Uterine fibroids

When your surgeon wants to go in after them

Uterine fibroids are almost as common as the uterus itself. They happen so frequently that your doctor may just assume that you have them, depending on your symptoms. Fibroids are noncancerous tumors that grow in or on the uterus and can cause heavy bleeding, pain, and pressure on other organs inside the pelvic cavity, such as the large intestine. Sometimes fibroids cause no symptoms at all, or the symptoms are so mild that no treatment is necessary. However, sometimes the fibroids cause pain that is unbearable or bleeding that necessitates blood transfusions. In these cases, your doctor may want to perform surgery to remove the fibroids. A few options are available to deal with this condition surgically.

No blood means no fibroid: uterine fibroid embolization

Uterine fibroid embolization is a popular new treatment for fibroids that does not require surgery. It is performed by an interventional radiologist, but still requires a one day hospital stay due to intense cramping. The idea behind this approach is to isolate the artery supplying blood to the fibroid and block it off with small, rice-sized pellets to cut off its blood supply. This effectively kills the fibroid and is an effective way of removing them without actually performing surgery. Pregnancy is still possible after this procedure, but some evidence exists that placental abnormalities are a concern following embolization. In addition, if the fibroids are large or located on the outside of the uterine wall, the body will not be able to pass them on its own. A hysteroscope, or an instrument introduced through the vagina, will be used to remove the larger fibroids.

My, oh, myomectomy: just take the fibroids, doc!

A myomectomy is a surgical procedure that removes the fibroids and nothing else. It is conservative treatment for women older than 35 who need relief from symptoms but cannot wait for menopause when the fibroid symptoms will stop on their own. It also preserves the uterus and, thus, your fertility. Myomectomy is performed a few different ways depending on where the fibroids are located and how involved they are. The hysteroscopic approach is the least complicated because it does not require any surgical incisions. It merely removes the fibroids through a scope inserted into the vagina. This is adequate for small fibroids that are inside the uterus. Laparoscopic myomectomy removes the fibroids through small incisions in the abdomen. The surgeon uses long instruments and lighted cameras to see into the abdominal cavity. For severe cases, a full abdominal incision laparotomy may be necessary to remove complicated or large fibroids.

Children are history: opting for the hysterectomy

A hysterectomy is only recommended in extreme cases of fibroids, and you should seriously consider other forms of treatments before opting for such a radical surgery. Still, if your fibroids are leading to servere pain, blood transfusions, and other medical conditions, hysterectomy might be the only option available to you, especially if other options have failed to control your fibroids. Having a hysterectomy, of course, means you can no longer have children, and that is something that you will have to weigh against your relief from fibroids. A total hysterectomy can be performed vaginally, and it removes the uterus itself along with the cervix. A subtotal hysterectomy is usually performed through an incision in the abdomen and removes just the uterus. Some risks of this surgery include infection, blood clots, and bowel obstruction. This surgery definitely solves the problem of fibroids, but it is not an option for women who still want to bear children.

References

• National Uterine Fibroids Foundation; Treatments
• Mayo Clinic; Myomectomy
• Mayo Clinic; Uterine Artery Embolization

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