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Fibroids should be treated early. Uterine fibroids will grow, and if left untreated can become very large. The most effective fibroid removal surgery techniques are either a laparoscopic myomectomy for women who wish to maintain fertility, or a laparoscopic hysterectomy for women who are done with childbearing.
Watching and waiting to treat fibroids is an out-of-date practice. Early detection and removal can prevent long-term complications.
The CIGC GYN Laparoscopic Fibroid Surgery Advantage
The Center for Innovative GYN Care® state-of-the-art laparoscopic fibroid surgery techniques make it possible to treat complex conditions using just two small incisions. Recovery from CIGC fibroid removal procedures is just 1-2 weeks.
DualPortGYN® and LAAM-BUAO® (laparoscopic assisted abdominal myomectomy) were developed by the CIGC minimally invasive GYN specialists to improve the outcomes of GYN surgery. DualPortGYN and LAAM® take advantage of advanced surgical techniques that enhance the safety of each procedure.
The CIGC Laparoscopic Gynecologic Techniques
- DRASTICALLY REDUCE SURGERY TIME
TWO SMALL INCISIONS
5 mm incision at the belly button; 1.5 in incision at the pubic bone
RECOVERY IS FAST
Approximately 10-14 days
TRYING TO CONCEIVE
Patients are required to wait a minimum of six months after myomectomy before trying to conceive.
The LAAM myomectomy is an advanced fibroid removal procedure that preserves the uterus. It is performed by the CIGC minimally invasive GYN specialists. A LAAM myomectomy, is performed on women who are able to maintain fertility. This advanced technique uses two small incisions to remove fibroids, large and small. Fibroids are thoroughly removed, and the uterus is then expertly repaired by hand. Even women who have been told they must have an open procedure may be candidates for a LAAM myomectomy. Recovery from LAAM is about 10-14 days.
The DualPortGYN hysterectomy is an advanced laparoscopic procedure that removes the uterus and all fibroids. A hysterectomy is a cure for fibroids, and is a good option for women who are prone to recurring fibroids, and who no longer wish to or are no longer able to conceive. The DualPortGYN minimally invasive hysterectomy approach used at CIGC allows women to recover in about one week.
Fibroid Symptoms Can Lead To Additional Conditions
Heavy Bleeding From Fibroids Can Cause Anemia
Anemia can leave women feeling fatigued, light headed, and in severe cases can affect the cardiovascular system. When some fibroids grow, they can create more surface area in the uterus, which can lead to more volume during the menstrual cycle. Women who suffer from anemia may need blood or iron transfusions.
Fibroids Can Block Fallopian Tubes
Blockage of the tube can result in the eggs not being fertilized. Conversely, fertilized eggs may not reach the uterus. If a fertilized egg cannot reach the uterus, it can result in an ectopic pregnancy which can become very dangerous and must be treated immediately.
Fibroids That Grow In The Lining Of The Uterus Can Prevent An Embryo From Attaching.
Pregnancy can only occur if an embryo can implant on the endometrial lining, with the placenta developing and obtaining blood supply from the uterine muscle. Fibroids can compete with an embryo for blood supply.
Problems during pregnancy can include:
- Placental abruption – detachment of the placenta, causing bleeding and loss of pregnancy.
- Abnormal growth of the pregnancy – development of the fetus can be compromised by improper blood flow due to a fibroid, or a large mass may prevent the fetus from reaching full birth weight.
- Pre-term labor and birth – contractions and early labor can be caused by the fibroid tumor prohibiting the growth of the fetus. Early labor may lead to an early delivery of the baby and possible developmental problems.
It is not advised to delay treatment for fibroids. Many women are told by their OBGYNs or general practitioners that they can watch and wait, but delaying fibroid removal can lead to complications.
Large fibroids can create blockages to the delicate structures in the pelvic cavity. Damage to kidneys and impact on circulation can be the result of growing fibroids. Fibroids can press on the ureters, bladder and kidneys. Pressure on the urinary tract can cause either a need to urinate frequently, or block the movement of urine. Distention and dilation of the kidneys can cause permanent damage.
