Treating Fibroids and Alternatives to Invasive Surgeries
Nearly 70% of premenopausal women will suffer from uterine fibroids at some point in their lives. Uterine fibroids are noncancerous growths in, on, and around the uterus. Many women discover the presence of uterine fibroids because of symptoms such as excessive bleeding during periods, swollen abdomens and pain during sexual intercourse. Other women are diagnosed with fibroids before symptoms develop. Most physicians who suspect uterine fibroids confirm the diagnosis via one or more diagnostic tests before exploring treatment options.
- Lab tests: Blood tests are performed when patients present with fibroid symptoms such as heavy or prolonged menstrual bleeding. The results from blood tests can help the physician determine if the patient is anemic or having issues with blood loss as a result of the fibroids.
- Ultrasound: Ultrasound imaging provides an inside view of soft tissue and the uterus through high-frequency sound waves. Depending on the placement of uterine fibroids, the ultrasound might be transabdominal (over the stomach) or transvaginal (inside the vagina).
- Magnetic resonance imaging (MRI): MRIs provide higher-resolution images of the uterus and surrounding tissues, allowing the physician to find more specific locations and sizes of the uterine fibroids.
- Hysteroscopy: A small scope, or camera, and tube are inserted through the vagina and cervix to directly examine the uterus.
After a woman is diagnosed with symptomatic uterine fibroids, most doctors will start to explore treatment plan options to address the fibroids, fibroid symptoms, and any lingering effects. Concerns about current or future symptoms, as well as less-invasive treatments, should be explored with an OB/GYN while the treatment plan is being developed.
- Waiting and Watching
- Acessa Procedure (Laparoscopic radiofrequency ablation)
- Uterine Artery Embolization (UAE)
Waiting and Watching
Waiting and watching is often the first option presented to women with uterine fibroids. This approach may be optimal for women who have no symptoms or those who find their current symptoms manageable. Because fibroids often grow and may shift in placement throughout a woman’s life, this option may temporary and used while determining a longer-lasting option to treat fibroids.
Uterine fibroids can be affected by the hormones of the menstrual cycle. One of the most common and noticeable symptoms of uterine fibroids is heavy bleeding and longer than normal periods lasting more than seven days. Medications can address heavy periods or bleeding, though none currently destroy or fully shrink fibroids. Common medications for fibroids are:
- Gn-RH agonists: Gonadotropin-releasing hormone (Gn-RH) agonists release hormones that put the body into a state similar to menopause and post-menopause. This will improve heavy bleeding and may reduce the fibroid size. Common names for these drugs include Lupron and Synarel. Because many women find issues with postmenopausal bodily changes, like hot flashes, Gn-RH agonists are typically administered as short-term drugs.
- IUDs: IUDs are small, T-shaped intrauterine devices release progestin, which can reduce menstrual bleeding. IUDs are a popular option because they provide long-lasting birth control. A short insertion procedure gives women birth control for anywhere from 3 to 12 years, all while lessening menstrual and fibroid-related symptoms. However, progestin-releasing IUDs typically do not shrink uterine fibroids.
- Tranexamic acid: Tranexamic acid is known often by its branded name Lysteda, this is a non-hormonal oral medication women use when they experience heavy bleeding.
- Other birth control: Oral contraceptives, especially ones with progestin, offer treatment for bleeding but typically do not affect the size or frequency of uterine fibroids.
Acessa Procedure (Laparoscopic radiofrequency ablation)
The Acessa Procedure, also known as laparoscopic radiofrequency ablation (RFA), is an outpatient procedure (i.e., go home from the surgery the same-day) performed under general anesthesia (i.e., patients are asleep during surgery) to treat uterine fibroids. It is a minimally invasive alternative to hysterectomy, myomectomy and uterine artery embolization (UAE) for uterine fibroids. Acessa utilizes radiofrequency ablation (heat) under laparoscopic ultrasound guidance to shrink or eliminate the fibroid, without harming healthy uterine tissue. Radiofrequency ablation is a technique used in other procedures to destroy tumor tissue, including liver ablation. The Acessa Procedure allows the physician to treat almost all fibroids regardless of size and location.
Acessa is FDA cleared and has 38 peer-reviewed publications proving the safety and effectiveness at reducing menstrual blood flow and other fibroid symptoms.
What happens to the fibroid with the Acessa Procedure?
Fibroids are heated to the point where they are destroyed and no longer fibroids. The cellular matrix changes. They go from hard golf balls or baseballs to marshmallows. Since the fibroid is like a marshmallow, the fibroid typically stops causing the symptoms. When the heated tissue shrinks, the destroyed cells typically get recycled in the body. The recycling process is a normal healing process the body does with any destroyed tissue cells.
Uterine Artery Embolization (UAE)
An interventional radiologist uses a catheter to deliver small particles of embolic agents to block the blood supply to the uterus. The fibroids then shrink and die because of blood loss. UAE is not used to treat larger fibroids. Because the agents affect the bloodstream and can raise chances of infection, there is risk to the uterus or other nearby organs if blood flow is reduced too much. Without any complications, patients usually spend one night in the hospital for pain control and recover in an average of seven to 10 days.
Myomectomy is a procedure in which uterine fibroids are surgically removed from the uterus. Recovery times average two to six weeks, depending on the surgical approach. There are many types of myomectomies available, including:
- Abdominal Myomectomy: A small cut is made through the lower abdomen, and the physician will remove fibroids on the outside wall of the uterus.
- Laparoscopic Myomectomy: Four one-centimeter cuts are made around the abdomen for a small rod and scope to insert instruments that will be used to remove the uterine fibroids.
- Hysteroscopic Myomectomy: Instruments will be inserted into the uterus through the cervix to remove submucosal uterine fibroids.
This is often the most common surgical treatment for uterine fibroids, yet it is also the most invasive. This surgery removes the woman’s uterus. It can signal the woman’s body to transition into a post-menopausal state, with hormone changes and symptoms. The average recovery time is four to six weeks.
Seek expert advice
Many women can feel overwhelmed about what to do when living with uterine fibroids. This can be exacerbated when the treatments do not effectively treat the symptoms, some of which women live with for years, even decades.
Women should always discuss these options with a physician. Sometimes, women may desire to seek a second opinion. Not all doctors offer every fibroid treatment option. To find a physician who offers multiple treatment options, including Acessa, search here on the Physician Finder.