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What Are Uterine Fibroids ?
Uterine Fibroids are the most common tumors of the female genital tract. They are noncancerous (benign) growths that develop in the wall of the uterus, and range greatly in size from very tiny (a quarter of an inch) to larger than a cantaloupe (10 inches or more).
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UTERINE FIBROIDS: TREATMENT OPTIONS
There are three main treatment options for syptoms relating to uterine fibroids:
A number of insurance companies are paying for fibroid embolization procedures, but several are not. You will want to talk with your interventional radiologist about this before your procedure. We have written an informative letter regarding this procedure that you may find helpful when dealing with your insurance company. For additional information, please contact an Interventional Radiologist at 619-849-XRAY (9729).
References
- Wallach, EE. Myomectomy. In:Thompson JD Rock, eds. Linde’s Operative Gynecology, 7th ed. Philadelphia: J.B. Lippincott, 1992; pp. 647-662.
- Hutchins FL. Abdominal myomectomy as a treatment for symptomatic uterine fibroids. Obstet Gynecol Clinic North America 1995; 22:781-789.
- Doemeny J, Gilbert W, Moore TR, Angiographic Embolization in the management of hemorrhagic complications of pregnancy. Am J Obstet Gynecol 1992; 166: 493-497.
- Greenwood CH, Glickman MG, Schwartz PE, et al. Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization. Radiology 1987; 164: 155-159.
- Heaston DK, Mineau DE, Brown BJ, et al. Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation Am J Roentgenol 1979 133:152-154.
- Higgins CB, Bookstein JJ, Davis GB, et al. Therapeutic embolization for intractable chronic bleeding. Radiology 1977; 122: 473-478.
- Ravina JH, Bouret JM, Fried D, et al. Value of preoperative embolization of uterine fibroma: a report of a multicenter series of 31 cases. Contraception, Fertilitie, Sexualite 1995; 23: 45-59.
- Goodwin SC, et al. Uterine artery emoblization for the treatment of uterine leiomyomata midterm results. JVIR 1999. 10:1159-1165.
- Spies JB, et al. Uterine Artery Embolization for Leiomyomata. Obstetrics & Gynecology. Vol. 98, July 2001.
- Walker WJ, Pelage P. Uterine Artery Embolizaiton for Symptomatic Fibroids: Clinical Result in 400 Women with Imaging Follow-up. British Journal of Obstetrics and Gynecology, November 2002.
- Spies et al. Complications after Uterine Artery Embolization for Leiomyomas. Obstr and Gyn 2002, 100(5, part 1): 873-879.
- Society of Interventional Radiology. Advanced Seminar on Uterine Fibroid Embolization. October 8-9, 2004. Seattle, Washington.
Uterine Fibroid Drug Therapy -
The following drugs might be used:
- Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin).
- Birth-control pills
- Hormonal therapy
In some patients symptoms are controlled with these treatments and no other therapy is required.
When used long term, some hormonal therapies can have risks and side effects such as menopausal symptoms, erratic or no menstruation, decreased bone density, vaginal dryness, bloating, and mood swings. Hormones such as GnRH analogues are administered by injection by the gynecologist. These hormones reduce estrogen levels and this results in reduced blood flow to the uterus and the fibroids, decreasing their size. The effectiveness of hormones is considered temporary as studies show that when the therapy is stopped, fibroids often return to their original size within six months.
Uterine Fibroid Surgical Options
Myomectomy is a surgical procedure to remove the fibroids and leave the uterus in place. This is performed for women who wish to maintain their ability to have a child. Myomectomy is successful in controlling symptoms about 80% of the time. However, the more fibroids there are in the uterus, the less successful the surgery generally is. Fibroids grow back several years after myomectomy in 10-30% of cases. The risks of myomectomy include infection and bleeding. The procedure may cause extensive pelvic scarring which may make future surgery difficult and contribute to future fertility problems. Long-term studies of myomectomy patients who attempted to become pregnant have shown pregnancy rates between 40 and 60 per cent. Myomectomy can be performed using a hysteroscope, a laparoscope or through an abdominal incision.
- Hysteroscopic myomectomy is used for fibroids inside the uterus, just below the lining and projecting into the uterine cavity. This is usually done as an outpatient procedure with anesthesia.
- Laparoscopic myomectomy is used if the fibroid is on the outside wall of the uterus, particularly if the fibroid is pedunculated. Small incisions are made so the doctor can insert the probe fitted with surgical instruments inside the abdominal cavity. The gynecologist can view the fibroids through the laparoscopic camera as the instruments are guided to the site to remove the fibroids. General anesthesia is required.
- Abdominal myomectomy is a surgical procedure in which an incision is made into the abdomen to access the uterus and another incision is made in the uterus to remove the fibroid. Once the fibroids are removed, the uterus is stitched closed. General anesthesia is required, and there is a several-day hospital stay. Recovery is 4-6 weeks.
Hysterectomy is the surgical removal of the uterus. It can be performed in several ways: using a vaginal approach, using a laparoscope through several small skin incisions, or using a traditional surgical incision. General anesthesia is required. Hysterectomy requires 3-4 days of hospitalization and a 4-6 week recovery period. There is a 2% risk of post-operative bleeding and a 15-38% risk of post-operative fever with hysterectomy. Hysterectomy is the most common current therapy for women with fibroids and is effective in almost all cases in which bleeding is a problem.
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About Uterine Fibroid Embolization