Non surgical alternatives to hysterectomy for fibroids
In America alone is estimated that as many as 30-40 percent of women will develop fibroids in their childbearing years. African American women are three to five times more likely than Caucasian women to develop fibroids. While many women do not develop symptoms and do not require treatment some do. Symptoms include pelvic pain including chronic pelvic pain, excessive bleeding, abnormal bleeding or urinary frequency, and urgency. f you would like to avoid surgery there are nonsurgical treatment options to a hysterectomy for fibroids that can help improve your symptoms.
What are uterine fibroids?
Uterine fibroids are benign growths in the uterus that can vary greatly in size. These benign tumors are made up of muscle and connective tissue and can grow on the inside, outside, or in the wall of the uterus. It is not known for certain what causes fibroids to develop, but it is thought that they may be influenced by hormones such as estrogen and progesterone.
What risk factors for uterine fibroids?
While any woman can develop uterine fibroids, certain factors may increase your risk of developing fibroids, such as:
- age (fibroids are most common in young or reproductive age - women ages 30-40)
- race (African American women are more likely to develop fibroids than Caucasian women)
- family history (if your mother or sisters have had fibroids, you may be more likely to develop them as well)
- obesity
Although premenopausal women frequently get fibroids, they can occur in postmenopausal women as well.
What symptoms can uterine fibroids cause?
The symptoms of uterine fibroids can vary greatly from woman to woman and may depend on the size and location of the fibroid(s). Some women with fibroids may have no symptoms at all, while others may experience one or more of the following often revolving around your menstrual cycle:
- heavy menstrual bleeding
- abnormal menstrual bleeding
- prolonged menstrual periods
- abnormal uterine bleeding
- pelvic pain or pressure
- chronic pelvic pain or pressure
- frequent urination
- difficulty emptying the bladder
- constipation
- backache or leg pain
- infertility
How are uterine fibroids diagnosed?
Your doctor may feel your abdomen for lumps or masses. She or he also will ask about your menstrual history, including how long your periods last and how often you have them. If you're experiencing pain or pressure in your pelvis, she or he may want to do a pelvic exam.
To get a better look at your uterus and surrounding structures, your doctor may order an imaging test. Ultrasound is the most common type of test used to diagnose uterine fibroids. Other imaging tests include magnetic resonance imaging (MRI) and computed tomography (CT).
Once uterine fibroids are diagnosed, how are they treated?
The type of treatment recommended depends on several factors, including:
- your age
- the location, size and number of fibroids
- your symptoms
- your plans for future pregnancies
- the side effects of various treatments
For some women, no treatment is necessary. If you're not experiencing any symptoms, and the fibroids are small, your doctor may simply suggest monitoring them - watchful waiting - with pelvic exams and ultrasounds a few times a year to make sure they're not growing. If your fibroids are large or causing pain or other symptoms, however, there are several treatment options available.
Imaging & Interventional Specialists offer FDA-approved treatments (non-surgical alternatives) for uterine fibroids.
Call us now or schedule an appointment to discuss your condition and your options.
Nonsurgical alternatives for uterine fibroids include:
Non-surgical treatments for uterine fibroids include watchful waiting, medications, focused ultrasound and a new emerging non-surgical procedure called uterine fibroid embolization.
Medications:
Hormonal therapy: This approach uses hormonal medications birth control pills (oral contraceptives), patches or injections to help shrink fibroids by controlling the levels of estrogen and progesterone in your body. However, once you stop taking the hormones, the fibroids often return.
Intrauterine device (IUD): This T-shaped device is inserted into the uterus to release small amounts of a hormone called levonorgestrel, which helps shrink fibroids and can also help relieve pain.
Gonadotropin-releasing hormone (GnRH) agonists: These drugs work by temporarily putting a woman into menopause, which decreases the levels of estrogen and progesterone in the body and helps shrink fibroids. Common side effects include hot flashes and vaginal dryness.
