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Fibroid Treatments 101 – Finding Fibroid Pain Relief

Acessa Health | November 4, 2020

We know suffering from symptomatic fibroids is hard. Add in the stress of having to choose a treatment option you’ve never heard of. No one has time for that. That’s why we are going to give you the low down on some of the most commonly offered fibroid treatment options, so you can start your journey to finding fibroid pain relief.

WARNING: We want to be real with you about these treatment options – and that means getting into the details. There are some images below that may be considered graphic.

Hysterectomy

Hysterectomies are the most commonly offered treatment option when it comes to uterine fibroids. In fact, it is the most frequently performed gynecologic surgery in the United States, with over 600,000 performed annually – 250,000 of which occur because of fibroids.1,2  

A hysterectomy involves removing the entire uterus from the body. There are three ways a hysterectomy can be performed. The method your physician chooses is likely dependent upon the size and location of the fibroids. The three methods include:

 

  • Open
    • This requires an open abdominal incision.
  • Laparoscopic (Robotic or Straight Stick)hysterectomy
    • A laparoscopic hysterectomy entails the surgeon making small incisions on the abdomen and performing the hysterectomy using a laparoscope.
  • Vaginal
    • A vaginal hysterectomy removes the entire uterus through the vagina.

 

Like any procedure, there are pros and cons to choosing a hysterectomy. Many women choose a hysterectomy because it removes the entire uterus, meaning it addresses all fibroids & fibroid related symptoms. It also ensures those pesky fibroids won’t be making an unwanted comeback. However, it has one of the longest average recovery times, at four to six weeks.3

Hysterectomies are generally very safe, but there are ultimately risks to any surgery. Risks of abdominal, robotic, and vaginal hysterectomies include heavy bleeding, blood clots, infection, damage to surrounding organs, and earlier onset of menopause.,4,5

Myomectomy

A Myomectomy is another common option when it comes to uterine fibroids. This procedure involves surgically removing the fibroid directly from the uterine lining. After the fibroid is removed, the surgeon will suture the uterine muscle back together. Like a hysterectomy, there are multiple approaches to completing a myomectomy.

  • Open (abdominal incision)
    • Like an open hysterectomy, an open myomectomy entails your surgeon making an abdominal incision to access your uterus and remove the fibroids.
  • Laparoscopic (Robotic or Straight stick)
    • This is often referred to as “minimally invasive.” In these procedures, several small abdominal incisions are made to gain access to the uterus.
  • Hysteroscopic
    • A hysteroscopic myomectomy is performed by inserting an instrument through your vagina and cervix into your uterus. The fibroid is then cut from the uterine lining.

Although the risk of complications during a myomectomy are low, it is important to know what they are. Some risks include: excessive blood loss, a rare chance of spreading cancer, and scar tissue. When the fibroid is cut from the uterine lining, it can lead to adhesions, and bands of scar tissue can develop after surgery.6 Myomectomies are also similar to hysterectomies in their recovery time. On average, recovery lasts 2-4 weeks.7

Still, myomectomies are right for a lot of women. Some women may consider a myomectomy if they are interested in preserving their uterus or are considering future fertility.

Acessa – Laparoscopic Radiofrequency Ablation (Lap RFA)

Acessa, or Laparoscopic Radiofrequency Ablation, was designed to maintain the integrity of the uterus by focusing treatment solely on the fibroid (vs. a myomectomy which involves cutting into healthy uterine tissue to removing a fibroid.)8,9

Acessa works by applying heat directly into the fibroid – which then destroys the fibroid tissue, causing it to shrink over time. Imagine the fibroid starting like a hard baseball, then after Acessa and over time, it shifts into a soft marshmallow.

How does that help symptoms of the fibroid isn’t removed? 

The uterus is designed to contract (after all, it’s primary purpose is to contract when delivering a baby!). When it has hard baseball-like fibroids in it, it has difficulty contracting as it is designed to, causing symptoms like heavy periods, pressure and pain.

This change in the size and consistency of the fibroids then leads symptoms such as heavy periods, frequent urination, looking pregnant when not, pelvic pain, etc. to improve over time.

How long is “over time”? 