Pressure from fibroids on veins can cause varicosities, leg swelling (edema), and dangerous blood clots that can travel to lungs, creating a potentially fatal pulmonary embolism.
LAAM Minimally Invasive Fibroid Removal for Fertility – An Advanced Laparoscopic Myomectomy
The CIGC state-of-the-art LAAM procedure is one of the most advanced fibroid removal techniques available for maintaining fertility. This procedure is only performed on women who are able to maintain fertility.
- Women age 45 and younger with fibroids who are able to maintain fertility.
- A woman’s age is the single most important factor affecting her fertility. Fertility decreases exponentially after 40. (Age 40, the chance of conceiving is about 5%. At age 43-44 the chance of conceiving with IVF is 1%.)
- A myomectomy is not recommended for women who are unable to maintain fertility or who are no longer interested in childbearing.
- There is a higher risk of a patient needing future surgery after a myomectomy, exposing them to additional anesthesia, additional recovery time.
- If childbearing is no longer possible or desired, a hysterectomy for fibroids is a cure, eliminating the need for future surgery.
- Women with fibroids who have pre-arranged for a donor egg or IVF options.
- Depending on the viability of the uterus, it is possible for some women over the age of 45 to conceive with IVF or with donor eggs.
- These arrangements must be made and confirmed prior to consulting with a CIGC surgeon.
LAAM makes it possible to remove small and large fibroids while preserving the uterus using just two small incisions. LAAM is a hybrid technique that combines the best of laparoscopic and open myomectomy procedures. The incisions are small (one 5 mm incision at the belly button, and one 3 cm incision at the bikini line) and the fibroids are thoroughly removed.
The combined techniques retroperitoneal dissection, uterine artery ligation/occlusion, and strategically placed incisions set LAAM apart from all other fibroid removal techniques. The CIGC specialists use these advanced techniques to ensure a safe, thorough and effective procedure, and recovery is fast. Most patients can return to normal activity, including work and school, in about 10-14 days. All patients should follow the recovery recommendations specified by their surgeon.
- The smaller incisions help with faster healing, compared to open or robotic procedures that have longer recovery times. Robotic procedures can take up to 4 weeks for recovery. Open procedures can take up to two months for recovery.
- The lower incision allows the surgeon to feel all of the fibroids in the uterus for a thorough procedure. It is important to remove all of the fibroids from the uterus. If fibroids are left behind, they can grow and continue to cause problems, which may result in the patient needing additional procedures.
LAAM techniques outperform other standard laparoscopic techniques. Non-LAAM laparoscopic myomectomy procedures can leave fibroids behind, either because they are small and missed by the surgeon, or because blood loss is not well controlled and the procedure has to be stopped for the safety of the patient. Open procedures can cause long painful recoveries, and create extensive pelvic adhesions. Myomectomy procedures that do not use RP Dissection or complications Uterine Artery Ligation have higher risks of complications.
NOTE: LAAM minimally invasive myomectomy is performed on women who are able to maintain fertility. When fertility is no longer a viable option (1% or less), and fibroids interfere with day-to-day activities, a myomectomy is not recommended due to the potential for the need for future surgery. With any myomectomy procedure, fibroids can return. Performing fibroid removal alone (a myomectomy), versus removing the uterus (hysterectomy), when fertility is no longer possible increases the risks to the patient. Women 45 or over, unless they have arranged to have a donor egg prior to having fibroid removal, should consider the benefits of a hysterectomy to ensure fibroids do not grow back.
Two small incicions
5 mm incision at the belly button; 1.5 in incision at the pubic bone
Approximately 10-14 days
Trying To Conceive
Patients are required to wait a minimum of six months after myomectomy before trying to conceive. The layers of the uterus must heal properly. This is essential for ensuring a safe pregnancy. All patients should follow the recovery recommendations specified by their surgeon.
