Treatment Options for Fibroids
At L.A. Women’s Health & Wellness, we are proud to offer a wide range of non surgical and medical options as well as minimally invasive treatment options for women suffering from uterine fibroids.
If you have been told that you need a hysterectomy and other options have not been discussed with you please give us a call for a full evaluation and discussion of your treatment plan.
Surgical Options Include
Uterine artery embolization (UAE), a minimally invasive technique, is accomplished through a small needle opening in the groin. This procedure works by cutting the blood supply to the fibroids, blocking their source of nutrition. Subsequently this allows for the patients body to absorb the fibroid tumors over time. 85% of women report resolution of their symptoms three months after the procedure. General anesthesia is not required and it is best performed under local anesthesia with conscious sedation. It is an outpatient procedure with the usual one week recovery time.
Myomectomy removes fibroids and repairs the uterus. Can be done through and incision in the abdomen, laparoscopically, or hysteroscopically. 18,000 myomectomies are performed every year. Not a cure and the fibroids may return. 50% of women who had a myomectomy had evidence by ultrasound of recurrence of their fibroids within one year.
Hysterectomy is the only complete cure that involves removing the entire uterus or the womb.
In our center we offer the full range of diagnostic and treatment options. Including surgical and non-surgical treatment and minimally invasive options such as laparoscopic and Hysteroscopic surgeries and uterine artery embolization. Not all procedures are ideal for all therefore contact us for a personal evaluation and treatment plan.
We recognize fibroids as a complicated and debilitating medical problem in women. Our goal is to offer each patient personalized, advanced, and least invasive option, without unnecessarily removing an organ in the treatment of fibroid tumors.
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization (UFE) is a non-surgical procedure that is performed through a needle incision in the groin. It involves having a long, thin tube inserted near the groin into the femoral artery that provides blood to the leg. The catheter is then carefully guided into the blood vessels that supply the uterus under guidance of a special x-ray. Once the blood vessels that feed your fibroids are identified they are blocked using tiny particles that are designed specially for this purpose. Without blood, over the next few months the fibroids shrink, along with their symptoms. 80% of women who have fibroids with symptoms are candidates for UFE. 90% of patients will have resolution of their symptoms by three months after the procedure. The vast majority of patients will be back at work in a week to 10 days. This procedure is outpatient and our centers are designed specially to provide patients with the best experience possible.
In France during mid 1980’s, Jacques Ravina, MD, observed that some of his patients receiving uterine embolization as pre-operative maneuver before myomectomy experienced resolution of their symptoms and canceled their surgeries. Later that year a groupof physicians from UCLA, a gynecologist and an interventional radiologist, initiated the use of UFE as primary treatment for uterine fibroids. It is estimated that more than 100,000 women have undergone this treatment worldwide. Yearly 15,000 to 18,000 cases are performed each year in the United States.
It is estimated that 80% of women who have fibroids with symptoms are candidates for UFE. Patients should be symptomatic with respect to their fibroids. Balk symptoms include pain or urinary frequency, excessive bleeding, or both.
Approximately 90% of patients will have resolution of their heavy bleeding or pelvic pain and pressure. Symptom relief is the goal of the therapy. In three months after UFE patient symptoms are better even though an imaging study will not show the fibroids to be completely resolved. Fibroids will continue to shrink beyond this time, and the patient will continue to improve. Of course, the bigger the fibroid, the longer it will take to shrink and for the patient to achieve symptom relief.
The vast majority of patients will be back at work in a week to 10 days. There are plenty of patients or ready to be back to full activity or nearly full activity in about three to four days, and then there are others we need to weeks. Heavy lifting and deep bending are avoided for a few days after the procedure, as is routine after any arterial puncture.
Myomectomy is the standard of care for fibroid treatment in women who want to preserve fertility. Compared with myomectomy, UFE is superior in terms of durability and relieving bleeding symptoms and sometimes the pain. However it is not quite as effective as myomectomy for relief of pressure symptoms, at least initially: it takes a bit longer to see improvement because volume reduction after UFE is a gradual process, rather than immediate as it is after myomectomy. One drawback of myomectomy is that although their larger fibroids are removed small seed fibroids a left behind and can continue to grow. The recurrence rate of fibroid symptoms after myomectomy is 10% per year, cumulative. Therefore, three years after the procedure, about a third of patients will experience symptoms again, and by 10 years, patients who have not yet entered menopause will haveat least some of their symptoms return. There are no comparable 10-year data for recurrence of symptoms after UFE.
