What are common methods of fibroid removal?

Fibroids are tumors or lumps of smooth tissue that grow outside or within the uterine wall of women. Most fibroids are non-cancerous, but they can cause bloating, pelvic pain, difficulty urinating and constipation. Some women may also experience heavy bleeding due to uterine fibroids and run the risk of becoming anemic. Nearly 20 to 80 percent of women develop uterine fibroids by the age of 50. Women experiencing moderate to severe symptoms may wish to have the uterine fibroids removed and have the option to undergo any of the following procedures for fibroid removal, depending upon their preferences and the severity of their condition:

Endometrial Ablation—Pros and Cons

Endometrial ablation is a procedure to remove the lining of the uterine wall, and thereby reduce or eliminate menstrual bleeding. It is not specifically designed or approved to treat fibroids but some endometrial ablation devices are approved to be used in the presence of fibroids. To perform endometrial ablation, the surgeon inserts a heated balloon or a tool into the uterus to either heat or freeze the lining. This procedure is minimally invasive, which is a benefit, but it is only recommended for women who have completed childbearing.

Myomectomy—Pros and Cons

Myomectomy is a procedure that removes only the fibroids from the uterus. Myomectomy can be performed by any one of the following three ways: hysteroscopy, laparotomy or laparoscopy. Nearly 80 to 90 percent of women experience relief from symptoms of uterine fibroids after this procedure. However, sometimes this procedure involves making an incision in the uterine wall to remove the larger fibroids. Smaller fibroids may not be removed if it involves another incision in the uterus and increases risk. If small fibroids are not removed, they may grow, become problematic, and patients may be , subjected to another procedure in the future.

Hysterectomy–Pros and Cons

Hysterectomy is a surgical procedure that is recommended for women who are either struggling with very large fibroids or have a multitude of fibroids (too many to treat or remove individually). A hysterectomy involves the complete or partial removal of the uterus and is the only way to prevent the reoccurrence of uterine fibroids. It is also recommended at times for women experiencing heavy bleeding due to uterine fibroids, as this might be the only way the doctors can stop the dangerous bleeding. While this procedure does prevent uterine fibroid regrowth, it is also highly invasive and requires recovery time, with the post-operative recuperation varying between one to two months in some cases.

The Acessa System – Pros and Cons

The Acessa Procedure is a minimally-invasive technique that treats uterine fibroids. The Acessa System has been cleared by the FDA with this specific indication for treating uterine fibroids. Radiofrequency ablation is performed during the Acessa procedure where a small array of needles points directly apply energy to each uterine fibroid. As a result, the fibroids are treated and the surrounding uterine tissue remains healthy and intact. This procedure makes use of laparoscopic ultrasound probe technology to detect fibroids as small as 2mm in diameter. The Acessa Procedure is minimally invasive and patients can go home the same day. Some patients experience minor abdominal discomfort requiring non-steroidal anti-inflammatory medication after the procedure, patients can generally return to work within 3-5 days. There are many risks involved in laparoscopic procedures to learn more you should consult an Access-trained gynecologist.

Sources:

  1. http://www.nichd.nih.gov/health/topics/uterine/conditioninfo/treatments/pages/surgical-treatments.aspx
  2. http://womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html?from=AtoZ

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Fibroids Are Not Color Blind

Over the years, researchers have examined the epidemiological connection between a wide variety of patient characteristics and the occurrence of uterine fibroids, seeking to identify risk factors. Age, weight, diet, geographic location, lifestyle factors like cigarette smoking, medical conditions, and history of childbirth have all been studied, and many have been correlated with fibroids in one way or another. But time after time, study after study, one characteristic has stood out as a major indicator of fibroid risk: race. And the conclusion that researchers have consistently reached is this: uterine fibroids (also known as leiomyomas) disproportionately affect women of color.

Certain, specific differences have been seen in the cases of black women: research shows that, in comparison to white women, black women tend to develop a larger number of fibroids and experience more fibroid-related symptoms. A study published in 2013 by the American Society for Reproductive Medicine reported that, “African-American women had substantially more fibroids” with an average of 9.9 fibroids compared to the Caucasian subjects’ average of 4.5 fibroids. Additionally, Weiss et al. conducted a multi-ethnic, multisite, longitudinal study of 3,302 women ages 42-52 and concluded that “previously diagnosed leiomyomas were presenting symptoms more frequently in African-American woman than Caucasian women (85% vs. 63%)”.