DualPortGYN Minimally Invasive Hysterectomy – An Advanced Laparoscopic Hysterectomy
Hysterectomy is the procedure that removes the uterus, and in many cases, the cervix and fallopian tubes. (For many woman, it is possible to retain their ovaries, which can prevent them from experiencing surgical menopause). Hysterectomy is a cure for fibroids. Once the uterus is removed, fibroids cannot return.
The state-of-the-art techniques used in the DualPortGYN hysterectomy create a safer procedure so that women can have surgery and return home the same day. The CIGC minimally invasive specialists are able to perform complex surgeries while ensuring the patient has an exceptional procedure with fast recovery. After a DualPortGYN minimally invasive hysterectomy, Most patients can return to normal activity, including work and school, in about 1 week. All patients should follow the recovery recommendations specifed by their surgeon.
Two 5 MM Incisions
One at the belly button
One at the pubic bone
Approximately 1 week
A Safer Minimally Invasive GYN Surgery
Advanced Laparoscopic Fibroid Removal Techniques Make It Possible To Return Home The Same Day & Recover Faster
- Return home same day
- Less pain
At CIGC, controlling blood loss and improving visibility makes it possible for our advanced laparoscopic GYN specialists to perform minimally invasive outpatient surgery for complex fibroid conditions that may normally be performed as open procedures by non-laparoscopic surgeons.
The incisions used for the CIGC surgeries are very small, and placed in the midline, away from the abdominal muscles. The size and placement of these incisions allows patients to feel better faster.
A LAAM myomectomy is designed to preserve fertility for women who are able to have children.
Myomectomy is a more invasive procedure than a hysterectomy, and is not recommended for women who no longer are able to have children.* (This includes women who are no longer interested in child bearing, as well as women who are unable to have children, or who are menopausal). Discuss your plans for fertility with your doctor, and make sure you are both on the same page before proceeding with surgery.
If preserving fertility is possible, a myomectomy is appropriate. If fertility is no longer an option, and fibroids are recurring, a hysterectomy may be a better solution.
Many women believe a myomectomy is a less painful procedure than a hysterectomy. In most patients, fibroids grow in the muscle of the uterus. Rarely are fibroids “pedunculated” or on stalks – these types of fibroids are more easily removed. Fibroids that are in the muscle (also known as “intramural”), on the outside (“serosal”), or in the cavity (“submucosal”) require an incision(s) in the uterus for removal. Myomectomy incision may need to be deep in the muscle to remove the tumor, and often requires a longer healing time due to the repairs needed within the uterus. In addition, the fibroids need to be removed through the abdominal wall in a myomectomy, which increases the size of the incisions and leads to increased pain, even with a laparoscopic procedure.
*A WOMAN’S AGE IS THE SINGLE MOST IMPORTANT FACTOR AFFECTING HER FERTILITY.
Rates of fertility decrease as a woman reaches her mid-30s, and women who conceive later are at a greater risk of pregnancy complications. Women in their late 30s are approximately 40 percent less fertile than women in their early 20s.
However, once a woman is in her 40s, rates of fertility decrease exponentially. Ovarian reserve is diminished, and the lower quality of the eggs affects the quality of the potential embryo, leading to high rates of complications, including miscarriage.
- At age 40, fertility has fallen by half. (At age 30, the chance of conceiving each month is about 20%; At age 40, the chance of conceiving is about 5%.)
- At age 43-44, women have a 1% chance of getting pregnant with IVF. The integrity of the eggs and the embryos that form are 80% more likely to have chromosomal abnormalities.
- Without IVF, women aged 43-44 have less than 1% chance of getting pregnant.
Why This Matters For Fibroid Removal
Performing fibroid removal alone (myomectomy), versus removing the uterus (hysterectomy), when fertility is no longer possible increases risks to the patient. Myomectomy is more invasive, results in larger incisions and more pain, and may lead to additional surgery to either remove fibroids or the uterus in the future due to fibroid recurrence.
A DualPortGYN hysterectomy at CIGC has a faster recovery than other laparoscopic or open hysterectomy procedures. This surgery also has a faster recovery than any myomectomy procedure, and the recovery from DualPortGYN is less painful.
