NON-INVASIVE TREATMENTS FOR FIBROIDS
1. Watchful waiting
If your fibroids cause only minor symptoms – or none at all – there may be no need to treat them. If your fibroids are not bothering you, your best option could be "watchful waiting." Your fibroids might only grow slowly or might even shrink after menopause.
But if your fibroids do become uncomfortable and start to interfere with your daily life, go back to your doctor to discuss treatment options.
2. Hormone treatment
Medications for uterine fibroids aim to treat some of the symptoms that make fibroids uncomfortable, such as heavy periods and pelvic pressure. They work by targeting the hormones that regulate your menstrual cycle. These medications won't get rid of fibroids, but they can shrink them. The possible side effects are a lot like the symptoms of menopause, like weight gain, hot flashes, mood swings, vaginal dryness and loss of libido.
If you decide that hormone therapy is the best treatment for you, it's important to remember that if you stop taking the medications, your fibroids are likely to grow back.
Types of medications
There are several types of hormone treatments and medications available for women suffering from fibroids:
- Gonadotropin-releasing hormone (Gn-RH) agonists - Gn-RH agonists work by blocking the production of estrogen and progesterone, the reproductive hormones that have been linked to the development of fibroids. When your body stops making these hormones, you stop having periods. Your fibroids should shrink and, if you suffer from anemia, the medication can improve that, too. Your gynecologist will typically prescribe Gn-RH agonists for only up to six months, because long-term use can lead to bone loss.
- Progestin-releasing intrauterine device (IUD) - Many women will be familiar with IUDs as a form of birth control, but they can also help ease the heavy periods that often come with fibroids. After your doctor inserts the IUD into your uterus, it releases a small amount of progestin that can reduce menstrual bleeding. But an IUD doesn't shrink fibroids, it only helps manage the symptoms.
- Other medications - There are other ways to help make the symptoms of fibroids easier to handle, but they won't shrink the fibroids and, right now, there is no medication that can get rid of fibroids completely. Oral contraceptives (the birth control pill) can help control heavy periods and cramping. And NSAIDs (nonsteroidal anti-inflammatory drugs) can also ease the pain that can come with fibroids, but they don't reduce menstrual bleeding. If you have very heavy bleeding during your period, which can cause anemia, your doctor might recommend you take an iron supplement.
3. MRI-Guided Focused Ultrasound Surgery (FUS)
Although it's technically a surgery, FUS requires no incision and is usually done as an outpatient procedure.
Using an MRI scanner to see the size and location of the fibroid, a doctor uses high-intensity ultrasound waves to heat parts of the fibroid, killing the tissue. The procedure can take three or four hours and you will be awake the whole time. You will probably feel a warm sensation on your belly during the procedure and some patients can experience abdominal pain, cramping or nausea following the surgery.
After the treatment, some patients complain of cramps, shoulder or back pain that lasts a few days, but most women can go back to work within two days.
If you and your doctor decide you need more aggressive surgery, learn about some of your options here.
MINIMALLY-INVASIVE AND LESS INVASIVE FIBROID TREATMENTS
1. Uterine Fibroid Embolization (UFE)
UFE is a minimally invasive non-surgical procedure performed by an interventional radiologist.
Fibroids need a blood supply to stay alive and grow. UFE halts and reverses the growth of fibroids by blocking their blood supply. The procedure is performed by a specialist MD called an interventional radiologist while the patient is conscious or minimally sedated, but feeling no pain. It does not require general anesthesia.
For up to 90% of women who choose UFE, the treatment is a success, shrinking their fibroids and also easing symptoms like heavy periods, abdominal pressure, loss of bladder control and constipation.
2. Endometrial Ablation
Using specialized tools inserted through your cervix (the canal that connects your vagina and your uterus) your doctor will destroy the lining of your uterus with extreme cold, extreme heat, microwave energy or electric current. The treatment is mainly used to reduce heavy menstrual bleeding — in some cases, it can stop your period altogether. At the same time, the procedure can treat submucosal fibroids that are smaller than 1 inch in diameter. But it can't treat fibroids that are outside the interior lining of the uterus.
Although endometrial ablation does work well for some women, the long-term results for treating heavy bleeding with endometrial ablation are not always predictable, and there is a relatively high rate of recurrence. patients rather frequently report that ablation had failed and that their heavy periods returned after a year or two.
SURGICAL TREATMENTS FOR UTERINE FIBROIDS
A myomectomy is when a doctor surgically removes fibroids from the patient's uterus (womb). For some women whose fibroids have made it difficult for them to have a baby, this treatment can help increase their chances of getting pregnant.
Of all the surgical options for treating fibroids, myomectomy is the best one for women who plan to have children, because it keeps the uterus intact.
The type of myomectomy your doctor recommends will depend on factors like the size, number and location of your fibroids.
With an abdominal myomectomy the surgeon makes either a vertical incision, from just under your belly button to the top of your crotch, or a horizontal incision along your bikini line. It's usually used for multiple or larger fibroids and the surgeon may need to make more than one incision.
