With increased use of medical imaging 70% of women will have uterine fibroids
detected. These benign tumors grow in the muscular wall of the uterus.
They are more common during the 3rd an 4th decades of life. Most fibroids
do not cause problems so watchful waiting is appropriate. When symptoms
occur such as heavy menstrual bleeding, painful cramps, urinary frequency,
pelvic pain or pressure that compromises the quality of a woman’s
life, then intervention is indicated:
Medical Therapy: Unfortunately, birth control pills often prove ineffective in long term
control of heavy bleeding from fibroids. Nevertheless a trial may be worthwhile
for women who have not completed their families.
Progesterone releasing IUD: In a study of women with small to moderate fibroids, insertion of the
Mirena IUD substantially reduced bleeding to normal amounts in 85% within 3 months.
This IUD lasts up to 5 years.
Endometrial Ablation: A study of women who had heavy periods and small fibroids impressively
demonstrated 95% had satisfactory improvement and some were period free.
This treatment heats and removes the inside lining of the uterus so it
is only for women who have completed their families. While we perform
NovaSure endometrial ablation in the outpatient surgery center, since it only takes 1 ½ minutes
we also conveniently offer it in our office at Women’s Health Specialists.
This avoids the anxiety and expense of trip to the operating room and
general anesthesia. Patients typically return to regular activities the
Myomectomy If the fibroids project into the uterine cavity then they may be amenable
to incision free removal with a scope. Otherwise for women desiring to
retain their uterus for childbearing, removal of fibroids and reconstruction
of the uterus can be accomplished through an abdominal incision. Fibroids
causing infertility are best treated with
myomectomy. Approximately 1 in 4 women will require future surgery for symptoms from
growth of new fibroids.
Uterine Artery Embolization: Interventional radiologists perform this treatment by inserting a tube
and temporarily blocking the blood vessels that go to the uterus. About
70 80% of patients initially report satisfactory resolution in symptoms.
The rate of future fibroid intervention is similar to myomectomy patients.
Pregnancy is not recommended afterwards.
Hysterectomy: Fibroids are responsible for 1/3 of hysterectomies. We promote vaginal and
laparoscopic removal of the uterus (not ovaries so does not effect hormones), because
they offer patients significantly less painful and shorter recoveries.
At times uterine enlargement or complicating factors may dictate an abdominal
So know you know that hysterectomy is not your only option when fibroids
produce disruptive symptoms. Looking ahead there are devices and hormonal
medications in various stages of development that will expand this selection
in the near future.