UFE is performed as any otherangiogram. After preparing the skin at the strain local anesthesia, a needle is placed into the femoral artery and then switched for a diagnostic catheter. Fluoroscopy is used to guide the catheter into the uterine artery where tiny round particles are injected directly into the main uterine artery segment; individual fibroids are not injected. There is variety of embolic materials used for this procedure. Also different embolic material is used for women that wish to preserve fertility.
Blood flow carries the particles into the uterus, where they permanently lodge in the small vessels around the fibroids to block the flow of the blood and oxygen to these fibroids. The fibroid choke, shrink, and die, and a body converts them into scar tissue. This process is called hyaline degeneration, and is similar to what occurs naturally after menopause. Fibroids need estrogen as much as oxygen to live; after menopause, they stop receiving any estrogen and turn into scar tissue.
Since the entire uterus is embolized, every fibroid, including seed fibroids, is infarcted. Clinical studies have shown that UFE does not affect the rest of the uterus because there is sufficient collateral blood flow to maintain a healthy myometrium. There are women who have had successful pregnancies after UFE, and most women continue to have menses on a normal schedule after the procedure. That said advisability of UFE in women who desire future fertility currently remains unresolved.
UFE is an outpatient procedure and our centers are designed specially with this procedure in mind. Patients usually return home after resting a few hours while being carefully monitored in our specialty center. Following release, any pain or inflammation can usually be handled with over-the-counter analgesics and prescribed medications.
The most significant complication with UFE is infection, which fortunately is relatively uncommon. About 5% of patients will slough at fibroid. Complications associated with the Artriography itself are about 1 in 1000 to 1 in 500.
Based on 30-day and one-year data, close to 90% of patients responded to UFE during this time. Most patients, particularly those over 30 years of age, experienced durable responses to the treatment. Recurrence of symptoms and repeat procedures occur in about 10% of patients by 3 years, and we predict that about 20% of patients will have another procedure after UFE in five years. These rates are the same as or better than the rate seen with myomectomy.
We tell our patients to take one week off from work or from routine activities. The average recovery time is four days. Almost every patient who was not back to baseline in four to five days is constipated, and this condition is a major factor in the discomfort at that time.
Universally, patients who have had both myomectomy and UFE report that the pain after myomectomy was much greater than after UFE. Intuitively, it is not difficult to understand why this is so. Studies have demonstrated lower pain control requirement for patients recovering from UFE than for those recovering from myomectomy or hysterectomy.
If the symptoms of fibroids, such as prolonged or unusually heavy menstrual periods, abdominal pains, anemia, bladder or bowel issues, become too difficult to ignore, surgical treatment of your fibroids can offer you relief.
Laparoscopy and hysteroscopy are minimally-invasive surgical procedures that can be used to remove certain types of fibroids. They are much less drastic than an abdominal myomectomy and since no reproductive organs are removed, future pregnancies may be possible.
Hysteroscopic removal of fibroids requires no incisions at all, and those whose fibroids can be treated by this method often return to work the next day.
There is very little recovery time or pain for those who have a laparoscopy since the incisions are quite small, only about 5mm or not even a quarter inch long.
Myomectomy is the removal, through surgery, of uterine fibroids. These fibroids, which are very rarely cancerous, can appear either in or on the uterus. While they can often be left untreated, but watched by you and your gynecologist, myomectomy is the term that describes their removal.
There are various forms of myomectomies performed by the gynecologists at FTG:LA, and you and your doctor will decide which one is right for you. A laparoscopic myomectomy is only minimally invasive, but is more suitable for a small number of fibroids that are on the outside of the uterus or that are attached to it by stalks. If your fibroids are within your uterus, a hysteroscopic myomectomy might be considered, and this procedure requires no incisions since it is performed through the cervix.
If a hysterectomy is necessary, it may be possible to have it done through the laparoscope. Those who have had a laparoscopic hysterectomy can sometimes return home the same day and need only a couple weeks to recover.
