Where can I learn more about fibroid treatment options?

If you have been newly diagnosed with fibroid tumors or fear that you might have developed one or more fibroids, it is valuable to educate yourself on the condition and all of the treatment options available. These days, Internet research is, the preferred and most convenient method of obtaining information. With the vast amounts of medical information and fibroid-related websites that are floating around in cyberspace, however, you may not know where to start, or which online sources are reliable. For those fibroid sufferers who prefer to do research offline, certain sources are also more reliable than others. To ensure that the information you’re getting is trustworthy, follow these tips:

Government and Academic Websites

Not all websites are created equal, and bogus information can often be packaged in very fancy or official-looking websites. (Didn’t your mother warn you to not trust everything you read on the Internet?) Generally speaking, websites with URLs ending in “.gov” or “.edu” are going to be some of the most trustworthy sources of medical information, because their contents are produced and verified by government or educational institutions, respectively.

PubMed.gov [link: http://www.ncbi.nlm.nih.gov/pubmed/] is operated by the National Institute of Health and is an extension of the US National Library of Medicine; it contains a massive database of research studies, clinical data, and medical journal articles. The U.S. Department of Health and Human Services operates WomensHealth.gov [http://www.womenshealth.gov/index.html], where fibroid patients can find a wealth of information on fibroids and their treatment.

Additionally, reputable medical schools with affiliated women’s health clinics typically provide general information on gynecological conditions, as well as information on fibroid treatments that their clinics perform and any clinical trials in which their institution is participating. The Women’s Health Center at the University of California, San Francisco (UCSF) operates a dedicated Comprehensive Fibroid Center [http://coe.ucsf.edu/coe/fibroid/index.html], where cutting-edge treatments and fibroid research are continually being performed.

Websites of National Health Organizations

In addition to government and academic websites, websites published by nationally-recognized associations, such as the American Society for Reproductive Medicine’s ReproductiveFacts.org [http://www.reproductivefacts.org/] can be good resources for information on gynecological conditions like Uterine Fibroids.

Websites of FDA-Regulated Products

Websites belonging to companies that develop and/or manufacture fibroid treatments (such as acessaprocedure.com), are also excellent resources for learning about your treatment options, since the accuracy of the information they contain must follow FDA requirements and are sometimes included in FDA audits. Companies manufacturing fibroid treatments typically offer ample information about the procedure, device, or drug or their website, and any product claims made on sites by these FDA-regulated products must be substantiated by clinical data. Be advised that such quality assurance does not necessarily exist, however, with the websites of companies that sell or endorse homeopathic or “alternative” fibroid treatments, however, because the claims of products or procedures of this nature may not have been approved or cleared by the FDA; thus, you may want to double-check any information obtained about your condition from those sites.

Your Physician

While you can probably find out everything you ever wanted to know about the condition and treatment of Uterine Fibroids on the Internet, a knowledgeable, licensed gynecologist is still the best source of advice on treating your individual case. As with any medical condition, no single treatment is appropriate for every patient. A physician has the ability to consider your unique medical history, state of health, and the nature/severity of your fibroids when recommending a course of treatment.
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If you have not yet been diagnosed with fibroids and are experiencing abnormal symptoms like heavy menstrual bleeding, abdominal or lower back pain, and severe bloating, protect your health by seeing a doctor as soon as possible. Once you have seen a doctor and know exactly what you’re dealing with, you can start exploring your options for relieving those burdensome symptoms, treating their underlying cause, and moving on with your life.

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Endometrial Ablation vs. Radiofrequency Ablation: What’s The Difference?

 

The term “ablation” refers to a process by which tissue is destroyed, typically using either heat (thermal ablation) or cold (cryoablation). Ablative technologies are used to treat numerous medical conditions, including gynecological issues. We often hear of two procedures in particular, endometrial ablation, and radiofrequency ablation, and many people confuse the two treatments. Don’t let the similar names deceive you though: while both procedures leverage ablative technology, they are very different in their applications. To clear up the confusion, here’s a rundown on the defining characteristics of the two ablation therapies.

Endometrial Ablation (EA)

How EA Works
Endometrial ablation is typically used to treat prolonged, abnormal uterine bleeding. It does so by ablating the lining of the uterus, known as the endometrium, permanently destroying the tissue. There are several different methods of endometrial ablation: these include freezing (cryoablation techniques), directly applying heat from fixed-frequency microwaves or radiofrequency energy; and using hot fluid through techniques like balloon endometrial ablation.

In EA, treatment is limited to the endometrial layer, the surface tissue that lines the uterine cavity, and the basalis layer, where the endometrial tissue originates. Destroying the basalis layer prevents new tissue from growing, thereby reducing or eliminating menstrual bleeding.