Frequently Asked Fibroid Treatment Questions
A woman’s age is the single most important factor affecting her fertility. Rates of fertility decrease as a woman reaches her mid-30s, and women who conceive later are at a greater risk of pregnancy complications. Women in their late 30s are approximately 40% less fertile than women in their early 20s. However, once a woman is in her 40s, rates of fertility decrease exponentially. Ovarian reserve is diminished, and the lower quality of the eggs affects the quality of the potential embryo, leading to high rates of complications, including miscarriage.
At age 40, fertility has fallen by half. (At age 30, the chance of conceiving each month is about 20%; At age 40, the chance of conceiving is about 5%.) At age 43-44, women have a 1% chance of getting pregnant with IVF. The integrity of the eggs, and the embryos that form are 80% likely to have chromosomal abnormalities. Without IVF, women aged 43-44 have less than 1% chance of getting pregnant.
A Woman’s Age Matters For Fibroid Removal Surgery
When fertility is no longer a viable option (1% or less), and fibroids are controlling your life, a myomectomy is not recommended. Performing fibroid removal alone (a myomectomy), versus removing the uterus (hysterectomy), when fertility is no longer possible increases the risks to the patient. Women 45 or over, unless they have arranged to have a donor egg prior to having fibroid removal, should consider the benefits of a hysterectomy to ensure fibroids do not grow back.
A DualPortGYN hysterectomy at CIGC has a rapid recovery of about 1 week and the recovery is less painful. A hysterectomy does not have to mean early menopause. The hormones that make estrogen are not affected by the removal of the uterus. If the ovaries are healthy, they can be left intact.
A LAAM myomectomy can accommodate fibroids both small and large for women who can maintain fertility, as long as the uterus can be reconstructed. Our experienced laparoscopic specialists determine if a patient is a candidate for this surgery. For many patients, if the uterus is too damaged, or fertility potential is extremely low, LAAM is not recommended.
Fibroids are non-cancerous growths (tumors) that occur from the muscle of the womb. The womb is also called the uterus. Fibroids are “fibrous” tough masses that require estrogen and progesterone – the female hormones – for growth.
Where Are Fibroids In My Uterus?
Fibroids can occur anywhere in the uterus, and are named for their location. Cervical growths are rare. Most develop from the muscle of the uterus, the myometrium. Fibroid tumors are named for their location.
- Serosal – These develop on the outside of the uterus, and involve the serosal lining.
- Pedunculated – These develop on stalks outside of the uterus.
- Intramural – These develop within the uterine muscle.
- Submucosal – These involve the endometrial lining.
How Common Are Fibroids?
Eighty percent of women have fibroids in their womb, with 12% to 25% having problems from them such as heavy bleeding and pain. It is the most common GYN condition in women.
African-American women have fibroids two to three times more than Caucasian or Hispanic women. African American women can develop fibroid problems at an earlier age. They have a much higher chance of fibroids growing larger and causing more problems than fibroids in Caucasian women. Symptoms include heavier bleeding that can lead to anemia, and infertility. See the full list of symptoms below.
What Are Fibroid Symptoms?
- Heavy bleeding and clots with the menstrual cycle resulting in anemia (low blood count) and tiredness
- Severe pain with the menstrual cycle
- Frequent urination
- Pain in the legs and back, pelvic pressure, swelling of the abdomen, pain with intercourse
- Clots in the legs and pelvis
How Can Fibroids Affect Fertility?
Submucosal growths can cause infertility by preventing implantation. Implantation occurs when the embryo (the egg and the sperm combined) attaches to the endometrial lining, with the placenta developing and obtaining blood supply from the uterine muscle.
Submucosal growths can prevent implantation, and can cause problems with conception (the ability to become pregnant) or can result in miscarriage (loss of the pregnancy). Intramural fibroids (in the muscle) can also prevent conception. Tumors can also obstruct the fallopian tubes, resulting in difficulty in becoming pregnant. Blockage of the tube will not allow the embryo to pass into the uterine cavity, and implant on the endometrial lining.
Problems during pregnancy can include:
- Placental abruption – detachment of the placenta, causing bleeding and loss of pregnancy.