You will be asleep for the procedure and will probably need to stay in hospital for two nights afterward. Then you'll spend four to six weeks recovering at home.
If your fibroids are small or you only have a few of them, your doctor might recommend removing them with a laparoscopy. This surgery only requires four small incisions, instead of the large ones used in an abdominal myomectomy.
In a laparoscopy, the surgeon inserts a laparoscope — a thin, lighted tube with a camera at the end — through one of the incisions so they can see your ovaries, fallopian tubes and uterus. Then they put long, thin instruments through the other incisions and use those to remove the fibroids. Once your fibroids are removed, the surgeon cuts them up into pieces small enough to pull out through the incisions.
You will be asleep for the surgery and because the cuts are smaller, recovery time is shorter than with an abdominal myomectomy. Most women can leave the hospital the same day or the next day and spend two to three weeks recovering at home.
A hysteroscopy is similar to a laparoscopy, but doesn't require any incisions. In this type of myomectomy, the surgeon also uses a laparoscope to look inside your uterus, but inserts it into your vagina instead of through cuts in your belly. They then use specialized tools, like a wire loop, to cut off and remove the fibroids.
This surgery is only an option for women suffering from submucosal fibroids, which grow from the wall of the uterus into the uterine cavity. Fibroids that grow inside the uterus wall or on the outside of the uterus can't be treated using a hysteroscopy.
Whichever type of myomectomy you and your doctor decide on, it might not cure your fibroids completely. The procedure might miss tiny fibroids, called seedlings, and between 42% and 55% of women who have a myomectomy develop new fibroids later on.
Like with any other surgery, a myomectomy can result in complications. Although they are rare, they can include:
- Infection of the uterus, fallopian tubes or ovaries
- Scar tissue developing in the uterus after the fibroids are removed
- Childbirth complications, where uterine scars rupture late in a pregnancy or during delivery
- Injuries to the bladder or bowel
- Heavy bleeding or other major problems, which may force your doctor to remove your uterus completely, a procedure called a hysterectomy
A hysterectomy — when the surgeon completely removes your uterus (womb) — is the only proven cure for uterine fibroids. If you choose to have a hysterectomy, you will stop getting your period, you won't feel any more pressure in your abdomen, you will regain your bladder control and new fibroids can't grow back.
While a hysterectomy is the most thorough treatment for fibroids, it's also the most drastic. It's a major surgery and it means you can no longer get pregnant. If you have not hit menopause yet and decide to also remove your ovaries (the organs that produce your eggs) you will experience early menopause and all of the possible symptoms that come with it, such as hot flashes, mood swings and vaginal dryness, loss of libido, etc.
There are three types of hysterectomy:
- Total hysterectomy is the most common type. With this procedure, the doctor removes all of the uterus, including the cervix.
- Partial hysterectomy, also called a subtotal or supracervical hysterectomy, removes just the upper part of the uterus, leaving the cervix in place.
- Radical hysterectomy removes all of the uterus, the cervix, the tissue on both sides of the cervix, and the upper part of the vagina. This procedure is rarely necessary for treating fibroids and is most often used to treat certain types of cancer, like cervical cancer.
There are also several different techniques your doctor might use to perform your hysterectomy:
In this surgery, the doctor removes the uterus through the opening of the vagina, so there's no need to make an incision. You will be asleep for the procedure and will probably stay two nights in the hospital. Patients say they feel a lot of pain for 24 hours after the surgery and less pain for 10 days after that. Full recovery usually takes about four weeks.
Because the uterus has to fit through the vaginal opening, a vaginal hysterectomy can't be used on anyone with an enlarged uterus.
Laparoscope-assisted vaginal hysterectomy (LAVH)
During this surgery, the surgeon uses a laparoscope (a thin, lighted tube with a tiny camera at the end) to help them see inside your uterus and guide them during the procedure. The surgeon makes four small incisions — in your belly, below your bikini line and near each hip — and inserts thin surgical tools through them to cut your uterus free from your pelvic wall. The surgeon then removes your uterus through an incision in your vagina.
You will be asleep through the procedure. Women who have an LAVH usually stay in hospital between one and three days after the surgery and then spend up to four weeks recovering at home.
For this surgery, the surgeon removes your uterus through a large incision that goes either vertically, from your bellybutton to your crotch, or horizontally along your bikini line.
You will sleep through the procedure and stay in the hospital one or two days, maybe longer. Recovery at home could take six to eight weeks.
Discuss your options with VIVA EVE: The Fibroid Experts
For patients looking for a less invasive treatment, uterine fibroid embolization (UFE) is an attractive option. And if your fibroids don't bother you much, you may be able to treat them with medication alone.
The doctors at VIVA EVE have years of experience in the treatment of both uterine fibroids and adenomyosis. We provide high-quality, personalized care for each and every patient we see. We'll partner with you to determine the best way to treat your problematic symptoms.