, nonsurgical uterine fibroids treatment called uterine fibroids embolization. This procedure appears to be safer than surgery and is highly effective.