BEST TREATMENT FOR UTERINE FIBROIDS

Uterine fibroids can often be discovered during a routine pelvic test with your OBGYN. If the doctor feels abnormalities in the shape of your uterus, this may be an indication that uterine fibroids are present.  

Treatment for fibroids can vary from no treatment at all to surgical and medical procedures. Some women may have little to no symptoms, while others can experience debilitating issues such as: 

• Heavier than normal menstrual bleeding.
• Periods that last more than a week.
• Anemia
• Pain with intercourse
• Pelvic pain and/or pressure
• Frequent urination
• Problems emptying the bladder
• Constipation
• Leg pains and/or backache

If you have been diagnosed with uterine fibroids and are looking for the best treatment option, this can be an overwhelming task. To help you along this wellness journey, we can provide a breakdown of the main treatment options. 

Looking to find the Best Treatment for Uterine Fibroids in Miami, Pompano, and South Florida, we can help. Broward County: (954) 884-8150 Dade County: ​​(305) 907-6191.

Medication 

There are medications available to help temporarily treat fibroid symptoms but the fibroids will still remain. For some women, this option is preferred to surgery. It is vital that each patient discuss medication options with her physician and consider the risks and side effects beforehand.

Contraceptives

Some women have found relief from fibroid symptoms with the use of contraceptives (birth control pills). Though these hormonal medications aim to regulate the menstrual cycle and reduce excessive bleeding, they do nothing to shrink or remove the fibroids.

Hormone therapy

Hormone therapy is a common approach by many OBGYNs. It works by using medications to block the production of estrogen and progesterone, thereby putting a woman’s body into almost a menopause-like state. As a result, menstruation stops, and fibroids can potentially shrink. Some of the common medications used are Depo Provera and Lupron. Some of the risks involved with Depo Provera include:

Nausea
Weight gain
Headaches
Depression
Difficulty getting pregnant up to 10 months after stopping treatment.

Lupron has similar side effects and there have been concerns from the National Women’s Health Network (www.nwhm.org) who state “there should be increased public awareness of the potential harms of Lupron so that women can make an informed decision about using the drug. Women have contacted NWHN, stating that Lupron has had adverse effects on their health and daily life. Some of the side effects listed by Everyday Health include dizziness, hot flashes, headache, joint pain, bone pain, nausea, changes in sexual desire, depression, and heart rhythm changes.”

For these reasons, many women prefer to avoid medications to treat their uterine fibroids.

Medicated Intrauterine Devices (IUD) 

An intrauterine device (IUD) is a small plastic device that is inserted into the uterus to prevent pregnancy. It works by discharging a modest quantity of hormones directly into the uterine cavity. In some cases, this may help with excessive bleeding caused by fibroids.

An IUD placement is usually performed during a regular office visit with your OBGYN and does not require any kind of surgery. This is not, however, considered one of the most effective methods to treat uterine fibroids.

Hysterectomy 

Hysterectomy is a major surgery where the uterus is removed. This ends menstruation and the ability to conceive. This procedure may also involve the removal of additional organs, such as fallopian tubes and/or ovaries. Here are the different options for organ removal for a hysterectomy:

Complete/Total removal  

This involves the removal of both the uterus and cervix.

Partial or Subtotal Hysterectomy (Supracervical Hysterectomy)

The removal of the upper uterus but the cervix is left intact. 

Total hysterectomy with bilateral salpingo-oophorectomy

The removal of the uterus, fallopian tubes (salpingo), cervix, and ovaries (oophor). 

A radical hysterectomy with bilateral salpingo-oophorectomy 

The removal of the ovaries, uterus, cervix, fallopian tubes, the upper portion of the vagina including some surrounding tissue, and lymph nodes (in applicable cases). This type of hysterectomy is commonly performed to treat cancer of the uterus or cervix. 

There are also many surgical approaches to perform a hysterectomy such as: vaginal hysterectomy, laparoscopic hysterectomy, and abdominal hysterectomy. The procedure of choice depends on a variety of factors that will be assessed by each doctor and discussed with the patient. 