The racial disparity in fibroid occurrence isn’t fully understood. The research that exists mostly defines the relative risk of the condition in terms of black and white. Obviously, black and white women aren’t the only ones affected by uterine fibroids. While very little data exists on the differences in susceptibility and symptoms between other ethnicities, a 2011 study conducted by the U.S. Armed Forces identified the relative risk of fibroids for multiple ethnic groups. The study looked at the population of active military women who were diagnosed with fibroids between 2001 and 2010: 11,931 cases were recorded. The researchers concluded that, relative to the white, non-Hispanic population, the risk of fibroids was slightly higher (1.1 times) for Hispanics and Asians/Pacific Islanders, and slightly lower (.9 times) for American Indians/Alaskan Natives. By comparison, African American women were 4.4 times more likely to have the same diagnosis, and women in the ethnic category of “Other” had almost double (1.9 times) the incidence of fibroids. These findings are depicted in the graph below.

Fibroids--race_MSMRgraph

As of now, there are no clear answers to explain why symptoms and presentation of uterine fibroids are different in women of color. However, the connection between fibroids and race is certainly a topic of interest to researchers, physicians and fibroid patients alike, and one that continues to be the subject of medical research.

Sources:

  1. Schwartz, S.M. “Epidemiology of uterine leiomyomata”, Clinical Obstetrics & Gynecology. June 2001; Vol.44(2):316-26
  2. Moorman, P.G. et al. “Comparison of characteristics of fibroids in African American and white women undergoing premenopausal hysterectomy”, Fertility & Sterility, March 2013; Vol.99(3)768-776>
  3. Weiss, G. et al. “Racial differences in women who have a hysterectomy for benign conditions”, Women’s Health Issues, May-June 2009; Vol.19(3):202-10
  4. Eltoukhi, H.M. et al. “The health disparities of uterine fibroid tumors for African American women: a public health issue”, American Journal of Obstetrics & Gynecology, March 2014; Vol.210(3)
  5. “Uterine Fibroids, Active Component Females, U.S. Armed Forces, 2001-2010”, Medical Surveillance Monthly Report, December 2011; Vol.18(12):10-13

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Is a hysterectomy the only way to treat fibroids?

Depending on their size and number, uterine fibroids can cause symptoms that range from bothersome to severe. These benign tumors, which can grow in your uterine wall, inside your uterus or on the external portion of your uterus, are relatively common in menstruating women and may require treatment in the event that heavy bleeding, cramps, frequent urination or swelling occur due to their presence. If you have this condition and are considering fibroid surgery, you may be under the impression that a hysterectomy is the only solution to your problem. The good news is that these uterine tumors can be treated in other ways that are less surgically invasive.

Hysterectomy Risks and Benefits

One reason why your doctor may recommend a hysterectomy is that this type of surgery for fibroids provides a permanent cure for the condition. Because the uterus is removed during a hysterectomy procedure, uterine fibroids do not have a place in which to grow back, and any symptoms caused directly by the fibroids should cease. However, due to the nature of this surgical procedure, a hysterectomy is generally not the first course of action unless uterine fibroids are causing major health issues. Some of the complications associated with a hysterectomy include a prolonged recovery period – typically 4 to 8 weeks – if the ovaries are removed during hysterectomy, hormone fluctuations brought about by early menopause, pelvic discomfort and bladder problems.

Uterine Fibroid Embolization

The procedure known as uterine fibroid embolization is another treatment method that your doctor may offer. This option is technically not a fibroid surgery as it is performed via catheter by a radiologist. The purpose of a uterine fibroid embolization is to cut off the blood supply to the tumors so that they will shrink significantly or disappear. The catheter used in this process is fed from your thigh into your uterine artery, upon which time an injected solution blocks the fibroids’ blood source. Embolization is a non-invasive uterine fibroid treatment that provides many women with symptom relief and does not involve a difficult recovery. Potential complications include the onset of premature menopause, infection and the need for subsequent procedures in the event that fibroids return.

