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

Hysterectomy

• 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