Fibroids

How are fibroids treated, and what are my options?

• Hormone Therapy - One way to reduce symptoms is by taking a type of medication called a Gn-RH (gonadotropin-releasing hormone) agonist. These hormones shrink fibroids by blocking estrogen production. Treatment is short-term, usually no longer than 3-6 months, and the fibroids usually return after treatment is discontinued. In addition, hormone therapy can have adverse side effects including those associated with induced menopause such as hot flashes, vaginal dryness, insomnia, irritability and depression. That is why these drugs are generally used only when a woman is close to or already in menopause or to shrink the fibroids and decrease bleeding prior to surgery.
  
  
• Uterine Artery Embolization - This procedure is one of the newest non-surgical approaches to treating fibroids, but it is still experimental and its long-term results are unknown. During an embolization, the doctor - usually one who specializes in radiology - uses X-ray images to guide a thin tube (catheter) through an artery in your leg to the arteries in your uterus that deliver blood to the fibroids. Once the catheter is in place, the doctor inserts tiny particles of plastic into the uterine artery. Clots then form around the particles, blocking blood flow to the fibroid. Without a blood supply, the fibroids shrink or disappear over time.

Surgical Options

• Myomectomy - A myomectomy is a surgical procedure to remove fibroids while leaving the uterus intact. It's a good option for women who want to maintain their fertility. A traditional myomectomy is done through a long, open incision in the abdomen. Some surgeons perform myomectomies using less invasive techniques that let you heal quickly and produce minimal scarring. These include Laparoscopic Myomectomy and Hysteroscopic myomectomy. See description below.
  
  Laparoscopic myomectomy: Fibroid is removed by using a laparoscope inserted through the abdomen. A surgical instrument called a tissue morcellator may be used to cut up and remove the fibroids through a tiny incision.
  
  Hysteroscopic myomectomy: Fibroid is removed by using a telescope-like instrument called a hysteroscope that is inserted through the vagina and cervix into the uterus. With this approach, the fibroid can be removed intact or a targeted electric current shaves away or vaporizes the fibroid.
  
  Learn more about the GYNECARE VERSAPOINT* Bipolar Electrosurgery System here, a minimally invasive technique, which uses vaporisation therapy to remove fibroids. Ask your doctor whether these less invasive options may be appropriate.
  
  It is estimated that in 25-50 percent of women who have had a myomectomy new fibroids may grow (Source: Minkin MJ and Wright CV. The Yale Guide to Women's Reproductive Health. New Haven, CT: Yale University Press; 2003:205. ISBN: 0-300-09820-0). The procedure is also slightly more difficult to perform than a hysterectomy and can cause more blood loss. Other potential risks include infection, damage to vital organs and, in rare cases, perforation of the uterus.
  
  Myomectomies are also associated with a high rate of adhesion formation. Adhesions consist of scar tissue that develops internally at the surgical site and can cause internal organs to bind to one another; they can sometimes cause pelvic pain and infertility. Modern surgical techniques can help to reduce adhesions, and surgeons can also place a barrier over the site to keep organs from becoming joined. The barrier gradually dissolves as you heal. Be sure to talk with your doctor prior to having a myomectomy about the steps he or she will take to keep adhesions from forming.
  
  Learn more about pelvic adhesions.
  
  Learn more about the GYNECARE INTERCEED (TC7) Absorbable Adhesion Barrier for preventing adhesion formation.
  
  
• Myolysis - This is another experimental procedure still under study. It involves using lasers, electrical current or freezing to destroy fibroids during a laparoscopic procedure.
• Hysterectomy - A hysterectomy is the surgical removal of the uterus, and is the only definite treatment for fibroids. A traditional hysterectomy is major, invasive surgery requiring general anesthesia, a 3-6 day stay in the hospital, and up to 6 weeks of recovery time. After a hysterectomy, you will no longer be able to become pregnant. If your ovaries are removed in addition to your uterus, you may experience the symptoms associated with menopause - such as hot flashes, insomnia, vaginal dryness, irritability or depression - unless estrogen replacement therapy begins soon after surgery. Hysterectomy is a common treatment for fibroids - but perhaps too common. Many of the 600,000 hysterectomies performed in the U.S. each year may be unnecessary.
  
  For all these reasons, it is important that you talk with your doctor about less invasive treatment options first. If you and your doctor ultimately decide that a hysterectomy is best for you, there are less invasive approaches to performing a hysterectomy that may lessen post-operative pain, recovery time and scarring compared to the traditional "open" approach.
  
  Learn more about different kinds of hysterectomy, including less invasive and more preservative techniques or compare hysterectomy treatment options.
  
  Compare treatment options for uterine fibroids.
  
  What factors should I consider as I think about my treatment options?
  
  What questions should I ask my doctor about?

Remember that learning all you can - and asking questions about those issues that are most important to you - is the best way to feel confident that you are making the very best decision possible.

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