- Abnormal growth of the pregnancy – if blood flow is compromised or a growth is very large that can prevent the baby from growing properly.
- Pre-term labor and birth – preventing normal growth leading to contractions and early labor. Early labor may lead to an early delivery of the baby and possible developmental problems.
Does The Fibroid Location Cause Different Types Of Symptoms?
Yes. Fibroid location is important in understanding how fibroids cause problems.
HEAVY BLEEDING: Submucosal growths can cause severe bleeding, even if they are small, by increasing the area of the lining, and also increase menstrual flow and decrease the normal ability of the lining to stop the bleeding.
Intramural fibroids that are larger or close to the cavity will increase blood flow to the uterus and affect the normal systems that control bleeding in the uterus. These will also increase the size of the cavity of the uterus, thereby increasing bleeding.
BLEEDING AND PAIN: Fibroids that increase bleeding into the cavity of the uterus, such as submucosal and intramural, result in the formation of clots in the cavity. Pain is caused by distension of the cavity and passage of the clots. Many patients pass very large clots and have extreme pain with their menstrual cycle due to clot formation.
PAIN AND PRESSURE: Larger intramural and serosal tumors increase pain with the menstrual cycle, and can also “degenerate”, or lose their blood supply, causing severe pain. Subserosal growths can also take up space and push against other structures like the spine and pelvis causing pelvic pressure and pain, and pain to the back. Pedunculated fibroids often lose their blood supply and degenerate. These can also twist on themselves, causing very severe pain.
FREQUENT URINATION: Intramural and subserosal fibroids can increase the size of the uterus, which can press on the bladder. The bladder cannot fill to its capacity, and empties more frequently. Growths in the back of the uterus cause this problem frequently by pushing the uterus toward the front and compressing the bladder, and also can cause back pain.
CONSTIPATION: Constipation is a less common symptom, which results from large fibroids in the back of the uterus that can obstruct or block the rectum, leading to back up of stool and constipation. Many patients have alternating bouts of constipation and diarrhea. This is the result of growths blocking the passage of stool, which then “sits” in the rectum. The function of the rectum is to absorb water from the stool. The longer the stool sits, the more water is absorbed, and the result is hard stools that do not pass, causing constipation. Diarrhea occurs when the pressure in the rectum builds to a point that exceeds the blockage. The result is passage of loose stool beyond the blockage point, causing diarrhea.
PAIN WITH INTERCOURSE: Pain with intercourse, also caused dysmenorrhea, can occur from fibroids at the front or top of the uterus. This is an unusual symptom, but it can occur.
LESS COMMON SYMPTOMS
CLOTS IN THE PELVIS AND THE LEGS: Very large fibroids pressing on the sides of the pelvis can block the large veins draining blood from the legs. This results in slow movement of blood in the veins, also called “stasis”, which results in clots. Clots cause swelling to the legs, and also can result in clots breaking off and passing to the lungs. This is called a pulmonary (lung) embolism (clot) and can be life-threatening.
OBSTRUCTION OF THE URETERS: Very large fibroids pressing on the side of the pelvis can also cause partial blockage of urine from the ureters. The ureters are the tubes that allow urine to flow from the kidney to the bladder in the pelvis. This can result in hydronephrosis (hydro = water, nephrosis = kidney), or swelling of the kidney due to accumulation of urine in the kidney. Usually this is mild, and does not compromise kidney function. In more severe cases, back pain can occur as well as loss of function to the kidney over time.
PROLAPSE OF CERVICAL FIBROIDS: Passage of fibroids from the cervix or cavity can cause bleeding, pain, and infection. These are generally rare and are treated with vaginal removal.
How Are Fibroids Diagnosed?
Ultrasound is a simple, inexpensive, and very effective method for diagnosing the size, number, and location of fibroids, and is very well tolerated by the patient. MRI, or Magnetic Resonance Imaging, is usually not needed, but can provide more information about the specific location of growths and rule out adenomyosis. CT scans, or Computed Tomography, are not helpful, and should not be performed. Pelvic exams may be helpful, but are very limited in their ability to identify the size, number, and location. Pelvic exams can also confuse pelvic masses with fibroids, and have significant limitations in patients with prior surgery, other GYN conditions such as endometriosis, and in heavier patients. Pelvic exams can also be painful both during and after exams.
