Uterine fibroids are noncancerous tumors of the uterus that cause heavy bleeding and pressure in the pelvis. In many women, fibroids have no symptoms and exist unknowingly. They are discovered during an annual gynecologic exam and confirmed by ultrasound or MRI. As fibroids enlarge from prolonged exposure to estrogen during the reproduction years, they press on nearby anatomical structures, causing a variety of symptoms. The most common symptoms are heavy uterine bleeding and pelvic pressure. When fibroid symptoms begin to affect your health and quality of life, you should seek medical treatment.
Laparoscopic Myomectomy
Small fibroids that protrude from the outside surface of the uterus (subserosal) or extend outward from the uterus by a stalk into the abdominal cavity (pedunculated subserosal) are treated by laparoscopic myomectomy. For larger fibroids, an abdominal incision is required to perform a laparotomy or abdominal myomectomy. According to Dr. Paul Indman's website, All About Myomectomy, the recovery time for abdominal myomectomy is between four to six weeks. A laparoscopic myomectomy is a less invasive procedure with a faster recovery time of one to three weeks.
Hysteroscopic Myomectomy
Hysteroscopic myomectomy provides access to fibroids inside of the uterine cavity. Fibroids that bulge (submucosal) or extend from the inner uterine wall by a stalk into the uterine cavity (pedunculated submucosal) are removed by using a hysteroscope. Removing fibroids by this method do not guarantee a cure from fibroids. According to "Williams Gynecology," the incidence of recurrence following myomectomy range from 40 to 50 percent. Patients with recurrent fibroids may require further surgical therapy. Hysteroscopic myomectomy can be completed in an office setting with minimal anesthesia and recovery is one to three days.
Hysterectomy
Hysterectomy is an operation that removes the uterus. According to "Williams Gynecology," hysterectomy is the most common surgical treatment for uterine fibroids in the United States. More than 3.5 million hysterectomies were performed in the United States between 1994 and 1999 and almost one third were performed to treat women diagnosed with uterine fibroids. Hysterectomy is considered the "cure" for fibroids and is reserved for women who have no desire for future pregnancies.
The operation can be performed through the abdomen, vagina or by laparoscopy. A uterus containing large fibroids can be treated with gonadotropin releasing hormone agonists (GnRH) for three to six months. GnRH produces temporary menopause and reduces estrogen levels. After three months of treatment, fibroids can shrink as much as 50 percent, allowing the uterus to be removed through the vagina and avoid an abdominal incision. The short-term treatment with GnRH may reduce bleeding during surgery.
Women over 45 are recommended to remove the ovaries during hysterectomy to eliminate the risk of ovarian cancer. The recovery period for hysterectomy ranges four to eight weeks and varies in accordance to the surgical approach selected by your doctor. For example, a vaginal hysterectomy patient will heal faster than a patient with an abdominal hysterectomy. In general, an abdominal incision takes longer to heal and recover from than tiny laparoscopic abdominal incisions or hysteroscopic surgical treatments.
References
- Williams Gynecology; Schorge, et al; 2008.
- All About Myomectomy: What is Abdominal Myomectomy?