Progestin therapy: This treatment involves taking progestin - either in pill form or as an IUD - to help control heavy bleeding. It doesn't shrink fibroids, but it can ease symptoms such as bleeding and pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs can help relieve pain by reducing inflammation.
Non surgical alternatives to hysterectomy
MRI-guided focused ultrasound surgery: During this minimally invasive procedure, sound waves are targeted at the fibroid to heat and destroy the tissue and so the fibroids shrink.
Myomectomy : This surgical intervention removes the fibroids from the uterus, but leaves the uterus intact. Myomectomy can be performed by laparotomy (making a large incision in the abdomen) or by laparoscopic surgery (making small incisions in the abdomen and using thin instruments to access the uterus).
Hysteroscopic resection: In this procedure, a thin scope is inserted through the vaginal canal and cervix into the uterus. The doctor then uses tools to remove fibroids that are growing on the inner wall of the uterus. Hysteroscopic resection is also known as Transcervical Resection of Fibroids (TCRF).
Endometrial ablation: This procedure destroys the uterine lining (the endometrium), which can help control heavy bleeding. Endometrial ablation can be performed in several ways, including with a laser, electrical current, heated water or freezing techniques. Ablation is only done on women who do not plan to have any children in the future since it detroys tissue in the uterine cavity where implatation occurs.
Uterine fibroid embolization (UFE) also called Uterine artery embolization (UAE):
This is a new, "pinhole", essentially noninvasive procedure quickly becoming one of the most sort after procedures to treat uterine fibroids. UAE is currently the preferred treatment option in Europe and many other countries around the world.
UFE involves placing a catheter (thin tube) into an artery that supplies blood to the uterus (uterine artery). Once the nonsurgical treatments. This is probably the most minimal of minimally invasive procedures and involves inserting a small catheter into the blood vessels that supply blood to the uterus, then injecting small particles to cut off blood flow to the fibroids. In this way a UFE can effectively shrink fibroids and relieve symptoms.
Hysterectomy involves removal of your entire uterus so child bearing is not possible. Further by disrupting the pelvic floor, prolapse is possible leading to symptoms such as incontinence or bowel/bladder changes.
Uterine Fibroid Embolization offers the same symptomatic relief as a hysterectomy without the surgical risks and with quick recovery times. Most women go home the day of their procedure or overnight at the most, while a hysterectomy usually requires a hospital stay of 2-5 days.
Complications from UFE are minimal but can include cramping, nausea/vomiting which is easily controlled with medication, and infection which is uncommon.
Why is Uterine fibroid embolization (UFE) also called Uterine artery embolization (UAE) an effective alternative to a hysterectomy?
Because it is a minimally invasive procedure that doesn't require any cutting, a UFE compared with a hysterectomy is:
- less risky
- easy to recover from (you go home the same day with a Band-aid)
- you resume activities more quickly
- you preserves your uterus, so you can still have children if you want to
- there is no disruption to you pelvic floor so there is no risk of prolapse or incontinence
What type of fibroids can UFE/UAE treat?
Fibroids are classified by where they occur as:
- Submucosal (under the lining of the uterus)
- Intramural (in the wall of the uterus)
- Subserosal (on the outer surface of the uterus)
- Pedunculated (attached to the uterus by a stalk)
UFE/UAE can treat any type or size of fibroid, even larger fibroids, but is most commonly used to treat intramural and submucosal fibroids.
Why Imaging & Interventional Specialists?
Imaging & Interventional Specialists provide world class treatment and are leaders in interventional radiology. They have expertise in the minimally invasive, nom surgical procedures that can treat your fibroids and stop your symptoms.
Using state-of-the-art equipment, our experienced board-certified specialists are focused on your best outcome. Our minimally invasive image guided procedures are cutting edge technology without the cutting, without the scalpel. You leave with a Band-Aid!
- Procedures are usually done in a comfortable outpatient setting with familiar friendly staff
- Pinhole procedures offer fast recovery, less risk, and less pain
At Imaging & Interventional Specialists board-certified physicians offer in-house testing for diagnosis and to develop an individualized treatment plan for your uterine fibroids.
