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6 Alternative Fibroid Treatment Options For Women Considering Hysterectomy

Dr Eisen Liang - Thursday, February 09, 2017

6 Alternative Fibroid Treatment Options For Women Considering Hysterectomy

Just diagnosed with Fibroids? What are the fibroid treatment options?

Before consenting for hysterectomy, be fully informed about other less invasive treatment options.


There are various treatment options for uterine fibroids. However, some women may not be aware of these and are quite often advised that the only solution is a hysterectomy, which is the removal of the uterus from the body. Unless it’s cancerous, hysterectomy may not be necessary. Hysterectomy is, of course, a major surgery and carries with it all the risks of major surgery. Also, some women understandably mourn the loss of their womb.

That's why more women need to be aware of the alternatives to hysterectomy. Below is a brief discussion of various treatment options. Suitability will depends on the type and severity of one's symptoms as well as the location and size of the fibroids, and more importantly, the woman’s personal preference.  Hysterectomy should be considered as a last resort, when all other less invasive treatments have failed or deemed unsuitable.

Fibroids are common benign tumours. Many women with fibroids do not experience symptoms.  However if one is suffering fibroid symptoms, treatment may be needed.

 

Medical therapy

To control heavy bleeding during periods, a doctor may prescribe non-steroidal anti-inflammatory drugs, birth control pills, or progesterone agents. Keep in mind though that these do not reduce the size of fibroids.

Gonadotropin Releasing Hormone (GnRH) agonist also controls bleeding and may reduce the size of the fibroid and the uterus. However patients are usually advised to limit their use of this drug to 6 months due to its common side effects such as hot flashes, mood swings, and osteoporosis. After stopping GnRH agonists, fibroids usually start to regrow.

Cyclokapron reduces heavy bleeding by enhancing clotting ability. In rare cases for high risk patients, it can cause serious side effects such as deep venous thrombosis (DVT) and pulmonary embolism (clots in the lung).

 

Mirena IUD

(Source: Image via mirena-us.com) 

A Mirena IUD is an intra-uterine device, which is a device that is inserted into the uterus and stays in for a period of time where it slowly releases the progesterone hormone. While an IUD may be helpful for reducing the heavy periods associated with fibroids, it does not reduce the size of fibroids. Also, if one has large fibroids that are distorting the cavity, the IUD may be difficult to insert or remove and sometimes it may not stay in. Some women may experience prolonged / irregular periods, or continuous spotting with the Mirena IUD.

 

Endometrial Ablation

This procedure involves the use of heat energy to get rid of the inner lining of the uterus. The patient is put under general anaesthesia and the surgery is done in an operating theatre. After the procedure, the patient may no longer have a menstrual period. If the uterine cavity is distorted by fibroids, the procedure may not be successful due to lack of effective contact between the heating device and the lining of the uterus.

The procedure does not shrink fibroids and therefore does not relieve bulk symptoms such as urinary frequency.

 

Uterine Fibroid Embolization (UFE)

UFE is local anaesthesia non-surgical procedure performed by an interventional radiologist. The procedure embolizes or blocks the blood supply to the uterus. The lack of blood supply to the uterus makes the fibroids shrink and as a result alleviates bulk symptoms such as urinary frequency. UFE is also highly-effective in reducing heavy menstrual bleeding and relieving period pain. This non-surgical alternative to hysterectomy is essentially as effective as hysterectomy. UFE has shorter hospital stay and quicker time to return normal life and activities

 

Hysteroscopic Resection

This procedure is much less invasive than a hysterectomy but still need to be performed under general anaesthesia and in an operating theatre. It is only suitable for small fibroids protruding into the cavity of the uterus which are removed with the aid of a camera inserted through the vagina and the cervix.

 

Myomectomy

This procedure is done to surgically remove one or a few fibroids and is offered to women who wish to retain the uterus and fertility. Only when there is a small number of fibroids in suitable locations can this procedure be possible. It is technically more demanding to the surgeon, takes longer time to perform, more likely to require blood transfusion, and requires 5-6 weeks for recovery. Sometimes a myomectomy is converted to a hysterectomy if the surgeon is unable to control the bleeding or reconstruct the uterus.

Myomectomies improve heavy bleeding in 70-80% of patients. Development of internal scarring of the abdomen is a potential side effect. Recurrence of fibroids occurs in 40-50% of women.

Another procedure is laparoscopic myomectomy- a key hole surgery. The recovery time is quicker, although the surgical risks are not lower. Laparoscopic surgery is technically more demanding of surgeons due to limited access and visualization. It also poses the risk of injuries to blood vessels, bowel, bladder, and ureter. Whether laparoscopic surgery is the right choice for a patient depends on the reason for it, the desire for a quick recovery, as well as the skill and the experience of the surgeon.

 

Hysterectomy

When all other conservative treatments failed or deemed unsuitable, a hysterectomy may be needed. This operation removes the uterus from the woman's body. It is a major operation and  carries the risks of a major operation.

There are also potential long-term adverse effects to be aware of, such as vaginal prolapse.  Vaginal prolapse is where the top of the vagina gradually slips out of place, and may fall toward the vaginal opening because the uterus is removed. The uterus serves as important structural support for the top of the vagina. As the top of the vagina falls as a result of missing structural support, this may put additional stress on other ligaments supporting the pelvis.

Another potential side effect of hysterectomy involves the small intestines herniating downwards near the top of the vagina because the structural support provided by the uterus is gone. This condition is known as enterocele.

For hysterectomy, recovery can take up to 5-6 weeks. Hysterectomy should only be considered as a last resort when all other treatments for uterine fibroids have been tried and proven to be ineffective.

For women diagnosed with uterine fibroids who are experiencing severe symptoms, speaking with their  GP or gynaecologist about these options is the best route in finding the right treatment for them.


Dr Eisen Liang is an interventional radiologist with special interest in gynaecological intervention such as Uterine Fibroid Embolisation (UFE), adenomyosis embolisation and ovarian vein embolisation for pelvic congestion syndrome. He performed his first UFE in 1998 and has been performing UFE at Sydney Adventist Hospital since 2007.
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