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FIBROIDS Treatment Options
FIBROID Treatment Options

Fibroid Treatment Options

Treatment options for uterine fibroids can be surgical, medical, or radiological. The recommended treatment is based on a patient’s specific condition, symptoms, and future fertility goals.

Some physicians may direct patients to “watch and wait” to see if uterine fibroids worsen. But delaying treatment will almost certainly result in more severe symptoms, larger fibroids and a higher risk of complications with pregnancy and uterine inflammation and damage. Removal of many fibroids or large fibroids can result in scarring to the uterine, and can lead to abnormal healing. Patients should not wait until just before pregnancy to remove uterine fibroids, as this can lead to complications in healing and infertility.

Surgical Treatment Options

Before any type of surgery is performed, there needs to be an indication or reason for the procedure. Common indications for fibroid removal surgery may include:

  • Symptoms such as bleeding, pain, pressure and/or frequent urination
  • Infertility
  • Bloating and distension
  • Failed medical or radiological treatment
  • Return of fibroids after prior surgical treatment

Fibroids of all sizes can cause serious problems depending on where they are located, there is no minimum or maximum size of fibroid for surgically removal.

Myomectomy

Myomectomy refers to the removal of myomas (uterine fibroids) from the uterus. This procedure keeps the uterus in place, and is the procedure of choice for patients who wish to preserve their future fertility options. Removing fibroids from the uterus greatly enhances fertility. The uterine size returns to normal; fertility is enhanced by allowing for normal implantation of the embryo and growth of the baby, and

pregnancy is better tolerated. However, a myomectomy does not guarantee the uterus will be able to carry a full-term pregnancy. Removal of very large fibroids, or many fibroids from the uterus, may cause too much damage to the uterus to allow it to be fully repaired during surgery. Because a myomectomy is not always the most effective option for women who are past childbearing, a hysterectomy or other options should be considered.

Myomectomy Surgical Options

The Center for Innovative GYN (CIGC) care uses exclusively the LAAM® myomectomy procedure. This is a laparoscopic – or minimally invasive – fibroid removal procedure that uses only two small incisions to remove fibroids, both large and small, while keeping the uterus intact.

CIGC does not use open, robotic, or standard laparoscopic approaches for the removal of fibroids. These types of procedures are generally more invasive, require longer surgical and recovery times, are associated with more pain, have higher complication rates, and often do not remove all the fibroids present. (reference)

Hysterectomy

Hysterectomy refers to the removal of the uterus. There are three main types of hysterectomy procedures.

  • Partial hysterectomy is removal of the uterus, cervix, and fallopian tubes. Fallopian tubes should always be removed with the uterus, since this will decrease the risk of tubal cancer. Partial hysterectomy procedures do not remove the ovaries, and patients will not go into menopause with this procedure since estrogen production is continued from the ovaries.
  • Complete hysterectomy is removal of the uterus, cervix, fallopian tubes and ovaries. Since the ovaries are being removed, complete hysterectomy will result in menopause. The ovaries produce estrogen, and without estrogen menopause will occur.
  • Supracervical hysterectomy can be complete or partial and keeps the cervix intact.

The only method to prevent recurrence of fibroids is a hysterectomy. There is no other invasive or noninvasive method that prevents fibroid growth. This is the recommended option for women who are prone to recurring fibroids and who no longer wish to, or are able to, conceive.

Learn more about hysterectomy types.

Hysterectomy Surgical Options

The Center for Innovative GYN Care uses exclusively the DualPortGYN procedure. This is a laparoscopic, or minimally invasive, surgical procedure for hysterectomy. DualportGYN is a very safe advanced procedure that can be used to remove any size fibroid in the uterus. It also has the advantage of using “retroperitoneal” techniques to increase safety, dramatically decrease complications, minimize pain, and allow for recovery back to work in one week.

CIGC does NOT use robotic, standard laparoscopic, or open surgical procedures to remove the uterus. These types of procedures are generally more invasive, require longer surgical and recovery times, are associated with more pain, and have higher complication rates.

Laparotomy

A laparotomy is another name for an open surgical procedure used for myomectomy or hysterectomy. Laparotomy is commonly used for myomectomy in many patients, and frequently used for hysterectomy as well.

CIGC does not use laparotomy for the performance of hysterectomy or myomectomy surgery.
It is an invasive procedure with a large incision resulting in significant pain, a long recovery of eight weeks, higher complications, and requires hospitalization.

