Fibroids, also known as myomas or leiomyomas, are non-cancerous tumors that grow from the smooth muscle of the uterus. They can cause heavy menstrual bleeding, abdominal pain, bladder pressure and frequent constipation, so it is important that symptomatic fibroids are treated properly. Several uterine fibroids treatment options are available; the best option for each individual case is determined by reviewing a woman's medical history and evaluating the severity of the fibroids.
Medications
Several medications can be used to control bleeding and shrink fibroids. This is accomplished by decreasing the amount of estrogen that circulates, which starves the fibroids of their nourishment. Exogenous progestins such as medroxy-progesterone acetate and megestrol acetate can be taken orally to reduce fibroid bleeding, but these drugs do not shrink fibroids. Medroxy-progesterone acetate may also be given as an injection every three months. Danazol suppresses fibroid growth, but has a number of undesirable side effects. Leuprolide acetate is used to stop heavy bleeding and reduce the size of fibroids. This drug is effective because it blocks the production of estrogen.
Abdominal Myomectomy
Myomectomy is a surgical removal of uterine fibroids. This procedure is done when a myoma is causing heavy bleeding, urinary symptoms, and persistent pain and pressure. Myomectomy is also used to remove fibroids that grow rapidly and do not respond well to medication therapy. This procedure is the best fibroid treatment option for young women who still want to have children. Abdominal myomectomy involves general anesthesia and a 4-inch incision in the lower abdomen. During this procedure, the uterus is exposed so the fibroids can be removed. Once the fibroids have been removed, the uterine wall is repaired with surgical stitches and the abdominal incision is sutured shut. This procedure requires a recovery period of four to six weeks.
Laparoscopic Myomectomy
Laparoscopic myomectomy is less invasive and requires the surgeon to make three to four small incisions in the abdomen. The laparascope is introduced through the incision below the belly button, allowing the surgeon to see the surgical field. Other instruments are inserted in the remaining incisions to remove the myomas and repair the uterine wall. The small incisions are covered with adhesive bandages and the patient is usually discharged the same day. Hysteroscopic myomectomy can be done to remove submucosal myomas. This procedure is done under general anesthesia and does not require any abdominal incisions. During the procedure, the uterus is distended by solution that is instilled through the cervix. A thin, lighted telescope known as a hysteroscope is inserted into the uterine cavity. The myomas may be removed with a laser or micro-instruments that the surgeon inserts through the operating channel of the hysteroscope. Once the procedure is completed, the patient remains in the recovery room for a few hours before being discharged from the hospital.
Uterine Fibroid Embolization
During uterine fibroid embolization, small particles are delivered to the uterus. These particles block the arteries that provide blood flow to the uterus, which causes the fibroids to shrink. Using a fluoroscope, the physician inserts a catheter into the femoral artery and uses contrast material to advance the catheter into the uterine arteries. The embolic particles are released into both uterine arteries by repositioning the same catheter that was inserted in the femoral artery. This procedure is much less invasive than some uterine fibroid treatment options, and involves a short recovery period of only one week.
Hysterectomy
According to the University of Maryland Medical Center, fibroid removal accounts for 38 percent of the hysterectomies performed in the United States each year. However, hysterectomy is only used to treat severe fibroids that have not responded well to other forms of treatment. Supracervical hysterectomy is the removal of the uterus with preservation of the cervix. Total hysterectomy is the removal of the uterus and cervix. The ovaries and fallopian tubes may also be removed during a total hysterectomy. Abdominal hysterectomy requires a long recovery period of four to six weeks and a hospital stay of three to four days after the procedure. The less invasive vaginal hysterectomy reduces the length of recovery time and can allow women to get back to their normal activities sooner than if an abdominal hysterectomy were done.
