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HIFU Fibroids Treatment
About Fibroids
How to Treat Fibroids
What is MRI Guided HiFU
Case Studies

How to Treat Fibroids

What are the "Other Treatment Options"?

GnRH therapy

  • Medical therapy to suppress estrogens and shrink fibroids
  • Advantages:
  • Reduction in fibroid volume - allow easier resection using less invasive techniques, reduced blood loss and perioperative morbidity.
  • Disadvantages
  • Premature menopause symptoms
  • Osteoporosis
  • Rebound growth of fibroids if treatment is stopped


  • Surgical resection of the uterus with or without removal of the ovaries
  • Types of hysterectomy
  • Total: remove corpus and cervix
  • Subtotal: supracervical (spare the cervix)
  • Oophorectomy & salpingectomy: Unilateral or bilateral
  • Procedure subtypes
  • Abdominal
  • Vaginal
  • Laparoscopic assisted vaginal
  • Laparoscopic
  • Robotic
  • Advantages
  • Complete removal of the fibroid
  • Disadvantages
  • Surgical Scar – smaller for laparoscopic procedures
  • General anesthesia
  • Intraoperative and perioperative morbidity
  • Fertility – “The patient cannot become pregnant”
  • Hot flashes – just with hysterectomy alone
  • Premature menopause – if oophorectomy is also done

Abdominal Myomectomy

  • Open surgery for resection / removal of the fibroid
  • Advantages
  • Uterine conservation in patients who would want to maintain fertility
  • Disadvantages
  • Surgical Scar
  • General anesthesia
  • Post-operative recovery is slow
  • Intraoperative and perioperative morbidity
  • Recurrence rates of 10-27% (Hutchins FL etal and Candiani GB et al)

Laparoscopic Myomectomy

  • Laparoscopic resection / removal of the fibroid
  • Advantages
  • Less recovery time compared to an open surgery
  • Ideal for pedunculated subserosal and small intramural fibroids
  • Disadvantages
  • Difficult to tackle large or multiple fibroids
  • Not ideal to treat deep seated fibroids
  • General anesthesia
  • Post-operative morbidity

Hysteroscopic resection / endometrial ablation

  • A scope is placed in the uterine (endometrial) cavity and the targeted tissue is ablated
  • Advantages
  • Technique is to primarily treat submucosal fibroids
  • Reduced recovery times – outpatient procedure
  • Disadvantages
  • Not used to treat deep seated large or intramural / subserosal fibroids
  • High failure rate
  • Post-operative synechiae / adhesion formation.

Uterine Fibroid Embolization (UAE)

  • Interventional radiologist (IR) injects microparticles to block the primary vessel feeding the fibroid
  • The IR punctures the femoral artery in the groin and places a small catheter into the uterine artery
  • Under image guidance microparticles or microspheres are injected which block the vessels feeding the fibroid
  • The microparticles produce tissue infarction and death
  • Other uterine structures are spared.
  • Advantages
  • Abnormal bleeding and bulk symptoms reduce in 80-90% of cases
  • No surgical incision or general anesthesia required
  • All fibroids are treated simultaneously
  • Reduced recovery times: 7-10 days
  • Disadvantages
  • Post-embolization syndrome: acute / chronic pain, pyrexia (fever), nausea, vomiting, weakness and night sweats
  • Non-targeted tissue embolization: microparticles may drift into tissues, which were not intended for therapy and may lead to end-organ failure.
  • Infection of the dead tissue
  • Failure of embolization with fibroid re-growth
  • Technical failure rate: 1-2%
  • Overall failure rate: 9.4% (Huang et al, Fertil Steril 2006; Jan85(1):30-35)
  • Effect on fertility uncertain


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