Endometrial Ablation

Endometrial ablation is a surgical procedure used to treat heavy or abnormal bleeding by destroying the thin layer of the uterine cavity – the endometrial lining. Ablation procedures are best suited to those patients with a normal uterus, and generally do not work well in patients with uterine fibroids. This procedure should never be used for patients who desire fertility, as it will prevent implantation of the embryo into the uterine lining to allow for growth of the pregnancy.

Radiological Treatment Options

Radiological treatment of fibroids refers to locating the growths to be treated in the uterus by radiological tests, and then treating the fibroid through:

  • Embolization or blockage of each fibroid’s blood supply
  • Ultrasound waves or MRI-guided ultrasound
  • Radiofrequency Ablation (Acessa)

It’s important to note that fibroids are not removed with radiological procedures. Radiological fibroid treatment may lead to the “death” of fibroids in the body and can cause severe pain. “Bulk” symptoms – usually due to enlarged fibroids pressing on other organs – are not resolved quickly or at all with embolization. Examples of bulk symptoms include:

  • Bladder pressure causing frequency of urination
  • Pelvic pressure against the back and lower pelvis causing back and pelvic pain
  • Abdominal pressure against the bowel and abdominal wall causing abdominal bloating, pain, and distension.

After embolization and other radiological treatments, these symptoms may take months or years to fully subside. In many cases of patients with larger fibroids, these symptoms do not resolve at all. Fibroids left in the body, while they may no longer be growing, can also lead to long-term abnormal vaginal discharge and other complications.

Be sure to discuss these options for treatment with a fibroid specialist to fully understand what the best method for your individual case is. In many cases, the minimally invasive DualPortGYN and LAAM procedures for fibroid removal are more effective options compared to radiological approaches since the fibroids are removed. In contrast to radiological procedures, DualPort and LAAM procedures provide relief from these symptoms immediately, there is no hospitalization, pain is often much less, recovery is faster, and bleeding is controlled after surgery.

Radiological Treatment Options and Fertility


Fertility Patients: Embolization and all forms of radiological fibroid treatments, such as MRI-guided ultrasound and Acessa, are not recommended for patients interested in fertility. These treatments can damage the uterine muscle and the ability for the uterus to support a full-term pregnancy. They also will not remove fibroids that are in or near the uterine cavity, which most often contribute to infertility. Because the risk of miscarriage and other pregnancy complications is significantly higher with these procedures, a minimally invasive myomectomy (surgical removal of fibroids) is the recommended treatment for patients desiring pregnancy at any point in the future.

Non-Fertility Patients: For patients with larger fibroids, and who are not interested in fertility, any of these forms of radiological treatment are limited in their ability to control the growth of larger or multiple fibroids. They also do not prevent the growth of new fibroids.

Uterine Fibroid Embolization

Uterine Artery Embolization (UAE) and Uterine Fibroid Embolization (UFE) rely 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 radiation and dye to locate the uterine artery — a needle and tube are inserted into the large artery of the groin. Small plastic particles or “beads” are then inserted into the blood supply of the fibroid, blocking it. This causes necrosis, or death of the fibroid. Because there are two uterine arteries — one on each side of the uterus — both arteries need to undergo UAE to achieve optimum results.6 As stated above, this treatment method is not recommended for fertility patients. UAE should not be used for patients with adenomyosis, a pelvic mass, endometriosis, or other conditions that are treatable with decreasing the blood supply to the uterus or fibroids.

MRI-Guided Ultrasound

In this nonsurgical procedure, magnetic resonance imaging (MRI) is used to identify fibroids in the uterus, and then ultrasound waves are focused on each tumor to destroy it. This procedure cannot be used on patients who want to become pregnant, or for the treatment of adenomyosis. It is not effective for larger growths, for multiple fibroids in the uterus or for fibroids that have a 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, because the treatment can damage other vital organs.

Radiofrequency Ablation (Acessa)

Radiofrequency ablation (also known as the Acessa Procedure) is a fibroid treatment technique that aims to cut off the blood supply to each fibroid to stop their growth. While this technique is sometimes advertised as “nonsurgical,” it still involves laparoscopy under general anesthesia and small incisions to insert the instruments used to apply high levels of heat to the fibroids. The problem with this technique is it doesn’t remove fibroids from the uterus. Even if they’re not growing, fibroids can still cause symptoms like pelvic pain, heavy bleeding and infertility. Endometrial ablation is not recommended for patients who desire future fertility options due to the higher risk of damage to the uterus during the procedure.