ULTRASOUND OR SONOGRAM: Ultrasounds are easy to perform with minimal pain. Abdominal ultrasounds examine fibroids from the abdomen, whereas transvaginal ultrasounds examine the fibroids through the vagina. Transvaginal sonograms are very effective since the ultrasound device is directly placed on the uterus through the vagina.
Ultrasounds can easily see the number, location, and size of the fibroids. They are cost-effective, and should be used to follow growths that are enlarging or causing symptoms.
Saline sonograms use saline, or salt water, in the uterine cavity at the time of the ultrasound. This increases the ability of the sonogram to evaluate fibroids in or near the cavity of the uterus, and helps to see other structures in the cavity that may be missed by a regular ultrasound, such as growths in the cavity.
MRI [MAGNETIC RESONANCE IMAGING]: MRI, or Magnetic Resonance Imaging, is an expensive technique for imaging fibroids. Although it is more sensitive than an ultrasound, it is not necessary for the majority of patients with fibroids.
Indications for MRI:
Adenomyosis: MRI is helpful in identifying adenomyosis. Adenomyosis occurs when the endometrial lining of the uterus grows into the muscle. Pa-tients with this condition have bleeding into the muscle with every menstrual cycle, which can cause severe pain and heavy bleeding. Extensive adenomyosis can result in the formation of an “adenomyoma’, or collection of adenomyosis, which an ultrasound sometimes detects as a fibroid. Adenomyomas should not be removed, since the removal of an adenomyoma also results in the removal of a portion of the muscle of the uterus.
Embolization MRI is usually indicated when embolization procedures are being considered. MRI will help to determine planning for embolization and the potential success of the procedure.
OFFICE HYSTEROSCOPY: Hysteroscopy is used to evaluate the uterine cavity. There are better, less expensive options. Saline sonograms can provide similar information. Office hysteroscopy has become more popular with OBGYNs as a procedure that is easily performed in the office. Growths that are identified in an office visit usually cannot be removed, and most patients will require an operating visit for treatment. The result is a second surgical procedure for the patient, and two billable procedures for the surgeon. For this reason, office hysteroscopy is not recommended routinely for evaluation of fibroids in the uterine cavity.
HSG: HSG, or hystero (uterus) salpingo (tubes) gram, is an evaluation of the uterine cavity and the tubes, using dye passed into the uterus through the cervix that is radio-opaque. Radio-opaque means the dye can be seen with fluoroscopy – a radiological test that shows the dye passing through the uterus and the tubes. It is mostly used to ensure that the fallopian tubes are open. Although it can identify fibroids, polyps, or scarring in the cavity, it is generally not used for diagnosing fibroids.
How Can Fibroids Be Treated?
COMPARING FIBROID TREATMENTS
It is essential that all CIGC patients are well informed about the landscape of fibroid treatment options, and understand why we advocate for surgical intervention over other techniques. Understanding the benefits and risks of all types of treatments can help each patient choose the safest fibroid removal option.
Treatment options for fibroids is either surgical, medical, or radiological. The CIGC surgical approach to fibroid removal is unparalleled.
For any surgery to be performed, there needs to be an “indication”, or a reason for the procedure. Indications for fibroid removal surgery may include any of the following:
- Symptoms such as bleeding, pain, pressure, frequent urination
- Increasing abdominal girth due to enlarged uterus
- Failed medical or radiologic treatment
- Return of fibroids after prior surgical treatment
There are two surgical treatment options for fibroids:
Myomectomy — removal of fibroids only. (Many women are candidates for myomectomy for fertility. However, some fibroids can cause too much damage to the uterus for a secure repair for childbearing. Myomectomy is not a safe option for women who are past childbearing.)
Hysterectomy — removal of uterus and fibroids. (Hysterectomy is a cure for fibroids.)
