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Paul MacKoul, MD, FACOG
Treatment Options For Uterine Fibroids
The Center for Innovative GYN Care
. http://innovativegyn.com/

Treatment Options For Uterine Fibroids

Fibroids are non-cancerous smooth muscle growths in the uterus that can cause pain, bleeding, infertility and other medical problems. Traditionally, fibroids have been treated by open surgical procedures to either remove the fibroids and preserve the uterus, called myomectomy, or remove the fibroids with the uterus, called hysterectomy. Open myomectomy is a complicated procedure that is usually performed with a large incision in the abdominal wall, and is associated with high blood loss. Open abdominal surgery for hysterectomy also requires a large incision.
Myomectomy is usually indicated only for those patients who wish to preserve the uterus or become pregnant. Hysterectomy is a better surgical procedure for those not wanting pregnancyit will prevent future regrowth of fibroids since the uterus is removed.
The main problems associated with these open surgical procedures are hospital stay of 3-4 days, recovery time of 6-8 weeks, increased bleeding, pain, and complications such as wound infection, blood clots, etc.
Uterine artery embolization (UAE) was developed as an alternative to open surgical procedures. This procedure injects plastic particles into the uterine arteries through a catheter inserted into the large artery of the groin. These particles block blood flow to the uterus and the fibroids, causing the fibroids to necrosis, or die, resulting in less bleeding and some decrease in the size of the fibroids. UAE requires an overnight hospital stay and is associated with severe pain, sometimes for weeks, due to death of the fibroids. UAE is definitely an excellent alternative to open surgical procedures. Most patients would choose UAE over open surgery due to downtime associated with large incisions and the complications that can occur.
Laparoscopic surgical procedures to remove fibroids or the uterus offer many advantages over UAE.
Laparoscopy can be used to remove fibroids of any sizeresults with UAE are less successful with very large fibroids.
Laparoscopy offers choices remove the fibroids only, the uterus and ovaries, the uterus only, or the upper portion of the uterus with preservation of the cervix.
UAE is not 100% successful. With time, the uterus will redevelop its blood supply, and the fibroids will grow with recurrence of pain and bleeding. Laparoscopic hysterectomy removes the uterus and the source of the fibroids resulting in no more periods, bleeding, or pain.
UAE is not indicated for women desiring fertility, since it may affect the chances of becoming pregnant. Laparoscopic myomectomy is a better alternative, since this procedure removes all the fibroids without affecting the blood supply of the uterus, and does not compromise fertility.
Most importantly, when done properly laparoscopic procedures for either myomectomy or hysterectomy allow patients to leave the hospital the same or following day, result in minimal pain for only 1-2 days, allow patients to return to work within 510 days, and can be applied to all women regardless of the size of the fibroids or their desire to become pregnant. These procedures average less than 60 minutes of surgery and have very low complication rates.

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