A more invasive procedure, an abdominal myomectomy, is done through a larger incision in the patient’s belly. This larger opening means a longer recovery time, but it may be the best choice to remove your fibroids.
Myomectomies only involve removal of the fibroids. Since the uterus and other reproductive organs are left intact, pregnancies are possible following the operation.
Laparoscopic myomectomy uses small incisions near the umbilicus and pubic line. This surgery is commonly called band aid surgery since the incisions are so small only a band aid is required to cover them. Instruments are passed through these small incisions and are used to cut and remove the fibroid(s) from the uterus. This procedure, which only highly skilled doctors like those at Fibroid Treatment Group: L.A. can perform, is often done on an outpatient basis, and many women can leave the hospital the same day the operation is performed. Most patients also are able to return to work within a few days.
Laparoscopic myomectomy involves the removal of fibroids through instruments inserted through tiny incisions near the abdomen. One incision, in the navel, is used to insert a slim telescope through which the procedure can be viewed by the doctor performing the laparoscopy. Two other incisions, near the pubic line, are used to gently insert the tools that will perform the operation.
Although the incisions are tiny, laparoscopy is still considered surgery and recovery takes about one week for most women.
Those fibroids that are attached to the uterus by stalks, pedunculated myomas, are great candidates for this procedure, as are subserous myomas, which are close to the surface of the uterus. Submucous fibroids, which are deep in the uterine wall, are the hardest to remove through laparoscopy, and it is not always the best choice if there are a large number of fibroids of any type.
After the fibroid is cut from the uterus, it is trimmed into small pieces that can be removed through the tiny incisions. Following their removal, the uterus is repaired and some women are able to leave the hospital that same day. In other cases an overnight stay is recommended, but it is usually possible to walk later that same day, drive the next week, and return to work the week following that.
While some women have been able to conceive and deliver babies after having a laparoscopy, the ability of the uterus to handle all the stress during a pregnancy is still a factor. While some women are able to conceive and carry a child to birth after having their fibroids removed by laparoscopic treatment, not all can do so. Since studies on this are still uncertain, if future pregnancies are desired you should discuss this with your gynecologist, who may decide on a different treatment option.
Hysteroscopic myomectomy involves inserting a thin telescope through the cervix. While the procedure is normally done to confirm the presence of fibroids, special instruments attached to the hysteroscope can be used to remove them. This procedure is done through the vagina and requires no incisions. It is performed on an outpatient basis and the majority of women may go back to work the next day. It also allows suspicious lesions in the uterus to be biopsied and then removed.
Unlike a laparoscopy, the hysteroscopic myomectomy can only treat submucosal fibroids, or those that are inside the uterus. This procedure does not require any incisions to be made since the small telescope that is used in the procedure, the hysteroscope, passes through the cervix.
Attached to the telescope, which lets the doctor who performs the hysteroscopy monitor the procedure on a monitor, is a wire attachment through which electricity can pass that is used to cut through the fibroid and cauterizes the wound. The entire procedure typically takes less than an hour, and while anesthetic is necessary to reduce discomfort, the woman is able to return home that same day and can usually resume normal activity, including work and exercise, in one or two days.
Pregnancy rates following a hysteroscopy are good, which makes it an excellent choice if your fibroids can be treated by this method.
A hysterectomy is the complete removal of the uterus and should be understood as a major operation. Because the uterus is entirely removed, there is no chance that fibroids will reappear or for future pregnancies, but, as with any operation, there are possibilities for complications. The new techniques we practice may reduce your recovery time to as few as four to six weeks, nearly half the time that was once needed. We have removed many women’s uterine fibroids using all these treatment options and are fully experienced in performing them all. We will always discuss all your options and only recommend the treatment plan that is best for you and your life. The doctors at FTG:LA consider hysterectomies only as the absolute last resort because of these and other life-affirming reasons.
If absolutely necessary, a laparoscopic hysterectomy can be performed, sometimes on an outpatient basis. This procedure is done through tiny incisions in the abdomen and is performed using the laparoscope. Recovery from this procedure is usually quite quick, only a matter of a couple weeks and patients can often return home the same day it is performed.
Hysterectomy is a major operation that the doctors at Fibroid Treatment Group : L.A. consider only as a last resort. It can only be performed in a hospital under general anesthetic and involves the removal of the uterus.