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Uterine Fibroids, Part Two


November 19, 2010

By Emily Grose


In the last article, we explained what uterine fibroids are, and in this article we will discuss treatment options for women who have uterine fibroids. Most women with fibroids will never require treatment, but those showing symptoms or who have large fibroids have several treatment options. Treatment depends on the size and location of the fibroids, symptoms showing, whether or not the woman wants to become pregnant in the future, and the how close to menopause the woman is. Here are some of the options:


Medication


Women whose fibroids cause bleeding can often take low dose birth control, Depo-Provera or use an intrauterine device (IUD) to regulate bleeding [1]. There are medications available for short-term use that shrink fibroids and relieve symptoms, called “gonadotropin releasing hormone antagonists” or GnRHa. GnRHas is often injected or implanted, and while it works well, it is expensive, can only be used for six months because it can cause bone thinning. After its stoppage, fibroids usually grow back [1].


Myomectomy


A myomectomy is a surgery that removes fibroids while healthy uterus tissue is preserved; this option is good for women who desire to become pregnant in the future or want to keep their uterus. A myomectomy can either be major or minor surgery depending on the size, location and number of the fibroids [1]. It is important to note that there is risk of fibroid reoccurrence, and 25-50% of women with myomectomies reported another fibroid within ten years of the surgery [2].


Hysterectomy


A hysterectomy, the major surgery that removes the entire uterus, is the only permanent cure for uterine fibroids. Fibroid problems account for over one third of, or 200,000, hysterectomies in the United States per year [3]. This procedure is often recommended when fibroids are large, there is heavy bleeding, the woman is near menopause, or does not desire to have any more children [1]. A hysterectomy can be abdominal (through a cut in the abdomen), vaginal (removed through the vaginal opening) or laparoscopic (using a tiny incision and a long thin scope) [2]. In 2009, the American Congress of Obstetricians and Gynecologists recommended having a vaginal hysterectomy because it has better outcomes, fewer complications, and a shorter recovery, but many younger physicians also prefer laparoscopic procedures [4]. The United States has a very high hysterectomy rate compared to other countries, and there has been a lot of criticism that many of the hysterectomies performed are not actually necessary [5]. The American Congress of Obstetricians and Gynecologists recommends that if a doctor prescribes a hysterectomy, a woman should make sure other alternatives have been explored and she should get a second opinion [6].


Endometrial Ablation


Endometrial ablation is a minor outpatient surgery where the lining of the uterus is destroyed and removed using a laser or other methods [1]. Complications are unlikely and recovery is fast, although a woman cannot become pregnant after this procedure [1].


Myolysis


Myolysis is a procedure where a needle is inserted into the uterine fibroids and an electric current is used to destroy the tumors [1]. Cryomyolis is a similar procedure but it uses freezing instead of electric current [2].


Uterine Fibroid Embolization (UFE)/ Uterine Artery Embolization (UAE)


Uterine Fibroid Embolization (also called Uterine Artery Embolization) is a relatively new procedure and an alternative to surgery. Tiny plastic or gel particles are released into blood vessels that connect to the fibroids, cutting off fibroids’ blood supply, causing them to shrink [1]. The long-term side effects are not entirely known, and it is not known the effect this procedure has on the ability of a women to become pregnant in the future [2].


Conclusion


Remember, most uterine fibroids never require treatment, but if they do, they are several options to consider, both surgical and non-surgical. There are more options than those described above. Not every treatment is an option for every woman, but it is important to discuss with your health care provider what the pros and cons are for the treatment options available to you. If your health care provider recommends a hysterectomy, make sure he or she has explored alternatives, and get a second opinion.



Sources

[1] National Women’s Health Information Center (2008, May 13). Uterine Fibroids. U.S. Department of Health and Human Services. Retrieved on Oct. 13, 2010 from http://www.womenshealth.gov/faq/uterine-fibroids.cfm.

[2] Center for Uterine Fibroids (n.d.). About Uterine Fibroids. Brigham and Women’s Hospital. Retrieved on Oct. 13, 2010 from http://fibroids.net/homepage.html.

[3] Centers for Disease Control and Prevention (2009, May 7). Women’s Reproductive Health: Hysterectomy Fact Sheet. Department of Health and Human Services. Retrieved on Nov. 1, 2010 from http://www.cdc.gov/reproductivehealth/WomensRH/00-04-FS_Hysterectomy.htm.

[4] American College of Obstetricians and Gynecologists (2009, Oct. 21). ACOG Recommends Vaginal Hysterectomy As Approach of Choice. Retrieved on Nov. 1, 2010 from http://www.acog.org/from_home/publications/press_releases/nr10-21-09.cfm.

[5] Kantrowitz, B (2009, Feb. 26). Female Trouble. Newsweek. Retrieved on Nov. 1, 2010 from http://www.newsweek.com/2009/02/25/female-trouble.html.

[6] American College of Obstetricians and Gynecologists (2003, Aug. 29). ACOG Statement on Alternatives to Hysterectomy. Retrieved on Nov. 1, 2010 from http://www.acog.org/from_home/publications/press_releases/nr08-29-03-3.cfm.





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