In data collected, most improvement is seen within 3-6 months after the procedure, and continued improvement occurs throughout the first year after the procedure.10

You’re probably thinking, “that all sounds great, but how does it work?” Acessa is performed laparoscopically through three small incisions in the abdomen. During the procedure, your physician will use something called an ultrasound probe with guidance mapping. This allows him or her to see, and therefor treat, more fibroids. Finally, he or she will insert the tip of the Acessa handpiece into the fibroid tissue. The controlled heat destroys the fibroid, while preserving healthy uterine lining.

Fun fact: radiofrequency ablation is not a new technique. However, Acessa is the first of its kind to use Lap RFA on uterine fibroids. RFA has been used to treat conditions in the liver, bone, and prostate for years.

Benefits of the Acessa procedure include a quick recovery time, symptom improvement, and low reintervention rates (needing a second treatment.) 10 After the procedure, patients go home the same day, on NSAIDS, and are back to work in 4-5 days.10 Additionally, the shrinkage of fibroids can result in significant symptom improvement, including heavy periods, pelvic pain, and bulk.10

Although Acessa is a minimally invasive procedure, it is still surgery. That means risks are still a possibility. Risks of the Acessa procedure include, but are not limited to, skin burns from the dispersion of RF energy, post-procedural discomfort, infection, vaginal bleeding, and complications related to laparoscopy and general anesthesia.

Hysteroscopic Myomectomy

As mentioned above, a hysteroscopic myomectomy is a minimally invasive option for removing fibroids. During the procedure, your surgeon will remove the fibroids using instruments inserted through your vagina to gently cut away the fibroid tissue and remove it from the body.

Here is how it works:

  • Your surgeon inserts a thin camera (hysteroscope) through your vagina and cervix into the uterus to visualize the fibroids
  • He or she will then insert a second tool into your uterus through the vagina. This tool is designed to cut the fibroid tissue and remove it from the body
  • Once the fibroid is removed, the surgeon removes his or her tool from the body – nothing is left in your body after the procedure

Some surgeons choose to perform a hysteroscopic myomectomy concomitantly with Lap RFA. He or she may choose to do this based on the size or location of the fibroids. This allows for your surgeon to ultimately treat more of your fibroids!

As with any procedure, risks and benefits are associated with a hysteroscopic myomectomy. A lot of women choose this procedure because it is minimally invasive and preserves the uterine form and function, which is especially important if you plan to have children in the future. Additionally, most women return to normal activities within 2 days. Still, there are risks to be aware of. Some of these risks include damage to the cervix, putting a hole in the uterus, inability to completely remove the fibroids, and development of adhesions or scar tissue inside the uterine cavity.11

 

UAE

Uterine Artery Embolization – sometimes referred to as Uterine Fibroid Embolization – treats fibroids by cutting the blood flow off from the uterus, causing the fibroids to shrink and die.

During the procedure, an interventional radiologist inserts a catheter to inject small “embolic agents” (imagine tiny beads) into the uterine arteries – that’s where the blood supply for your uterus and fibroids comes from. The particles block the fibroid blood vessels, essentially causing it to starve. As a result, the fibroids shrink and die.

Generally, the patient goes home the same day as the procedure. Post procedural pain usually ends within a day or two but can last up to a few weeks. The average recovery time is 13 days.12 Women may consider UAE because it is minimally invasive and preserves the uterine function and form.

Just like any procedure – UAE has risks associated and they are about the same as the risks of any surgical treatment for fibroids. They include post-embolization syndrome, amenorrhea, pain, vaginal discharge of fibroid material, hot flashes, and endometritis/myometritis (infection).13

Choosing Your Treatment

Hopefully by now these treatment options feel a little less overwhelming, and a lot less confusing. If it still feels like a lot, not to worry! Try checking out our easy to use fibroid treatment comparison chart.

By the way, we want you to know that we get it. When all you care about is relief from fibroid symptoms, learning about treatment options can feel daunting. But here is the thing – if you do not educate yourself on all of the options, how will you know if they are all being offered to you? Maybe there is a better option for you – and the good news is that there are options.

