Treatment options for benign uterine fibroids
Uterine fibroids affect 70 to 80 percent of women. About 30 percent of women are symptomatic. Up to 75 percent of African-American women have fibroids. More than 200,000 hysterectomies are performed each year for uterine fibroids in the United States. The direct health care costs attributable to this condition exceed $2.1 billion annually.
Many fibroids can be felt on pelvic examination. Ultrasound can detect those that are silent. Not all fibroids require treatment, but many do. Signs and symptoms include:
- Heavy or prolonged menstrual bleeding
- Pelvic pressure
- Pain with menses
- Bowel and bladder dysfunction
Asking patients about the severity of their symptoms, whether their symptoms interfere with work or daily activities, or if they have new symptoms can help determine if fibroid treatment is necessary.
Hysterectomy is a proven option for women who are not interested in future pregnancy and want to eliminate fibroid-related problems permanently. Hysterectomy is also a good choice for women with concerns such as abnormal Pap tests that require intensive follow-up, adenomyosis or endometriosis. This surgery may have an impact on physical and emotional well-being, fertility, and sexual function.
Other treatment options
Today, multiple medical therapies and less invasive surgical approaches provide symptom relief, shorter hospital stays and speedier recovery than does hysterectomy. And some options preserve fertility for women who want to become pregnant in the future. Some of the more commonly prescribed treatments include:
Various medications are now available to treat fibroid symptoms such as heavy menstrual bleeding and pelvic pressure. These medications include:
- Oral contraceptives
- Gonadotropin-releasing hormone agonists
- A progesterone-releasing intrauterine device
- Tranexamic acid, a new nonhormonal drug product
These medications offer some symptom relief, but they do not eliminate fibroids.
Myomectomy is an effective surgical option for the removal of fibroids with preservation of the uterus. This approach can relieve symptoms related to fibroid bulk and bleeding without sacrificing fertility. Although an abdominal incision is sometimes required for very large or numerous fibroids, many fibroids can be removed hysteroscopically or through just a few small incisions using a laparoscope or robot-assisted approach to speed patients' recovery and return to work.
Abdominal myomectomy usually requires a hospital stay of two or three days. Postoperative recovery takes four to six weeks. Laparoscopic or robot-assisted myomectomy is often performed with no hospital stay, and recovery typically takes a few days to two weeks. Hysteroscopic myomectomy is usually performed with no hospital stay, and recovery typically takes less than one week. The majority of women experience symptom relief, but new fibroids can develop that may or may not require treatment.
Uterine artery embolization
Larger fibroids can also be effectively treated with uterine artery embolization (UAE). UAE is often appropriate for patients who want to return to work and normal activities quickly after treatment. Because UAE has the potential to affect ovarian function, it is not recommended for women who are pursuing pregnancy.
During this procedure, a physician threads a catheter through a small incision in the groin and injects small embolic particles into the uterine arteries to block the blood supply to the fibroids. Patients typically spend one night in the hospital after the procedure. They return to work between four and 14 days later. As with myomectomy, the majority of women experience symptom relief, but new fibroids can develop that may or may not require treatment.
Magnetic resonance-guided focused ultrasound
Also approved by the U.S. Food and Drug Administration for fibroid treatment, magnetic resonance-guided focused ultrasound (MRgFUS) is the first noninvasive treatment for uterine fibroids.
Although some patients have reported successful pregnancies following MRgFUS, more research is needed before determining this treatment's impact on fertility. Thus, women must be counseled regarding options before pursuing MRgFUS when their goal is pregnancy in the future.
MRgFUS takes place in an MRI machine, and no incision is required. After MR images map the fibroid locations, the ultrasound transducer sends waves through the abdominal wall and into the fibroid, destroying the tissue. Patients typically go home the same day the procedure is performed, and they can return to work and other activities within a day or two.
Points to remember
- Multiple treatment options are available for women who seek relief from heavy bleeding and other symptoms and signs related to uterine fibroids.
- Hysterectomy offers permanent symptom relief for women who are not interested in future pregnancies.
- Less invasive treatment options can offer symptom relief and speedier recovery. These options include medications, myomectomy, uterine artery embolization and magnetic resonance-guided focused ultrasound therapy.