Surgical Management of Fibroids

Surgical Management of Fibroids
Leiomyoma, also known as fibroids, are the most common benign tumor of the female genital tract. By the age of 45, over 60% of women are affected. These tumors cause symptoms of irregular, excessive bleeding, pain, and pressure. If left untreated they can contribute to infertility and cause potentially life-threatening bleeding.

Not every woman with fibroids will require treatment and even those who do maybe able to manage with medical therapy. Surgical therapy and procedures are available to manage the problems if medical treatment fails.

Uterine fibroid embolization is an alternative for women who desire a minimally invasive option for managing the fibroids. It entails injecting particles in the artery feeding the uterus to obstruct the vessels. The result is a decrease in the blood supply to the fibroids and they shrink over time. It is very effective in reducing the amount of blood loss with periods and in decreasing the bulk of the uterus. Some women don’t have periods after this procedure. Approximately 80% of women had improvement in their symptoms and 91% of those undergoing the procedure reported satisfaction with the therapy.
There are potential but rare complications of the procedure. The most common of course is failure of the procedure. A small percentage of women undergo premature menopause due to compromise of the ovarian blood supply. There are also rare reported cases of embolization of unintended vessels compromising blood supply to other tissue.

A new technique utilizes the MRI to guide focused ultrasound beams through the anterior abdominal wall and into the fibroid. This results in thermal ablation of the treated fibroid. This procedure allows for precise targeting of the fibroid and significant improvement in the symptoms.

If you desire to retain your fertility potential then it is best to consider a surgical procedure called a myomectomy. This involves a surgical incision and the individual fibroids are removed and the uterus repaired with sutures. This typically results in a normal sized uterus. Selective skilled surgeons can also perform this procedure via laparoscopy. Improvement in laparoscopic techniques and tools has made this procedure more widely available. For some women, this can be a permanent fix but for others there maybe a recurrence over time.

Hysterectomy is an alternative for women who have completed their childbearing and want a definitive treatment. If the uterus is removed there is no chance for recurrence of the fibroids. Removing the uterus does not result in menopause. Only if the ovaries are removed at the same time will menopause occur. A hysterectomy can be performed through the birth canal, abdominally or laparoscopically with or without robotic assistance. The surgical route is dependent on a number of factors but the most important include the size of the uterus, the skill set of the surgeon and the availability of necessary resources to facilitate the procedure.

There are a number of available procedures that can treat uterine fibroids. It is important for you to seek the care of an experienced gynecologist who can provide you with a comprehensive evaluation and counsel you on the options that best meet your needs.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!

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