Once you have been diagnosed with fibroids, your doctor will discuss with you the various methods for treating them. These methods range from watchful waiting to pharmaceutical therapy for fibroids that may have recently been diagnosed or may have some associated symptoms, but do not interfere with daily living.
However, many patients may require additional treatment options to manage more severe symptoms. Your physician may advise you of minimally invasive, uterus-sparing therapy, such as UFE, to surgical interventions, such as hysterectomy and myomectomy. It is important to be sure to discuss all of these options with your physician to see what is the best option for you.
Diagnosis and Watchful Waiting
If your fibroids do not cause symptoms, there is no need to treat them. Your doctor may want to watch them and monitor for any fibroid growth at each of your annual examinations. Some women may have fibroids, but not experience symptoms.
If you begin to experience, of have been experiencing, some or many of the symptoms previously indicated, there are several other treatment options that may be available to you. These include drug therapies; minimally invasive non-surgical options; and surgical options. Your doctor should discuss all the alternatives with you based on your condition.
Birth control pills many physicians will prescribe birth control pills as a means of controlling excessive bleeding caused by fibroids. Other non-steroidal anti-inflammatory agents (NSAIDs) may be prescribed for pain relief. Birth control pills effectively trick your body into thinking it is pregnant. There are several potential side effects of the use of birth control pills, including risk of high blood pressure, development of blood clots, increased risk of heart disease, and/or liver disease. Data suggests that fibroids may re-grow after this treatment ends.
GnRH Agonists can be prescribed by physicians when symptoms are not controlled by birth control pills, or can be prescribed as a first attempt in controlling fibroid symptoms. GnRH agonists are used to decrease the production of estrogen in the ovaries, which may reduce the size of fibroids and help manage the associated symptoms. Because of the decrease in estrogen production, there may be some side effects, such as hot flashes or mood swings. Furthermore, there may be some bone loss associated with prolonged use of GnRH agonists. In addition, data suggests that fibroids may re-grow after this treatment ends.
Non-surgical Option: Saves the Uterus and Stops the Fibroids
Uterine fibroid embolization is a procedure where an interventional radiologist uses a catheter to deliver Embosphere® Microspheres that block the blood supply to the fibroids. This is a minimally-invasive, non-surgical therapy that treats all fibroids. This procedure usually takes less than one hour. Clinical data suggests that patients treated with Embosphere Microspheres return to work and daily activities on average within 11 days. Patients treated with other embolic agents return to work and daily activities between 13 and 16 days. Potential benefits of UFE include:
- Preservation of the uterus
- Decrease in menstrual bleeding from symptomatic fibroids
- Decrease in urinary dysfunction
- Decrease in pelvic pain and/or pressure
- No surgical removal of the uterus and possible need of hormone replacement therapy (HRT)
- Virtually no blood loss
- Covered by most insurance companies
- Out-patient procedure (generally 10 to 23 hours)
- More confidence with less chance of soiling events
- Overall significant improvement in patients physical and emotional well-being
Overall, UFE is a safe procedure for treating symptomatic fibroids with minimal risk. Overall, 96% of patients indicated they were happy with their twelve month outcome, and would recommend UFE to a friend. Most reported risk factors and complications associated with UFE are transient amenorrhea, common short term allergic reaction/rash, vaginal discharge/infection, possible fibroid passage, and post-embolization syndrome. For more comprehensive information see possible risks and complications associated with UFE (PDF Format, below).
Hysterectomy is defined as the surgical removal of the uterus (womb). It is one of the most common of all surgical procedures and can also involve the removal of the fallopian tubes, ovaries and cervix. Following this operation you will no longer have periods, nor will you be fertile or be able to have any more children.
There are two main ways to perform a hysterectomy. The most common way is to remove the uterus through an incision in the lower abdomen. The second and less common way, is to remove the uterus through a cut in the top of the vagina, where the top of the vagina is stitched. Each operation lasts between one to two hours and is performed in the hospital under a general anesthesia
The are different types of hysterectomy:
- A total hysterectomy removes the complete uterus including the cervix. This is the operation most commonly performed.
- A subtotal hysterectomy removes the uterus leaving the cervix in place. If you have this operation you will need to continue to have Pap smear tests.
- A total hysterectomy with a bilateral or unilateral oopherectomy removes the uterus, cervix, fallopian tubes and both or one of the ovaries. If you you have not had your ovaries removed and you have not gone through menopause before your operation, there is a 50% chance that you will go through menopause within 5 years of having this operation.
Physically there are a number of issues that are common to all women having a hysterectomy. You will not have any more periods and you will not be able to have any more children. If you have had your ovaries removed you will go through menopause regardless of your age. Menopause is not related to age, it is related to the production of the female sex hormone, estrogen. Your physician should discuss Hormone Replacement Therapy (HRT) with you to help you understand the pros and cons of HRT.
Myomectomy is the surgical removal of the fibroids. While this procedure keeps your uterus in-tact, it can be a surgically challenging procedure and is not performed by all physicians. In addition, only certain fibroids may be treated with this therapy. An abdominal myomectomy is performed through a horizontal incision through the abdomen, similar to a bikini cut used in a cesarean section. Most types of fibroids, even very large ones, can be removed in an abdominal myomectomy. The recovery time varies with each patient, but typically is 4-6 weeks in length. Pedunculated and subserosal fibroids can be removed via a laproscopic myomectomy, which is performed through three small incisions. When a resectoscope is used to remove submucous fibroids, this is called a hysteroscopic resection. The use of a resectoscope requires proper training by the physician prior to use.
BioSphere Medical, Inc. website, embodies the text above. Reproduced with permission.