FACT SHEET covering top issues on fibroids
- 1Fibroids are a hormone dependent tumor – both estrogen and progesterone is necessary for the fibroid to grow
- 2Women may begin to develop fibroids as young as the early twenties
- 3Fibroids may cause reproductive problems
- 4Some fibroids grow in multiple numbers they often look like a single fibroid due to their tendency to grow in a cluster
- 5The most common symptom of fibroids is abnormal periods
How Are Fibroids Treated?
Fibroids that are causing significant symptoms need treatment however the right treatment will depend on the size and location of the fibroids, the age of the patient, how close to menopause the patient is, and whether or not the patient wishes to get pregnant.
Fibroids are able to be treated medically or surgically. Medicine that promotes brings menopause such as Lupron (Leuprolide Acetate) is often prescribed for fibroids as it is known to diminish the size of the tumor. We do not recommend this approach unless the patient is severely anemic and would like to buy some time to have the patient build up their blood stores. Lupron and other menopause medication is a temporary treatment which is primarily used to buy some time, usually about six months. As soon as the medication has stopped the fibroids will grow back. Lupron also has other side effects that are not commonly mentioned including hair loss.
Surgical treatment is a recommended option for dealing with fibroids. Depending on the patient’s symptoms and needs, there are essentially two main surgical techniques commonly used to treat fibroids. However, with the use of minimally invasive techniques, these two main categories can be broadened to other comprehensive surgical solutions for the patient, which means the maximum amount of fibroids are able to be removed.
For women who want to retain their uterus for fertility purposes, or patients who have heavy bleeding with a submucosal or endometrial fibroid component, a hysteroscopic resection - complete or partial - of the fibroid would be the ideal approach. Women who have multiple fibroids would require a minimally invasive approach using the laparoscopic technique of a laparoscopic myomectomy.
Laparoscopic myomectomies can be performed as a day surgery allowing the patient to return home that afternoon to recover. In the past, we have removed 25 fibroids at once by laparoscopy. Multiple myomectomy can be done in a regular open surgery as well. The patient would be required to stay at the hospital for at least four days to a week when this technique is used as there is a larger incision which could be midline or horizontal. The recovery after this particular surgery is very prolonged compared to the minimally invasive myomectomy technique of laparoscopic myomectomy.
With the recent introduction of the robotic myomectomy in the last decade, this is an option for women as well. However, one should understand the robot is a tool rather than a true robot that does the surgery for the doctor. Its use has to be clearly understood by the patient.
It is important to note that a laparoscopic myomectomy requires skill and experience with suturing to a thin, very small area of the pelvis. Unfortunately, if the surgeon is not experienced, many patients end up with larger scars after the surgery due to incompletion or complications during a minimally invasive surgery procedure.
Particularly in fertility cases for patients who have infertility problems or patients trying to conceive by IVF,
Fibroids can cause a reduced chance of conceiving and can increase the chance of complication during pregnancy such as miscarriage, early delivery, premature labor and birth. This means the surgery needs to be done with precision and accuracy to reconstruct the endometrial cavity to its original configuration.
The single most important element of fibroid surgery is to perform the surgery as bloodless as possible as there is an increased risk of blood loss. This means the defect that has been created after the removal needs to be closed very tightly, and the uterus has to be constructed to its original configuration which means the surgeon is performing a complete uterine reconstruction procedure. Every visible fibroid during the surgery needs to be removed to prevent recurrences and the stiches must be strong enough for the uterus to go through a full term pregnancy.
Many women elect to have a hysterectomy due to issues associated with the myomectomy. Certainly the hysterectomy is the more definite surgical solution. If a patient chooses the myomectomy, there is a 10- 50% chance of needing to have repeat surgery. There are patients that have additional pathologies, such as adenomyosis and endometriosis; therefore the hysterectomy may be a more reasonable treatment for some women.
In this case our experience is significant with the minimal invasive technique of removing the uterus. This technique is called a laparoscopic hysterectomy. Some patients will choose to have a total laparoscopic hysterectomy where the cervix is also involved and a pelvic floor reconstruction could be required, particularly for patients who have prolapse issues and additional pelvic floor problems such as incontinence and rectocele.
For patients who do not have these other problems and whose cervix is clean with no abnormal pathology, there is also the option of a super cervical hysterectomy. Both of these options are minimally invasive, regardless of the size. An experienced and skillful surgeon can accomplish these procedures with an outpatient surgery or with an overnight stay, with almost invisible incisions and almost colorless incisions on the abdominal wall.
While surgery is a definitive procedure, there is another procedure called embolization. In this case rather than going for a hysterectomy or myomectomy the patient chooses to go under embolization procedure where small plastic particles are injected into the arteries which reduces blood flow to the fibroid and causes it to shrink. Embolization is still at its investigational period therefore we have seen a significant number of failures as well as some horror stories with respect to each complication. Healing is prolonged with foul smelling discharge and significant pain is involved due to acute sequestration of blood supply to the uterus.
Another alternative to a hysteroscopic fibroid resection is an endometrial ablation, which we do not recommend. It is basically nothing but cooking the endometrial cavity. It does not treat additional adenomyosis and other problems. Another procedure is myolysis. Again we do not perform this surgery, particularly for patients who are planning to get pregnant.