Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Surgery options for treatment have both risks and benefits. Be sure to discuss these risks and benefits with
the doctor. Some treatment options may not be right for a woman because of the characteristics of
the 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 the abdomen). The surgical approach depends on the size and location of
the 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
the patient 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 with incisions through the vagina or abdomen. In some cases the procedure may be performed using laparoscopy. Use of GnRH agonists can reduce the size of the fibroid to allow less invasive surgical techniques. 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 there is suspicion of cancer or if 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,
she does not want surgery, or may not be good candidates for surgery. A specialist known as an interventional radiologist performs this procedure.