Medical therapy means treatment without surgery or radiological procedures. Medical therapy is limited, and often not helpful for most patients with bleeding, pain, and growth of the fibroids continuing over the long term. Medical therapy may help to decrease the bleeding associated with fibroids over the short term. Estrogen and progesterone encourages growth. Types of medical therapy may include hormones that block the effect of estrogen or progesterone, or reduce or eliminate the production of these hormones from the ovaries.
Oral Contraceptives: Oral contraceptives, or birth control pills, are not helpful in the treatment of fibroids, but may decrease bleeding in some patients. Birth control pills do not decrease the size or number of growths. It is thought that birth control pills may treat other problems causing bleeding in those patients with fibroids. This explains why bleeding is decreased in some patients who use birth control pills.
Progesterone: Progesterone is the anti-estrogen, and may help decrease the bleeding caused by fibroids by causing “atrophy”, or thinning of the uterine lining. Progesterone can be given as a pill or an injection. Progesterone does not decrease the growth of fibroids.
Lupron: Lupron is a temporary and effective medical therapy for fibroids. This drug blocks the production of both estrogen and progesterone. For most patients, this means bleeding slows down or stops, the growths shrink, and blood counts increase. Lupron cannot be prescribed for more than a year, and the side effects often limits its use. When the Lupron is stopped, the tumors will regrow and the symptoms will recure.
Lupron Side Effects: Hot flashes, mood swings, anxiety, depression, sleep problems, vaginal dryness, muscle and joint pain, osteoporosis (loss of bone mass). Patients will lose up to six percent of their bone mass when using Lupron for one year, with only half of this regained after the Lupron is stopped. Lupron is not used over the long term due to the above side effects and osteoporosis. Since the tumors regrow when Lupron is stopped, the only real use is before surgery to stop bleeding and treat anemia, or low blood counts, if necessary. Iron supplements will also increase blood counts, are much cheaper, and have far fewer side effects.
NSAIDS: There are Non-Steroidal Anti-Inflammatory Drugs such as ibuprofen (Motrin) or acetaminophen (Tylenol) that can decrease the pain, but will not affect growth.
Danazol: This is a male type steroid (androgenic = male, estrogenic = female) that stops the production of estrogen, causing a decrease in menstrual periods and bleeding. It does not decrease tumor growth, and has many side effects limiting its use.
NON-FDA APPROVED DRUGS
Mifepristone: This is the drug RU-486, used to medically terminate pregnancies. It has been shown to decrease the size and bleeding from fibroids at lower doses of five to 50 mg per day over a six-month period. These doses are not available in the US.
Ulipristal: This affects progesterone receptors, does not affect estrogen levels, and can decrease bleeding and the size of the fibroids without causing the negative side effects of Lupron. Most patients ultimately need surgery, and there may be an increased risk of precancerous or cancerous conditions of the uterus.
Aromatase Inhibitors: These drugs block the enzyme that converts male type hormones in the body to the female hormone estrogen. By decreasing the production of estrogen, these drugs have been shown to shrink fibroids and decrease the symptoms of fibroids. Further studies are needed to determine if these drugs are helpful in the treatment of fibroids.
Treatment of fibroids through radiology refers to locating the growths to be treated in the uterus by some type of radiological test, and then treating the fibroid either through Embolization or blockage of its blood supply, ultrasound waves, or through other methods.
UTERINE ARTERY EMBOLIZATION & UTERINE FIBROIDS EMBOLIZATION (UAE & UFE)
UAE or UFE relies on blocking the blood supply either to the uterine artery or to the fibroid. This approach uses plastic particles or some other method to eliminate blood flow to the tumor. Using fluoroscopy – a radiological test that uses dye to locate the uterine artery – a needle is inserted into the large artery of the groin. A small plastic tube is then inserted through the needle, and the blood supply to the uterus and fibroids is located. Small plastic particles or “beads” are then inserted into the blood supply of the fibroid, blocking the supply. This causes “necrosis” or death of the fibroid. Since there are two uterine arteries – one on each side of the uterus – both arteries need to undergo UAE to achieve the best results.
