Ovarian Fibroid Procedures

According to the University of Pennsylvania, fibroids are a common abnormal growth within the uterus and are the No. 1 reason U.S. women have a hysterectomy. Fibroids are believed to be affected by estrogen levels within the body. Formation of estrogen begins when a woman begins menstruating, peaks in her 30s and becomes nearly non-existent after menopause unless hormone supplements are taken. Fibroids can be as small as an apple seed or as big as a cantaloupe and they are most often non-cancerous. Most fibroids never become a problem. Surgery is only required when symptoms become severe.

When Surgery is Required

• Although fibroids often dissipate by themselves as a person ages, sometimes monitoring is not enough and additional treatment is required. The necessity of treatment is often determined by the severity of symptoms. Severe symptoms include heavy bleeding or painful menstrual cycles; the sensation of fullness in the pelvic region; enlargement of the lower abdomen; frequent urination; pain during sex; lower back pain; complication during pregnancy or labor, including being six times more likely than the average birth mother to deliver via cesarean; and reproductive problems such as infertility. Infertility due to fibroid formation, however, is very rare.

Surgical Procedures

• There are five surgical options to treat fibroids. Myomectomy is the best surgical option for women who wish to have children after fibroid treatment because it keeps the uterus intact. The worst-case scenario is that a woman may have to deliver via cesarean section. This can be a major surgery (i.e., involve entrance through the abdominal wall) or done vaginally through scopes. The surgical route depends on the size and location of the fibroids.

  Hysterectomy is the only guaranteed way to eliminate fibroids altogether without the chance of them recurring, since the uterus is removed during this procedure. However, this surgery must be considered carefully and if the patient wants to have children, other surgical options may need to be explored. Removal of the ovaries and cervix are also an option during this procedure, but this is not recommended unless deemed necessary. This procedure can also be performed either vaginally, if the fibroids are small, or through the abdominal wall for larger fibroid growths. This procedure has the longest recovery period of all the available surgical options for fibroid treatment.

  Endometrial ablation is done on an outpatient basis and uses various methods to burn the lining of the uterus to control heavy bleeding. The burning of the uterine lining can be done via many different methods, such as boiling water, lasers, wire loops, electric current, microwaves, freezing and other methods. Complications that occur from this procedure are extremely rare, and recovery time is quick and relatively painless. Approximately 50 percent of the women who opt for this procedure stop menstruating, while three out of 10 experience much lighter bleeding. Like the hysterectomy, pregnancy is not possible after this procedure.

  Myolysis is the simplest of all the procedures and perhaps the most minimally invasive. This technique for fibroid treatment involves inserting a needle directly into the fibroid via the use of a laproscope. Electric current or a freezing agent is then passed through the needle directly into the fibroid to destroy the growth.

  The final surgical approach to fibroid treatment is known as uterine fibroid embolization (UFE) or uterine artery embolization (UAE). The best patients for this procedure have fibroids that are causing heavy bleeding or pressure on the bladder or rectum, do not want to have a hysterectomy and do not wish to have children. In this procedure, a laproscope is used to find the blood supply to each fibroid. Once located, a thin plastic or gel particle is injected into the blood vessel to cut off the blood supply to the growth. This procedure can be an outpatient or inpatient procedure with few complications. Studies have shown that after this type of treatment, fibroids are not likely to recur.

Prognosis

• The prognosis for women who have issues with fibroid growth is determined by the treatment they choose. Typically, fibroids will not create a problem for most women and will go away on their own with time. They do not typically keep a woman from experiencing a happy and normal life. On the rare occasion that they do, the avenue of treatment chosen affects the prognosis regarding the recurrence of such growths.