Years ago, women with fibroids had two options — either leave them alone or have a hysterectomy, a surgery that, at the time, involved removing a woman’s uterus and, often, ovaries. Recovery was long and having children was no longer an option.
Today, advances in fibroid treatment provide new options that are minimally invasive, offer a faster recovery and may preserve fertility.
What are fibroids and who gets them?
Fibroids are benign (noncancerous) tumors that arise from a single muscle cell, most commonly in the uterus. They typically occur in women who are in their 20s to 50s. It’s unclear why certain women get them, but there appears to be some genetic predisposition. They are also more common in certain races, with African-American women more likely to have fibroids than women of other racial groups. It’s unclear if fibroids are related to infertility, but if they are in the cavity or affect the cavity of the uterus, it’s possible they can lead to recurrent miscarriages.
Fibroid treatment is needed only when symptoms arise. Symptoms can include heavy or irregular periods, constipation, frequent urination and, with larger fibroids, a feeling of discomfort.
At Froedtert & the Medical College of Wisconsin health network, we offer a variety of minimally invasive fibroid treatments and work with patients to personalize options to their needs and goals.
- Medical management — Fibroid sufferers often start with medical management. This category includes hormone options like birth control and nonhormone approaches like NSAIDs (e.g., ibuprofen) or tranexamic acid, a medication used to treat excessive bleeding. Medical management is geared to women with heavy or irregular periods rather than those with large fibroids because it doesn’t address fibroid size.
- Uterine fibroid embolization — This minimally invasive procedure is performed by an interventional radiologist. Using fluoroscopy, a form of real-time X-ray, small beads are guided into the blood vessels that feed the fibroids, causing the fibroids to shrink. Most women report significant or complete resolution of their symptoms. A day surgery procedure, it requires only a small nick in the skin and general anesthesia is not required. Some patients stay in the hospital overnight. Recovery time is typically less than two weeks. Due to the uncertainty of how uterine fibroid embolization affects pregnancy, physicians may recommend that women who want to have children choose another treatment option.
- Magnetic Resonance-guided Focused Ultrasound (MRgFUS) — Only available in Wisconsin at Froedtert & MCW Froedtert Hospital, this new technology uses a magnetic resonance scanner to target fibroids and spare healthy tissue. MRgFUS destroys fibroid tissue with high-intensity ultrasound beams. The procedure lessens bleeding and carries Food and Drug Administration clearance for women who desire future pregnancy. It does not require an incision or general anesthesia, and most patients return to normal activities in a few days. Because it is a new technique, long-term data on fertility is not available, but initial data supports its use in women who want to retain their fertility. However, patients must meet an extensive list of requirements to qualify for MRgFUS treatment.
- Minimally invasive myomectomy — In this minimally invasive procedure, fibroids are removed but the uterus is retained. Approaches include hysteroscopy and laparoscopy. Hysteroscopy involves placing a telescopic camera through the cervix to visualize the uterine cavity and enables the surgeon to remove the fibroids. During laparoscopy, the surgeon places a telescopic camera and instruments into the abdomen through small incisions. Through these incisions, fibroids are removed and the uterus is repaired. Hysteroscopy has a one- to two-day recovery period, while laparoscopy requires up to six weeks of restrictions, even though many patients are back to work within two weeks. Pregnancy is possible after a myomectomy from either approach.
- Minimally invasive hysterectomy — During a hysterectomy, the uterus and sometimes the cervix are removed. Most often, ovaries remain in place, allowing retention of natural hormones for health benefits. If uterus size is appropriate, a vaginal approach may be used, avoiding abdominal scars. While most women are able to go home the same day as the surgery, a one-night hospital stay is sometimes needed. Both minimally invasive hysterectomy and laparoscopy have similar recovery times with restrictions for six to eight weeks and ability to return to work in about two weeks. Hysterectomy is a definitive treatment as bleeding stops and fibroids are gone. Pregnancy is not an option after a hysterectomy.
Personalized Treatment Plans
Finding the best treatment option for each patient depends on her symptoms, fertility goals and recovery time needs. In my practice, I often see patients for a second opinion or by referral from their physician after they’ve been diagnosed with fibroids. We typically recommend that patients have an MRI before their visit so that they can meet with me and an interventional radiologist during the same appointment to review what we see and discuss what the best treatment approach would be.
To schedule an appointment, call 1-800-DOCTORS or 1-800-805-3666.