Vaginal Hysterectomy

A vaginal hysterectomy, as its name suggests, is when the uterus is removed from the vagina as opposed to an abdominal incision. To be a candidate for a vaginal hysterectomy, the size of the uterus must not be too large. This procedure is performed with general anesthesia and the recovery period may involve a combination of mild to severe pain that can last around 10 days. Full recovery usually lasts about 4 weeks. 

Abdominal Hysterectomy

This type of hysterectomy is when the uterus is surgically removed from the lower abdomen. In certain cases where the uterus is larger than normal or there is a scar from a previous operation, there could be a vertical incision instead of the usual “bikini cut”, which is horizontal. 

LAPAROSCOPIC HYSTERECTOMY

This is a newer procedure that is less invasive than traditional hysterectomies. The uterus is removed through a series of very small incisions in the lower abdomen (this may not be an option for women with a larger than normal uterus). Generally, the incisions are about one-centimeter wide and are made around the navel, below the bikini line, and near each hip. Then, carbon dioxide gas is infused inside the abdominal cavity to expand it so that the uterus and the organs around it can be easier to visualize. Through the incision points, a tiny telescope is placed so the doctor can see the uterus, ovaries, and fallopian tubes. Utilizing long instruments, the doctor cuts the uterus into segments so they can be removed through the incisions. Finally, the gas is released and the incisions in the abdomen layers will be closed with sutures (stitches) and the skin incisions are closed with sutures or titanium staples. The majority of women will spend about 1 night in the hospital followed by 2 to 4 weeks of recovery time. 

Looking to find the Best Treatment for Uterine Fibroids in Miami, Pompano, and South Florida, we can help. Broward County: (954) 884-8150 Dade County: ​​(305) 907-6191.

Myomectomy 

A myomectomy is a procedure where fibroids are surgically removed. Unlike a hysterectomy, the uterus is preserved. There are 3 general ways to do a myomectomy. The preferred method depends on the size and number of fibroids.

Abdominal Myomectomy

This is the common procedure for cases where fibroids are large or abundant. It is performed using general anesthesia so patients are not awake during the procedure. A surgical cut is made in the lower abdomen, also known as a “bikini cut”, and the fibroids are removed from the uterus wall. The uterus is then sewn back together with sutures (stitches). The general hospital stay for a myomectomy is at least 2 nights and the recovery period can range from 4 to 6 weeks.  

Laparoscopic Myomectomy

In a laparoscopic myomectomy, a series of small cuts are made in the lower abdomen. Carbon dioxide gas is then introduced to lift the abdomen, similar to the laparoscopic hysterectomy mentioned above. A tube known as a trocar is inserted into the incision and a tiny video camera called a laparoscope is placed into the tube. This allows the surgeon to see the ovaries so they can remove the fibroids through the other small incisions using special instruments. This procedure also requires general anesthesia and women usually spend about 1 night in the hospital followed by 2 to 4 weeks recovery time. 

Hysteroscopic Myomectomy

This less invasive myomectomy may be recommended in cases where a woman has small submucosal fibroids. These are a particular type of fibroids that develop throughout the inner layer of the uterus, also known as the submucosal layer. A hysteroscopic myomectomy is performed using an instrument called a hysteroscope, which is sort of like a telescope that allows doctors to remove fibroids using high-frequency electrical currents. Like an abdominal myomectomy, this procedure also requires general anesthesia. However, many patients are able to go home hours after the procedure, instead of days. 

Looking to find the Best Treatment for Uterine Fibroids in Miami, Pompano, and South Florida, we can help. Broward County: (954) 884-8150 Dade County: ​​(305) 907-6191.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) is an approach to treat uterine fibroids which is significantly less invasive than the traditional methods mentioned above. This safe and effective non-surgical procedure is performed under conscious sedation through an IV in the patient’s arm. The physician makes a tiny nick in the skin either in the groin or the wrist (this is always discussed in further detail by the doctor) and inserts a catheter into the artery. Using x-ray imaging, the physician guides the catheter to the uterine arteries feeding the fibroids. Once positioned, tiny embolic particles, the size of grains of sand, are injected into the uterine arteries. This blocks the blood flow to the fibroid tumors and causes them to shrink. As fibroids continue to shrink, the symptoms resolve.

