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Many people have or had fibroids in or around their uterus.
They’re muscle growths that aren’t cancerous and, for the majority of people, fibroids don’t cause major issues and may not be discovered or need to be treated. Even if you have several, they may not cause any symptoms.
However, one in every four people with fibroids will seek treatment because of their symptoms, which can become inconvenient or painful.
Fibroid symptoms
Fibroids can cause you to have heavy bleeding and longer menstrual cycles, as well as intense pain or cramping in your pelvis during your menstrual cycle.
As fibroids grow, they can stretch your abdomen. Depending on the location and size of your fibroids, you might have a harder time becoming pregnant.
If you experience these symptoms or know you have uterine fibroids, there are many options available to treat them, including some that don’t require extensive surgery.
Minimally invasive treatment options
Medication
You can take medications that stop or reduce the heavy bleeding your fibroids cause. While these treat bleeding (and pain, in many instances), they don’t eliminate or reduce the size of fibroids.
Fibroid medications include:
- birth control pills
- progesterone therapies
- intrauterine devices (IUDs)
- shots of medroxyprogesterone acetate (Depo-Provera)
Another option is gonadotropin releasing hormone (GnRH) analogues, a class of medications that lessens the amount of natural hormones our bodies create. In doing so, they reduce bleeding and the size of your fibroids. But they can only be used for up to two years, and symptoms could return after those two years.
Uterine fibroid embolization
Microscopic plastic beads are inserted into the arteries that go to your uterus, to block the flow of blood to the fibroids. That causes the fibroids to shrink within three months and reduce or eliminate symptoms.
Pros:
- Treats all fibroids
- Offers low risk of bleeding or complications
- Done in an outpatient procedure with quick recovery
- Leaves no scar
- Doesn’t require you to remove your uterus so future pregnancies may be possible
- Performed without general anesthesia
Patients receiving a uterine fibroid embolization receive medication to go into a “twilight” state. You’re relaxed and awake enough to breathe on your own, without a ventilator, which would be necessary during general anesthesia.
Cons:
- It can take up to three months after a procedure for symptoms to go away completely.
- You may feel pain between seven and 10 days after the procedure, then the pain will ease.
A hysterectomy is traditionally offered to permanently resolve fibroids, but surgery to remove the uterus is not right for everyone. Interventional radiologists at The Ohio State University Wexner Medical Center are offering a minimally invasive procedure to give women more options.
Transcervical uterine fibroid ablation
This minimally invasive treatment uses an ultrasound for imaging and heat to shrink fibroids.
There are two types of technology that can be used to do a transcervical uterine fibroid ablation. They differ in how they reach the fibroids and in how long it takes for you to recover after the procedure is done.
Pros:
- No incisions are needed.
- Fibroids are reduced in size.
- Symptoms improve.
Cons:
- Fibroids aren’t entirely removed.
Surgery options
Myomectomy
This type of surgery removes the fibroids from your uterus, allowing you to keep your uterus. A lot of different approaches can be used, depending on where the fibroids are. A myomectomy can be done entering your uterus vaginally or through small incisions in your abdomen.
Pros:
- Symptoms from the fibroids go away immediately after surgery.
- Recovery time is two to four weeks, a few weeks shorter than it is for a hysterectomy, a surgery that removes your uterus.
Cons:
- A longer recovery time than the minimally invasive procedures
- New fibroids can grow back requiring additional treatment.
Hysterectomy
A hysterectomy removes your uterus and fibroids. With this procedure, you’ll never grow new fibroids or have vaginal bleeding.
For most people who haven’t entered menopause, the ovaries, which provide hormones to our bodies, aren’t removed. This means that people who have this procedure won’t go into menopause after the surgery, because they’ll still have the ovaries to provide their natural hormones. A hysterectomy can be completed in two ways: laproscopic hysterectomy or a standard hysterectomy.
Laproscopic hysterectomy
Through small incisions on the abdomen, a camera and other instruments are inserted that allow the surgeon to remove the uterus with the fibroids. The uterus is then removed through your vagina or through one of the small incisions on your abdomen.
Pros:
- You can go home the same day of the surgery.
- Small incisions lead to an easier recovery.
- Lower blood loss during surgery
Cons:
- Not everyone is a good candidate for a laproscopic hysterectomy. It depends on the size of your uterus and fibroids and other factors related to your health.
Standard hysterectomy
This approach uses an incision on the abdomen to remove the uterus and fibroids.
Pros:
- Very large uterus and fibroids can be removed
Cons:
- Longer hospital stay
- More pain due to the larger incision on the abdomen
- Increased blood loss
Even if you have fibroids that cause you distress, that doesn’t mean you’ll have a hard time getting pregnant. A lot of women with fibroids have no trouble getting pregnant and have healthy babies.
If you’re having long and painful periods and excessive bleeding, see your health care provider to find out what you can do. Your uterus should not torture you. Sometimes a less invasive procedure can be done to bring you relief, but you also have the option of surgical treatments if you need them.
Amber Bondurant-Sullivan, MD, is an Ob/Gyn at The Ohio State University Wexner Medical Center.
Mina Makary, MD, is a vascular and interventional radiologist and leader of the Interventional Radiology APP Inpatient Service at The Ohio State University Wexner Medical Center. He’s also a clinical associate professor and director of Scholarly Activity and Research in the Department of Radiology at The Ohio State University College of Medicine.
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