Medical Therapy

Medical therapy treats fibroids without surgery or radiological procedures. This type of treatment is limited and often not helpful for most patients with bleeding, pain and long-term growth of fibroids. Medical therapy may help decrease heavy bleeding associated with fibroids, but this decrease is usually only temporary.

Lupron/Orilissa (GnRH Agonists/Antagonists)

Lupron and Orilissa are effective but temporary medical therapy methods for fibroids,4 and they may not be effective for everyone.

Lupron is a GnRH Agonist. This means that Lupron binds to the GnRH receptor in the pituitary gland, and “fools” the pituitary to not produce FSH. FSH is follicle stimulating hormone, which is responsible for stimulating the growth of follicles, or eggs, in the ovary to make estrogen. Essentially, Lupron stops the production of estrogen by the ovaries, and slows or stops fibroid growth.  Fibroids are dependent on estrogen for growth.  

Orlissa is a GnRH Antagonist. Orlissa blocks the actual GnRH receptor in the pituitary gland, which ultimately prevents the production of estrogen. Since Orlissa competes with GnRH, it may not block all the receptors, and some estrogen may be produced in patients. Orlissa in effect “competes” with GnRH for receptors, so it may not completely block all estrogen production if all receptors are not blocked. 

Lupron or Orlissa cannot be prescribed for more than a year, and when discontinued the fibroids and symptoms will recur.5 High patient dissatisfaction with Lupron and Orlissa have to do with the side effect of causing menopause, which includes hot flashes, night sweats, anxiety, depression, mood swings, vaginal dryness, and over time osteoporosis or deterioration of bone structure leading to fractures. 

Once Lupron or Orlissa are discontinued, the fibroids will grow back since estrogen production will start again from the ovaries.

Birth Control

Hormonal birth control may help decrease bleeding in some fibroid patients by stopping ovulation. Ovulation produces higher levels of estrogen that stimulate growth of fibroids. However, birth control pills contain estrogen, and over time will also cause the growth of fibroids. Types of birth control that physicians may prescribe for temporary fibroid symptom relief include oral contraceptives, intravaginal contraceptives, hormonal injections and intrauterine devices (IUDs).

Progesterone

Progesterone can help to balance out high levels of estrogen production and may help decrease heavy bleeding.3 Progesterone can be given as a pill or an injection but does not treat or decelerate the growth of fibroids.

NSAIDs / Pain Relievers

NSAIDs such as ibuprofen (Motrin) and pain relievers such as acetaminophen (Tylenol) can temporarily decrease pain and relieve inflammation but will not affect fibroid growth.

Danazol

Danazol is an androgen (male hormone) that is similar to testosterone. It stops the production of estrogen, causing a decrease in menstrual periods and bleeding.4 It does not decrease tumor growth and has many side effects such as hair growth, limiting its use and tolerability for many patients.

Iron Supplements and Iron Infusions

Anemia is a common complications of the heavy bleeding caused by fibroids. To treat anemia, doctors will often prescribe iron supplements to relieve symptoms and bring a patient’s blood count back up to normal levels. Iron supplements will not treat the cause of heavy bleeding, which may not cease until fibroids are removed.

Iron infusions are being used more commonly to treat the symptoms of fibroids, but not the fibroids themselves. Low iron levels and anemia result from heavy bleeding. Giving iron through an IV is a very expensive and ineffective method to control anemia since the cause of the bleeding – the fibroids – is not treated by iron infusions. It is recommended that patients do not consider Iron Infusions as a treatment method for fibroids. Rather, treat the fibroids themselves through either myomectomy or hysterectomy, which will stop the bleeding thereby treating the anemia and low iron levels.

Get Treatment from Board-Certified Fibroid Specialists

If you suspect you have fibroids and need treatment, CIGC can help. One of our expert fibroid specialists will perform an accurate diagnosis and provide a treatment plan to address your symptoms. Schedule a consultation today to have a specialist evaluate your symptoms and condition(s) and put you on a path toward treatment.

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References

  1. Danilyants N, MacKoul P, Baxi R, van der Does LQ, Haworth LR. Value-based assessment of hysterectomy approaches. J Obstet Gynaecol Res. 2019;45(2):389-398. doi:10.1111/jog.13853
  2. Faridi P, Fallahi H, Prakash P. Evaluation of the Effect of Uterine Fibroids on Microwave Endometrial Ablation Profiles. Annu Int Conf IEEE Eng Med Biol Soc. 2018;2018:3236-3239. doi:10.1109/EMBC.2018.8513051