Sources:
  1. Clarke-Pearson, D. L., & Geller, E. J. (2013). Complications of Hysterectomy : Obstetrics & Gynecology. Retrieved from https://journals.lww.com/greenjournal/Abstract/2013/03000/Complications_of_Hysterectomy.23.aspx
  2. Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122:233-241.
  3. Cleveland Clinic – Hysterectomy: Reocvery and Outlook https://my.clevelandclinic.org/health/treatments/4852-hysterectomy/recovery-and-outlook
  4. Mayo Clinic – Vaginal Hysterectomy https://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/about/pac-20384541
  5. Mayo Clinic – Abdominal Hysterectomy https://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/about/pac-20384559
  6. Mayo Clinic – Myomectomy https://www.mayoclinic.org/tests-procedures/myomectomy/about/pac-20384710
  7. Tsuzuki, Y., Tsuzuki, S., Wada, S., Fukushi, Y., & Fujino, T. (2019, January). Recovery of quality of life after laparoscopic myomectomy. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30255650
  8. Yelena Havryliuk, MD, Robert Setton, MD, John Carlow, EdD, MPH, Barry D. Shaktman, MD, Management of symptomatic fibroids: review and meta-analysis of the literature (2006—2016), Journal of the Society of Laparoendoscopic Surgeons, Vol. 21 (3) Jul—Sept 2017
  9. Lee BB, Yu SP. Radiofrequency Ablation of Uterine Fibroids: a Review. Curr Obstet Gynecol Rep. 2016;5(4):318—324. doi:10.1007/s13669—016—0183—x
  10. SG Chudnoff, et al. Outpatient Procedure for the Treatment and Relief of Symptomatic Uterine Myomas. Obstetrics and Gynecology, 2013;121(5):1075-82.
  11. AAGL Hysteroscopic Myometctomy https://www.aagl.org/patient/Hysteroscopic-Myomectomy-AAGL.pdf
  12. Pron G, Mocarski E, Bennett J, et al. Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. Journal of Vascular and Interventional Radiology : JVIR. 2003 Oct;14(10):1243-1250. DOI: 10.1097/01.rvi.0000092664.72261.f9.
  13. Kröncke, T., David, M., & participants of the Consensus Meeting (2015). Uterine Artery Embolization (UAE) for Fibroid Treatment – Results of the 5th Radiological Gynecological Expert Meeting. Geburtshilfe und Frauenheilkunde, 75(5), 439–441. https://doi.org/10.1055/s-0035-1545999

 

 

Acessa Health encourages patients to seek medical attention for typical and atypical symptoms associated with fibroids to help achieve and maintain good health with as high a quality of life as possible. Although many patients may benefit from the Acessa Procedure, this treatment is not for everyone and results may vary. You should talk to your doctor about the potential benefits and risks and whether this treatment is right for you. Information contained on this site is not to be used as a substitute for talking to your doctor. You should always talk to your doctor about diagnosis and treatment information.

 

The Acessa ProVu system is cleared by the FDA for the treatment of symptomatic uterine fibroids under laparoscopic ultrasound guidance.

The Acessa procedure is generally safe but complications may occur and can be serious. Risks and complications associated with the Acessa procedure include, but are not limited to: skin burns from the dispersion of radiofrequency energy, mild intra‐operative bleeding, transient urinary retention or urinary tract infection, adhesion formation, post‐procedural discomfort (cramping, pelvic pain), and transient amenorrhea, infection, injury to adjacent structures, vaginal bleeding and temporary anemia, blood loss requiring transfusion or hysterectomy, pneumothorax, wound dehiscence, deep vein thrombosis and pulmonary embolus, treatment failure, and complications related to laparoscopy and/or general anaesthesia including death.

Insufficient data exists on which to evaluate the safety and effectiveness of Acessa procedure in women who plan future pregnancy. Therefore, the Acessa procedure is not recommended for women who are planning future pregnancy. There is limited data regarding pregnancy following the Acessa procedure, if you become pregnant following the Acessa procedure, you should contact your doctor immediately.

Please consult with your doctor to understand the risks and benefits of surgery and find out if Acessa may be right for you. Rx Only. 

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