Frequently Asked Questions
What are the treatment options and which one is best for me?
While up to 75 percent of reproductive aged women in certain populations may have uterine fibroids during their lifetime, the percentage of women who experience symptoms are fewer — about 25 percent. For these women with symptoms, there are several treatment options. Which of these treatments is best depends on each woman's unique clinical situation and desires. Factors such as a desire for future pregnancy, size, location of the fibroids, and age are the major considerations.
Treatments for symptomatic fibroids range from medications like pain relievers and hormones, such as oral contraceptives, to minimally invasive procedures like uterine artery embolization, to surgeries such as myomectomy and hysterectomy.
What is expectant management?
Expectant management, the wait and see approach, is an option for women who do not have symptoms related to their fibroids. With expectant management, patients are monitored, but not treated, by their physician. Periodic exams may be scheduled to check for enlargement of the fibroids. If the patient remains asymptomatic, however, there is probably no benefit in checking for growth, other than for curiosity's sake. An ultrasound may be obtained to use as a basis for comparison and to confirm that the pelvic mass is a fibroid uterus and not an ovarian mass.
Fibroids do tend to increase in size until menopause. Unless this enlargement is accompanied by symptoms, however, expectant management may be continued.
What surgical treatments exist?
Surgical therapy includes myomectomy, in which fibroids, but not the entire uterus, are removed. This procedure allows a woman to keep her uterus, also potentially preserving future fertility. Approaches in this method may be hysteroscopic, placing a camera and instruments through the vagina into the uterus to guide submucosal fibroid resection, or laparoscopic, which uses a small camera directly within the abdominal cavity to aid removal of the fibroid(s). Most commonly, an open procedure, or laparotomy, is used to remove the fibroids through an incision in the abdomen.
Endometrial ablation is a new technique that has recently been approved to treat women with fibroids suffering from irregular bleeding. In this minimally-invasive outpatient treatment, the endometrial lining is destroyed with microwaves in a procedure lasting less than five minutes. Inital data reports improved bleeding in over 90% of patients.
Another surgical option is hysterectomy, in which the uterus is removed along with the fibroids. While hysterectomy is the only definitive treatment for fibroids, it also eliminates a woman’s ability to bear children. Hysterectomy may be performed by either a vaginal or abdominal approach, and may be assisted by a camera laparoscopically assisted vaginal hysterectomy (LAVH).
What is myomectomy?
Myomectomy is a surgical procedure in which only fibroids, but not the uterus, are removed. This preserves childbearing potential. Myomectomy can be performed in different ways depending on the location of fibroids within the uterus. The most common approach is abdominal myomectomy, which allows the surgeon to directly visualize the uterus and fibroids through an abdominal incision. In some circumstances, other approaches to myomectomy may be used. Submucosal fibroids may be reached by hysteroscopic myomectomy. This approach uses a camera inserted in the uterus through the vagina to enable resection of the fibroid. Subserosal fibroids, just beneath the outer covering of the uterus, may be best approached by laparoscopic myomectomy, which uses a small camera inserted into the abdominal cavity to identify and aid in removing the fibroid.
EWhile the procedure offers symptomatic reduction and decreases heavy, prolonged menstrual bleeding in most women, there is a small risk of symptomatic fibroid recurrence. Up to 10% of women may require additional operations due to future growth of new fibroids.
What is laparoscopic myomectomy?
Subserosal fibroids, which are just beneath the outer covering of the uterus, may be best approached by laparoscopic myomectomy. This approach removes fibroids from the uterus using a small camera and thin surgical instruments inserted into the abdominal cavity through multiple, small incisions. This procedure is technically more difficult and may have limitations in terms of the number, size, and location of fibroids to be removed. The main benefits of laparoscopic myomectomy are a quicker recovery and shorter hospital stay.
What is hysteroscopic myomectomy?
For submucosal fibroids, those within the cavity of the uterus, hysteroscopic myomectomy may be an option. This approach uses a camera, or hysteroscope, inserted in the uterus through the vagina to enable resection of the fibroid. The procedure is typically done on an outpatient basis, with patients often returning to work the next day. Limitations of this procedure include the size of the fibroid to be resected and co-existing fibroids that also need to be treated.
What is endometrial ablation?
Several techniques of endometrial ablation have been approved to treat women with fibroids suffering from irregular bleeding. In this minimally-invasive outpatient treatment, the endometrial lining is destroyed by a probe inserted into the uterine cavity through the vagina emitting energy from its tip, in a procedure lasting less than five minutes. Initial data reports improved bleeding in over 80% of patients, with up to 40% of patients never bleeding again.
What is abdominal myomectomy?
The most common method to remove fibroids from the uterus is abdominal myomectomy. Unless the uterus is massively enlarged, it is performed through a low transverse (bikini cut) incision. This surgical procedure allows for direct visualization of the uterus and fibroids through an abdominal incision. This procedure typically requires a two day hospital stay, with full recovery in four to six weeks.
What is hysterectomy?
Hysterectomy is a surgical treatment for symptomatic fibroids that removes the uterus along with the fibroids. Hysterectomy is the only definitive treatment for fibroids. Women electing to have a hysterectomy must be aware that removal of the uterus eliminates a woman’s ability to bear children.
Hysterectomy may be performed in different ways depending on the size of the uterus, scar tissue from previous surgeries, uterine mobility from prior vaginal deliveries, and skill of the surgeon. Abdominal hysterectomy, the most common technique, uses an abdominal incision to remove the uterus. Vaginal hysterectomy uses a vaginal approach to remove the uterus, without cutting through the abdomen. Laparoscopically assisted vaginal hysterectomy starts the hysterectomy through small abdominal incisions, then completes it with a vaginal approach. Laparoscopic hysterectomy uses a small camera inserted through the abdomen. Depending on a patient’s wishes, the ovaries and fallopian tubes may be removed as well.
Each year, 30% of all hysterectomies are performed for symptomatic fibroids—nearly 200,000 operations in the United States alone.
What is abdominal hysterectomy?
Abdominal hysterectomy removes the uterus along with all fibroids through an abdominal incision. This is considered definitive treatment for fibroids.
A variation of this procedure, supracervical hysterectomy, leaves the cervix intact. Potential advantages of supracervical hysterectomy include shorter operative time, decreased complication rate, decreased risk of vaginal vault prolapse later on, and preserved sexual function. Women at risk for cervical cancer or with abnormal Pap smears are not candidates for supracervical hysterectomy. Patients should expect to be hospitalized for a two days following abdominal hysterectomy, with full recovery within four to six weeks.
What is vaginal hysterectomy?
Vaginal hysterectomy removes the uterus and fibroids through the vagina, without need for an abdominal incision. The three limitations to vaginal hysterectomy are size, scarring, and prolapse. Most surgeons, unless they are skilled in the surgical techniques of morcellation, will only attempt vaginal hysterectomy is the uterus is smaller than 12-14 weeks gestational size. Additionally, if there is a history of prior abdominal surgery or a lack of uterine mobility, the vaginal approach may not be an option. The hospitalization is usually just overnight. Most patients are back to work within two to three weeks. If possible, the vaginal approach is preferable over the abdominal approach.
How long will it take to recover from surgery?
The length of time it takes to recover from surgery depends on the type of procedure used to treat the fibroids. Patients typically recover from hysteroscopic and laparoscopic procedures more quickly (within a week) than vaginal (two to three weeks) or open abdominal procedures (four to six weeks). The definition of recovery will also differ based on a patient's motivation, general health, and the requirements of their job.