Treatment of Uterine Fibroids
Uterine fibroids (leiomyoma) are benign (non-cancerous) tumors of the
uterus. Many women have fibroids and are not aware of them. The
uterus could contain a single fibroid of almost any size, or multiple fibroids
could enlarge the uterus as much as a pregnancy does. Fibroids of the
uterus are very common. Up to 50% of women will develop a fibroid in
their life. There is a genetic connection, so this condition tends to run in
families.
The problems caused by fibroids depend on the size and location of the
fibroid(s). Fibroids affecting the lining of the inside of the uterus are
most likely to cause symptoms. But, even fibroids within the wall or on the
outside of the uterus can be problematic.
Fibroids can arise
from any part of the
uterus
MRI showing one large
fibroid filling the pelvis up to
the umbilicus
Worsening menstrual bleeding and more painful menses are the most
common symptoms of women with uterine fibroids. Excessive blood loss
can result in significant anemia. Infertility and miscarriage are related to
uterine fibroids as well. Other symptoms may include frequent urination
or waking at night to urinate. Large fibroids can place pressure on the
bowel causing pain and constipation. Partial obstruction of the urinary
system can result. Large fibroids may cause pain and pressure anywhere
within the abdominal cavity.
Treatment of Uterine Fibroids
About half a million hysterectomies are completed every year. One third
of these procedures are done for uterine fibroids. For those women with
symptoms who have completed their families, hysterectomy is often
recommended. This is the only treatment option that eliminates the
possibility of new fibroid formation. For those women desirous of
pregnancy or those who just wish to preserve their uterus, other options
are available.
Myomectomy refers to the removal of uterine fibroids with preservation
of the uterus. With this surgical treatment, symptoms resolve and fertility
is preserved and enhanced.
Abdominal or open myomectomy requires an incision of several inches
across the lower abdomen. The fibroids are separated form the uterus
and the uterus is repaired. After surgery, a hospital stay of 2-4 days is
typical and recovery at home can last from 3-6 weeks. The uterus will
need to heal for several months before pregnancy is attempted. This
Open Myomectomy I
technique has been
available for over 50 years
and is still considered the “gold standard”.
A single fibroid in the
wall of the uterus is
projecting from the top
posterior portion of the
uterus.
The fibroid is
removed.
The uterus has a normal
shape after removal of
the fibroid and repair of
the uterine wall
Open Myomectomy II
Uterus with multiple fibroids
Fibroids removed from uterus
Uterus after repair from fibroid removal
Open Myomectomy III
Uterus enlarged with many fibroids
Fibroids removed from uterus
Uterus after repair from fibroid removal
Hysteroscopy refers to the inspection of the inside of the uterus with a
thin telescope that is passed through the vagina and through the uterine
cervix. Intracavitary fibroids occupy the inside of the uterus. Some
fibroids (submucosal) grow from the uterine wall and push into the uterine
cavity. Instruments attached to the hysteroscope allow the surgeon to
remove fibroids from inside the uterus. One of those instruments is called
a resectoscope; one of the newest instruments is called MyoSure. A
balloon catheter may be placed in the uterus after surgery to prevent
scarring. This catheter is removed in the office 1-2 weeks after the
procedure. Hysteroscopy is an outpatient procedure and recovery is
only a few days. Sometimes hysteroscopy may be used in combination
with other surgical treatments for fibroids.
Picture from hysteroscopy of a
fibroid inside the uterine
cavity.
JJHscope1.WMV
Laparoscopy refers to the inspection of the abdominal cavity. A small
incision is made in the abdomen (usually at the umbilicus). Up to four
additional incisions, all less than an inch, allow for the introduction of
instruments for operative repair. Abnormalities of the pelvis can be
evaluated, confirmed and often treated with this technique including the
removal of uterine fibroids. Problems such as pelvic adhesions and
endometriosis can be diagnosed and treated at the same time. Patients
can return home the same day or after an overnight stay in the hospital.
Recovery at home lasts for 1-2 weeks; much less than with the open
myomectomy technique. Some studies show that pelvic scarring after
surgery is reduced with this technique compared to open myomectomy.
The da Vinci robotic assistant is often used for the laparoscopic removal
of fibroids. This instrument allows for the removal of larger and more
numerous fibroids, situations that formerly required open surgery.
Laparoscopic view of uterus with large fibroid
Removing fibroid from Uterus with da Vinci robotic assistant
Fibroid separated from uterus
Defect in uterus after fibroid removal
Uterus after repair with da Vinci robotic assistant
Other treatment options include uterine artery embolization (UAE) and
MRI guided high focused ultrasound. These techniques improve
symptoms and allow for preservation of the uterus. However, some
studies demonstrate a higher incidence of complications in future
pregnancies after UAE. The MRI guided treatment is so new, we don’t
know how it would affect a future pregnancy. These treatments are
generally not recommended for women who would like to become
pregnant.
Physicians at NFC were among a small group of physicians performing
laparoscopic myomectomy in place of open myomectomy since the early
1990’s. They were the first physicians in Tennessee and the
surrounding area to use the da Vinci system for the removal of uterine
fibroids. Their years of experience in the surgical treatment of infertility
means that your NFC physician has expertise in the repair and
preservation of female pelvic anatomy. A consultation with an NFC
physician may include a physical exam, pelvic ultrasound and other
studies. Your NFC physician will discuss with you the treatment options
that are most appropriate for you.