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Treating Fibroids & Alternatives to Invasive Surgeries

Acessa Health | June 20, 2019

Know your options for treating uterine fibroids.

Nearly 70% of premenopausal women will develop from uterine fibroids at some point in their lives.We know that over 6.5 million women in the US have a diagnosis for uterine fibroids each year.2 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.4

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.4

Diagnostic Tests

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.4

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).4

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. 4

Hysteroscopy:

A small scope, or camera, and tube are inserted through the vagina and cervix to directly examine the uterus.4

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.

Below is a handful of treatment options available4:
  • Watching and waiting
  • Medications
  • Laparoscopic radiofrequency ablation (Acessa procedure)
  • Uterine Artery Embolization (UAE)
  • Myomectomy
  • Hysterectomy

Watching and Waiting

Watching and waiting 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 be temporary and used while determining a longer-lasting option to treat fibroids. On average, women wait 3.6 years before seeking treatment for their fibroids.3

Medications

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.4

IUDs:

IUDs are small, T-shaped intrauterine devices release progestin, which can reduce menstrual bleeding. These 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.4

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.4

Other birth control:

Oral contraceptives, especially ones with progestin, offer treatment for bleeding but typically do not affect the size or frequency of uterine fibroid.4

Acessa procedure (Laparoscopic radiofrequency ablation)

The Acessa procedure, also known as laparoscopic radiofrequency ablation (Lap 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 symptomatic uterine fibroids.9 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 destroy fibroid tissue, without harming healthy uterine tissue.9 Radiofrequency ablation is a technique used in other surgeries to destroy tumor tissue, including liver ablation.9 The Acessa procedure also allows the physician to treat almost all fibroids regardless of location.9

The Acessa ProVu system is FDA cleared and, as early 2020, the procedure has 47 peer-reviewed publications proving the safety and effectiveness at reducing menstrual blood flow and other fibroid symptoms.10

What happens to the fibroid with the Acessa procedure?

Fibroids are heated to the point where the cell tissue is destroyed.9The cellular matrix changes (imagine a hard baseball to a soft marshmallow).9,11,12 Once the fibroid is softer and smaller, it typically stops causing the symptoms.9,11,12 Additionally, over time the fibroid tissue continues to shrink7, and 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.9,11,12

Uterine Artery Embolization (UAE)4

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.5

Myomectomy

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.6 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. This is sometimes referred to as an open myomectomy.4

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.4

Hysteroscopic Myomectomy: 

Instruments will be inserted into the uterus through the cervix to remove submucosal uterine fibroids.4

Hysterectomy

This is often the most common surgical treatment for uterine fibroids, and it is also the most invasive.7 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 three to six weeks.4 There are three types of hysterectomies available, including:

Open, traditional hysterectomy: 

This involves a six to twelve inch incision made in the abdominal wall.4

Laparoscopic Hysterectomy:

Performed using the laparoscope. The surgical specimen is removed via the vagina.4

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

Sources:

  1. Baird DD, Dunson DB, Hill MV, Cousins D, Schechtman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003; 188:100 –107.
  2. Internal Analysis based on US Census population information total population women aged 15-64 (104 million women), Kaiser Family Foundation information for the number of Medicaid (25 million) and commercial lives (79 million), Wakely Actuarial Firm claims analysis for Fibroid ICD-10 diagnosis code prevalence in commercial claim data (6% of women in data set sought care for fibroid related diagnosis code) and internal assumption for Medicaid prevalence (6%)
  3. Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol. 2013;209(4):319.e1–319.e20. doi:10.1016/j.ajog.2013.07.017
  4. Mayo Clinic – Uterine Fibroids – mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288
  5. 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
  6. 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
  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. 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
  9. SG Chudnoff, et al. Outpatient Procedure for the Treatment and Relief of Symptomatic Uterine Myomas. Obstetrics and Gynecology, 2013;121(5):1075–82.
  10. Acessa Health Corporate data, proprietary system
  11. Leppert PC, Jayes FL, Segars JH. The extracellular matrix contributes to mechanotransduction in uterine fibroids. Obstet Gynecol Int. 2014;2014:783289. doi:10.1155/2014/783289
  12. 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

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.

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