Myomectomy Procedures

A myomectomy is a surgery for fibroids that involves removal of the tumors themselves while leaving the uterus in place. You may consider this option if you are hesitant to experience the menopausal symptoms that arise due to a hysterectomy but are suffering from pain due to fibroids. Myomectomies can be performed in several ways, either abdominally, laparoscopically (“keyhole surgery”) or hysteroscopically (through the vagina). Less invasive types, such as hysteroscopic myomectomies, may be outpatient, while other types require a brief hospital stay. The most common risks associated with this procedure for treating uterine fibroids include blood loss, formation of scar tissue and the need for a hysterectomy down the line.

The Acessa Procedure

The Acessa procedure is a new treatment option for uterine fibroids that has great promise due to its innovative technology, non-invasive nature and high success rate. The FDA-cleared Acessa Procedure is comprised of a handpiece with electrodes on the tip and a generator. Both of these are involved in the utilization of radiofrequency energy that shrinks or destroys each fibroid one at a time. During the procedure, a laparoscopic ultrasound probe is used to locate all of the fibroids. Though the procedure does require general anesthesia and two small laparoscopic incisions, Acessa is outpatient and involves little downtime. Acessa targets each fibroid directly so that surrounding uterine tissue stays healthy and functional. There are many risks involved in laparoscopic procedures, such as post-operative infection; to learn more you should consult an Access-trained gynecologist.

Sources:

  1. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-topic-overview
  2. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-treatment-overview

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Could fibroids be responsible for my heavy bleeding?

Ah, periods: one of the great joys of being a woman, right? (I’m kidding, obviously.) Bleeding for several days out of every month is generally inconvenient, often messy, and not at all fun… But it is a fact of life. However, not all periods are created equal; some women have heavier periods than others.

While “heavy” is somewhat of a subjective term, there are certain characteristics that distinguish abnormally heavy periods. Bleeding that could be described as “gushing” or “flooding”, for example, is not normal. Going through eight or more pads or tampons in a single day is also not normal. If you’re experiencing atypical bleeding of this nature, uterine fibroids may be the source of the problem.

Heavy bleeding is one of the most common symptoms associated with fibroids. Research has shown that women with large fibroids are two and a half times more likely to require eight or more pads or tampons on their heaviest days than women who do not have fibroids. In a study examining the link between heavy bleeding and uterine fibroids, researchers interviewed a randomly-selected group of women between the ages of 35 and 39 about their heavy menstrual bleeding (also known as menorrhagia). Of those women who were diagnosed with fibroids, 46% described having experienced “gushing” or “flooding” during their period, while only 28% of women without fibroids reported bleeding of that nature.

Why fibroids can cause excessive bleeding is unclear. However, there are plenty of theories: some experts in the field of Gynecology believe that intramural fibroids (those that grow inside the walls of the uterus) stretch the lining of the uterus, enabling more of it to be shed during menstruation. Another theory suggests that the bleeding results from fibroids impinging upon veins in the uterus, creating pressure that dilates veins in the endometrium which, during menstruation, increases blood loss. One group of researchers identified small irregularities in the contractions of uterine veins surrounding fibroids and concluded that, since the contraction of these veins plays a role in regulating blood loss, the heavy bleeding was the result of this phenomenon. None of these theories have been universally accepted as an explanation for the link between fibroids and heavy bleeding, but as fibroid research continues, a clear answer may soon emerge.

Whether your heavy bleeding is attributable to fibroids or a different issue, it can lead to further problems if left untreated, particularly anemia. An iron deficiency associated with excessive blood loss, anemia is characterized by symptoms of fatigue, dizziness, and headache. To prevent complications of heavy bleeding like anemia, women who experience especially heavy periods should consult a gynecologist right away; if you need help finding a gynecologist, our Physician Finder tool can help you identify qualified doctors in your area.

Sources:

  1. Istre, O. “Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy”, Best Practice & Research Clinical Obstetrics and Gynecology, 2008;Vol. 22, No. 4, p. 737
  2. Wegienka G, et al. “Self-reported heavy bleeding associated with uterine leiomyomata”. Obstetrics & Gynecology, 2003, Vol 101: pp. 431–437
  3. Burbank, F. Fibroids, Menstruation, Childbirth, and Evolution: The Fascinating Story of Uterine Blood Vessels, p. 107. Wheatmark, 2009. Tucson, AZ.
  4. Heavy Menstrual Bleeding in Fibroids” Fibroid.net retr.12/22/14 http://www.fibroid.net/heavy-menstrual-bleeding-in-fibroids
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