What procedures help treat uterine fibroids?

There are a number of procedures that help treat uterine fibroids. It is important to remember that prior to procedures there are less invasive ways to treat fibroids that should be tried first.

• Diet/exercise/weight loss: The risk for uterine fibroids is low for a woman <120 lbs. Her risk will increase 21%/22lb weight gain. Add "anti-estrogenic" foods to your diet. Flavonoids found in fresh fruit & vegetables, chocolate, and red wine block an important enzyme is estrogen biosynthesis. Limit red meat, dairy, and caffeine.
• Medications: Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen or tranexamic acid (which has specific effects on lining to decrease heavy flow) or oral contraceptive pills (OCPs) can be tried.

The procedures that help treat fibroids are divided into non-surgical procedures and surgical procedures. The 2 most notable non-surgical procedures are Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization (UAE), and MRI-guided Focused Ultrasound (MRgFUS). The 2 procedures can be performed as outpatients. UFE will treat all of the fibroids in the uterus, while MRgFUS can treat 1 large or up to 3 small fibroids. Recovery periods are slightly longer with UFE (4-5 days vs. 1-2 days). Insurance routinely covers UFE while very few insurances cover MRgFUS.

The 2 surgical procedures to treat fibroids are myomectomy (surgically removing as many of the larger fibroids as possible and sewing the uterus together) and hysterectomy (surgically removing the uterus with or without the ovaries). Due to the fact that fibroids are benign, the high success rate and patient satisfaction of UFE, and the consequences of women with benign disease that undergo hysterectomy, women should think long and hard before proceeding with hysterectomy versus other less invasive options.

There are different types of operative procedures which include traditional open incision or laparoscopic. Most surgical procedures are done open which have longer recovery times (6-8 weeks) than the less invasive surgical options (3-6 weeks). Laparoendoscopic single site surgery (LESS) and Robotic are subsets of laparoscopic surgery and trials are underway in an attempt to show advantages over laparoscopic. These have a steep learning curve and are significantly more expensive than regular laparoscopic surgery which should be kept in mind.

To treat uterine fibroids, surgery can be used to remove fibroids only (myomectomy) or to remove the entire uterus (hysterectomy).

Surgery is a reasonable treatment option when:

• Heavy uterine bleeding and/or anemia has continued after several months of therapy with birth control hormones and a nonsteroidal anti-inflammatory drug (NSAID).
• Fibroids grow after menopause.
• The uterus is misshapen by fibroids and you have had repeat miscarriages or trouble getting pregnant.
• Fibroid pain or pressure affects your quality of life.
• You have urinary or bowel problems (from a fibroid pressing on your bladder, ureter, or bowel).
• There is a possibility that cancer is present.
• Fibroids are a possible cause of your trouble getting pregnant.

• Myomectomy, or fibroid removal. This may improve your chances of having a baby if the fibroid is inside the uterus and prevents a fertilized egg from implanting in the uterus. Removing fibroids in other locations of the uterus may not improve your chances of becoming pregnant.
• Hysterectomy, or uterus removal. This is only recommended for women who have no future pregnancy plans. Hysterectomy is the only fibroid treatment that prevents regrowth of fibroids. It improves quality of life for many women. But it can also have negative long-term effects, such as pelvic organ prolapse. For more information, see the topic Hysterectomy.

Myomectomy or hysterectomy can be done through one or more small incisions using laparoscopy, through the vagina or through a larger abdominal cut (incision). The method depends on your condition, including where, how big and what type of fibroid is growing in the uterus and whether you hope to become pregnant.

Uterine Fibroids: Should I Have Surgery?

What to think about - If you are hoping for a future pregnancy, myomectomy is your one surgical option.

Heavy, prolonged and painful periods caused by uterine fibroids will stop naturally after you reach menopause. If you are nearing menopause and your symptoms are tolerable, consider controlling symptoms with home treatment and medicine until menopause. Uterine fibroid embolization (UFE) may also be a reasonable option for you, although it has some risks.