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Uterine Fibroids (cont.)

Surgery

Surgery options for treatment have both risks and benefits. Be sure to discuss these risks and benefits with your doctor. Some treatment options may not be right for you because of the characteristics of your fibroids or other health factors.

Myomectomy is the surgical removal of the fibroids only. This can be accomplished through hysteroscopy, laparoscopy, or, less frequently, an open procedure (an incision in your abdomen). The surgical approach depends on the size and location of your fibroid. Pretreatment with GnRH analogs has been shown to decrease blood loss and operative time in women undergoing myomectomy. Myomectomy has also been shown to have a decreased likelihood of injury to the bowel, bladder, or ureter than hysterectomy. The uterus is left intact in this type of procedure, and you may be able to become pregnant.
Hysterectomy is the surgical removal of the uterus (and fibroids). It is the most commonly performed surgical procedure in the treatment of fibroids and is considered a cure. Depending on the size of the fibroid, hysterectomy can be performed through your vagina or abdomen. Use of GnRH agonists can reduce the size of the fibroid to allow the less invasive surgery through the vagina. In past experience, less blood loss has occurred using hysterectomy than myomectomy. But this may change as preoperative hormone treatment is improved and blood loss is reduced because hormone use helps the tumors shrink. Hysterectomy with removal of the fallopian tubes and ovaries (called a salpingo-oophorectomy) may be indicated if cancer or ovarian masses are present.
Uterine artery embolization, or clotting of the arterial blood supply to the fibroid, is an innovative approach that has shown promising results. This procedure is done by inserting a catheter (small tube) into an artery of the leg (the femoral artery), using special x-ray video to trace the arterial blood supply to the uterus, then clotting the artery with tiny plastic or gelatin sponge particles the size of grains of sand. This material blocks blood flow to the fibroid and shrinks it. This method may prove to be a good option for women if other methods have not worked or who do not want surgery or may not be good candidates for surgery. A specialist known as an interventional radiologist performs this procedure.