This procedure is performed by special doctors known as Interventional Radiologists. These are medical doctors with specialized training after medical school. The field of interventional radiology utilizes a range of techniques which rely on the use of diagnostic image guidance such as: Ultrasound, X-ray fluoroscopy, (CT) Computed tomography or (MRI) magnetic resonance imaging to precisely target therapy without the need for large incisions. Catheters are used to administer any necessary treatment.

Studies have shown that over 90% of women who have a UFE procedure experience significant or complete resolution of their fibroid-related symptoms (Radiological Society of North America, Inc., RSNA) 

5 Benefits of UFE over hysterectomy or myomectomy

• Preservation of the uterus
• Effective for multiple fibroids and large fibroids
• Recurrence of treated fibroids is very rare
• Can be performed as an outpatient procedure
• Covered by most major insurance companies

Looking to find the Best Treatment for Uterine Fibroids in Miami, Pompano, and South Florida, we can help. Broward County: (954) 884-8150 Dade County: ​​(305) 907-6191.

Endometrial Ablation

Another treatment option for uterine fibroids is an endometrial ablation. This procedure is more common for women who have heavy bleeding between their menstrual periods. There could be many reasons for heavy menstrual periods, such as changing hormones. So although it may help with the symptoms, it does not directly shrink or eliminate uterine fibroids.

Endometrial ablation consists of removing the endometrium (thin layer of tissue that lines the uterus) using slender tools that are placed through the vagina to reach the uterus. So no incisions are necessary. There are many methods to perform the procedure such as: 

Electricity (also known as electrocautery or electrical)

The doctor uses electrical currents that are transmitted through a roller ball or wire loop to destroy the lining of the uterus. 

Hydrothermal

Fluid is pumped into the uterus and then heated up. After 10 minutes or so, the uterine lining is destroyed. 

Balloon therapy

A thin tube (catheter) with a balloon at the end is placed through the vagina into the uterus. The balloon is filled with fluid so it matches the shape and parameters of the uterus. As the fluid heats up, it destroys the uterine lining. 

Radiofrequency ablation (uses high-energy radio waves)

Doctor inserts an electrical mesh through the vagina into the uterus. As it expands, electrical currents made by radio waves destroy the lining of the uterus. 

Microwave ablation (uses microwaves)

Microwave energy is sent to the uterus through the vagina using a thin probe which destroys the uterine lining. 

In some cases, the tool used during an endometrial ablation may be a hysteroscopy. This allows the doctor to better navigate through the uterus with a camera. 

Endometrial Ablation Risks

• Difficulties with future pregnancies resulting in miscarriage
• Pain, bleeding, or infection
• Cold or heat damage to surrounding organs
• Injury to the uterine wall beyond the lining

This may not be the preferred treatment to address uterine fibroids, but you should consult with your physician. 

MRI Guided High-Intensity Focused Ultrasound (HIFU), also known as (MRgFUS)

This non-invasive treatment is generally used to treat a wide range of tumors and diseases, not just uterine fibroids. As its name would indicate, it uses an ultrasound transducer to transmit sound waves which generate heat at certain points within the body. In the case of uterine fibroids, it uses MR guidance to accurately target fibroids and destroy them, while sparing healthy tissue. 

Some of the risks of this procedure include: 

• Burns to the skin on your lower abdomen which can form scars
• Possible, but rare risk of bowel and/or bladder injury
• Temporary or permanent nerve damage resulting in numbness, muscle weakness, or loss of senses
• Blood clots after the procedure

There are also some significant drawbacks to this treatment for fibroids. It is considered investigational and not proven to be very effective in cases where there are multiple and/or large fibroids and/or if the patient has a large body habitus. As a result, HIFU is not covered by insurance carriers.  

Looking to find the Best Treatment for Uterine Fibroids in Miami, Pompano, and South Florida, we can help. Broward County: (954) 884-8150 Dade County: ​​(305) 907-6191.

If you are in the Miami or South Florida area, feel free to request a consultation or even a virtual office visit so you can speak to one of our doctors from the comfort of your home.

For more information on Uterine Fibroid Embolization or to schedule an appointment call: (305) 907-6191