EA procedures are performed in an office or hospital setting, usually with the patient under conscious sedation. Patients typically go home the same day, and full recovery takes about 1-2 weeks, depending on the specific procedure.

Outcomes
Endometrial ablation is used to control prolonged, abnormal vaginal bleeding. EA is most appropriate for patients that have completed childbearing, who have not seen results from other treatment approaches, and who are seeking an alternative to hysterectomy.

In most cases, EA meets its objective: an estimated 9 out of 10 women have lighter periods or no periods after undergoing the procedure. However, it’s difficult to predict whether a woman’s bleeding will stop completely. Estimates regarding the incidence of amenorrhea (the absence of menstrual bleeding) after EA vary widely from one study to the next, but it’s typically estimated to fall between 20% and 50%. A study by El-Nashar et al. asserted that the likelihood of amenorrhea occurring after EA depends on the type of ablative technology used, as well as patient characteristics like age and uterus size. Regardless, amenorrhea is not a guaranteed outcome. “If… a woman’s goal is amenorrhea, hysterectomy is the only reliable op¬tion,” reports Dr. Joseph Sanfilippo in an update to the medical community on EA-related developments.

It is important to note that endometrial ablation is not indicated for the treatment of uterine fibroids; any destruction of fibroids in the process of ablating the endometrium is incidental. Fibroids that grow partially or entirely within the walls of the uterus (known as intramural fibroids), as well as those growing outside the uterus (subserosal fibroids), are not reached during ablation. Those that protrude into the uterine cavity (submucosal) are sometimes shaved down hysteroscopically before ablation; however, if the fibroid originates below the basalis layer of tissue, it cannot be completely eradicated during ablation and may grow back, following the procedure.

Radiofrequency Ablation (Acessa Procedure)

How RFVTA Works
Radiofrequency ablation (short for “radiofrequency volumetric thermal ablation”, or RFVTA) is a specific ablation technique that is used to treat uterine fibroids in a procedure known as Acessa. In the Acessa procedure, a controlled volume of heat is applied directly to the fibroid, killing the tissue of the fibroid while leaving healthy surrounding tissue unharmed. Once the fibroid is destroyed, the dead tissue is simply reabsorbed by the body.
In performing RFVTA, a scope and a laparoscopic ultrasound probe are inserted through the abdominal incisions. Using the scope in conjunction with the ultrasound probe allows the operating physician to precisely pinpoint the fibroids’ location. Once the fibroids have been located, the surgeon uses a special tool with a retractable electrode array (the Acessa handpiece) to ablate the fibroid with radiofrequency energy.
RFVTA is performed in an outpatient setting. The surgery is minimally invasive: with the exception of two tiny incisions (no wider than 1/4 inch) on the abdomen, there is no cutting or suturing of uterine tissue. Patients go home the same day and return to normal activities within 2-3 days.

Outcomes
Clinical research has shown radiofrequency ablation to be very effective in shrinking or completely eliminating fibroids. The use of laparoscopic ultrasound reduces the risk of symptom recurrence by allowing the physician to find and treat all fibroids present in the uterus, not just the ones that were identified through previous diagnostic imaging. At 36 months post-treatment, 90% of patients needed no additional fibroid treatment. Though objectively measured bleeding at 12 months of follow up decreased in 82% of the women treated with RFVTA, the goal of treatment was not to destroy the endometrium or induce amenorrhea but merely to treat the fibroids.
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In the field of gynecology, ablation techniques can be used in addressing multiple conditions but it’s important to understand the difference between the technologies. Radiofrequency ablation with Acessa is an effective method for treating only the uterine fibroids without harming the rest of the uterus, whereas endometrial ablation effectively controls abnormal vaginal bleeding by directly ablating the lining of the uterus. Their usefulness is entirely related to their objective, and despite the commonality of a name, these procedures are very different in the objectives they serve.

SOURCES:

  1. American Society for Reproductive Medicine, “Endometrial Ablation”, ReproductiveFacts.org: 2011. Retrieved May 28, 2015, from http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endoablation.pdf
  2. El-Nashar, S.A. et al. ” Prediction of Treatment Outcomes After Global Endometrial Ablation”, Obstetrics & Gynecology, Jan. 2009; 113(1): 97–106. doi:10.1097/AOG.0b013e31818f5a8d.
  3. Sanfilippo, J. “Update: Options in Endometrial Ablation”, Supplement to OBG Management, Dec. 2009
  4. Berman, J.M. et al. “Three Years’ Outcome from the Halt Trial: A Prospective Analysis of Radiofrequency Volumetric Thermal Ablation of Myomas”, The Journal of Minimally Invasive Gynecology, 2014.

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