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What Are The Latest Treatment Options For Fibroids?

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By LARRY GLAZERMAN, MD Tribune correspondent

The Tampa Tribune

Published: November 22, 2008

Uterine fibroids are common benign tumors of the uterus. They are made up of the same tissue as the uterus itself. They are three to five times more common in African-American women than in women of other racial groups. Many women with fibroids have no symptoms, but about 30 percent will experience abnormal bleeding or symptoms of pelvic pressure, as well as pressure on the bladder or rectum.

If you've been diagnosed with fibroids, you have several options. If you're not experiencing any symptoms, it's perfectly reasonable to do nothing. You should see your healthcare practitioner regularly to confirm that the fibroids are not changing dramatically, but often no treatment is needed.

Medication often can help alleviate some symptoms, including abnormal bleeding and pain. Non-steroidal anti-inflammatory medications, such as ibuprofen, can often decrease bleeding and discomfort that accompany menstruation. Birth control pills also may decrease the amount and severity of bleeding. Sometimes a drug called a GnRH agonist, such as Lupron, can decrease the size of the fibroids. This is usually used in preparation for more definitive treatment.

Several newer, noninvasive procedures have shown significant success in treating fibroids without surgery. In uterine artery embolization (UAE), a thin catheter is passed through an artery in your leg to the artery that supplies the uterus. A substance is injected to seal these vessels, decreasing blood flow to the uterus and fibroids. About 70 percent of women who are good candidates for this nonsurgical option will experience decreased bleeding and pressure symptoms. It is an outpatient procedure that is performed in the X-ray department of a hospital.

The newest noninvasive treatment for fibroids is called magnetic resonance-guided focused ultrasound or MRgFUS. In this procedure, while you are lying in an MRI machine, high-frequency sound waves are directed into the fibroid to shrink it. This promising new technique is performed at a few medical centers across the country. Whether UAE or MRgFUS is a suitable treatment alternative depends on the location of the fibroids within the uterus, and the size and number of fibroids.

Surgery continues to be a reasonable option for women with fibroids. Myomectomy removes individual fibroids from the wall of the uterus. Unlike in the past, this can often be performed with a minimally invasive approach, using a laparoscope, hysteroscope or, sometimes, a robot. Myomectomy is a good option for women with a small number of fibroids who wish to retain their ability to conceive and bear children.

If childbearing is complete, a hysterectomy - removal of the uterus - is a possibility. Depending on your age, your ovaries, which produce hormones, may be left in place so that hysterectomy will NOT cause early menopause. Hysterectomy can be done vaginally, abdominally or, more commonly nowadays, laparoscopically, through several small incisions in your abdomen rather than one large incision. Laparoscopic hysterectomy allows for less pain, a shorter hospital stay (many women go home the same day), and a quicker return to work. In addition, in many cases, your cervix will also be left intact (laparoscopic supracervical hysterectomy), which may enhance sexual function after surgery, improve pelvic support, and lead to even quicker recovery.

There are more alternatives than ever before for effectively managing fibroids, so a frank discussion with your physician about what's best for you is essential.

Dr. Glazerman is assistant professor of obstetrics and gynecology and director of Minimally Invasive Gynecologic Surgery at USF Health.

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