Is Surgery Really Necessary If You Have Fibroids?

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According to Mayo Clinic
, as many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms.

Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

However, for many women, their fibroids can major cause of problems – in fact, according to Mayo Clinic, they can be a major reason women need to have hysterectomies.

How Are Fibroids Treated?

There’s no single best approach to uterine fibroid treatment.

According to Mayo Clinic, there are many different treatment options, including:

Watchful waiting

Again, many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option. Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop.

Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them.

Medications include:

Gonadotropin-releasing hormone (Gn-RH) agonists. Medications called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a Gn-RH agonist to shrink the size of your fibroids before a planned surgery. Many women have significant hot flashes while using Gn-RH agonists. Gn-RH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.

Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn’t shrink fibroids or make them disappear.

Noninvasive Fibroid Procedures

MRI-guided focused ultrasound surgery (FUS) is:

A noninvasive treatment option for uterine fibroids that preserves your uterus, requires no incision and is done on an outpatient basis.

Performed while you’re inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. The images give your doctor the precise location of the uterine fibroids. When the location of the fibroid is targeted, the ultrasound transducer focuses sound waves (sonications) into the fibroid to heat and destroy small areas of fibroid tissue.

Newer technology, so researchers are learning more about the long-term safety and effectiveness. But so far data collected show that FUS for uterine fibroids is safe and effective.

Minimally Invasive Procedures

Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

Uterine artery embolization. Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.

  1. In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. Myolysis is not used often. Another version of this procedure, radiofrequency ablation, is being studied.

Laparoscopic or robotic myomectomy. In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. Robotic myomectomy gives your surgeon a magnified, 3-D view of your uterus, offering more precision, flexibility and dexterity than is possible using some other techniques.

Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.

Traditional Surgical Procedures

Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids. Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead.

  1. This surgery — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children. And if you also elect to have your ovaries removed, it brings on menopause and the question of whether you’ll take hormone replacement therapy. Most women with uterine fibroids can choose to keep their ovaries.

Do I Really Need To Undergo Surgery?

According to the Mayo Clinic New Network, treatment options are limited and ultimately, surgeries are still the dominate treatment for this disease. But more options may be just around the corner.

In the Feb. 2, 2010, issue of New England Journal of Medicine, Ebbie Stewart, M.D., Mayo Clinic obstetrician, provides an editorial about a possible new medical treatment for uterine fibroids based on two studies published in the same issue. Donnez et al. report that progesterone-receptor modulators, drugs that influence the response to the ovarian hormone progesterone, are effective in treating uterine fibroids much better than a placebo or no treatment at all and equivalent to a GnRH agonist, but without the significant side effects. Dr. Stewart explains that GnRH agonists often cause women to feel like they are going through menopause and they also can contribute to bone loss.

Dr. Stewart says the progesterone-receptor modulators appear to be safe treatments and with both of these studies together, there is exciting news that there may be approved medical treatments for fibroids, ones that can be taken as a pill on a daily basis and give women both decreased menstrual bleeding and decrease the size of the fibroids.

Until more medical therapies become available, interventional therapies such as ultrasound artery embolization and focused ultrasound surgery have proven to be effective alternatives to hysterectomies. Dr. Stewart encourages women to educate themselves about their treatment options and to ask questions about alternatives to hysterectomies.

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