- Women who want to become pregnant should not consider UAE as an option. UAE can cause problems with miscarriage, placental problems (the placenta feeds the baby), and pre-term delivery. It has been noted that the rates of becoming pregnant are higher in patients who had myomectomy (surgical removal of fibroids) rather than embolization.
- Patients with adenomyosis have much poorer success rates with UAE. UAE is not helpful in the treatment of adenomyosis, with hysterectomy being the best option for these patients.
- Large fibroids are not as well-treated with UAE as with myomectomy. Larger growths may have multiple blood supplies and larger-sized vessels that cannot be completely treated with UAE procedures. They have a much higher chance of continued or regrowth after UAE treatment.
- Submucosal fibroids can detach from the uterine wall, and then pass out through the vagina or require removal if they are larger in size. Passage can happen up to a year or longer after the procedure, and can be associated with foul smelling discharge or severe pain.
- Pedunculated fibroids are not treated very well with UAE. Higher complications are seen when UAE is conducted on these types of fibroids, including twisting of the fibroid and pain, separation of the fibroid from the uterus and others.
- UAE should never be conducted on any patient that may have a precancer or cancer of the uterus. This includes uterine and cervical cancer, as well as overgrowth of the uterine lining called hyperplasia. Pap smears to check for cervical cancer, and uterine biopsy or D&C should be done for those patients in which cancer may be an issue.
What Can I Expect In The First Two Weeks After The Procedure?
Almost all women after UAE will have pain. This is due to loss of blood supply to the uterus and the fibroids, and can be mild to very severe. All patients are usually admitted to the hospital after UAE with a morphine pump, or PCA (patient-controlled analgesia) to control the pain.
Post-UAE Syndrome includes pain, cramping, nausea, vomiting, fever, tiredness, body aches. Most of these problems occur within the first two days of the procedure, and will decrease over the next seven days.
What Complications Can Occur After UAE/UFE?
Loss of ovarian function is the most common complication. Decreased ovarian blood supply and menopause can occur after UAE due to movement of some of the particles into the blood supply of the ovaries. This happens more often in those patients who are greater than 45 years of age (up to 10 percent), and less often in those patients less than 45 (three percent).
Other less common complications include:
- Fever in up to 4% of patients;
- Passage of a fibroid through the vagina in up to 5% of patients;
- Readmission to the hospital in up to 3.5% of patients;
- Need for surgery in 2.5% of patients;
- Allergic reaction in 2.5% of patients; or
- Bleeding and life-threatening event in up to 1% of patients.
SHORT TERM: Short-term data is much better than long-term data. The most reliable information comes from the Society of Interventional Radiology on over 1,200 patients. Three years after UAE the following results were reported:
- 95% with improvement in symptoms and quality of life;
- 29% with no bleeding reported after the procedure; and
- Surgery was required for 14.4% of patients after UAE, either with hysterectomy, removal of the fibroids, or repeated UAE.
LONG TERM: Results more than 5 years after UAE show 20% of patients requiring a surgical procedure to control fibroid symptoms, including hysterectomy, myomectomy or repeated UAE. This means that UAE was unsuccessful in one-fifth of the patients, and recurrence of bleeding, pain, or other symptoms due to enlargement or growth of new fibroids required surgical removal due to failure of the UAE procedure.
In this non-surgical procedure, MRI – Magnetic Resonance Imaging – is used to identify fibroids in the uterus, and then ultrasound waves are focused on the tumor to destroy it. This procedure cannot be used on patients who want to become pregnant, or for adenomyosis. It is not effective for larger growths, for more than five fibroids in the uterus, or for fibroids that have decreased blood supply. Although some reports are encouraging for this procedure, it takes multiple treatment visits, is expensive, and cannot be used if other organs such as the bowel are in front of the growths, since damage can result.
RADIOFREQUENCY ABLATION (RFA)
Also called myolysis, this is destruction of tissue using heat or freezing. A new procedure using radio waves has been introduced, but also has limited use and effectiveness for multiple or larger fibroids.