Hysterectomy: This is the surgical removal of the uterus requiring general anesthesia. It is widely available (every gynecologist is trained to perform it) but is associated with complications and side effects that are well documented – including a six-week recovery period. There is a 2 percent risk of post-operative bleeding, a 15 to 38 percent risk of post-operative fever, and a 0.5 percent risk of injury to a nearby pelvic organ. The incidence of cardiovascular disease increases three-fold in pre-menopausal women. Fifteen to 30 percent of women report decreased sexual function, an increase in depression and fertility loss. For these reasons, many women with symptomatic uterine fibroids are looking for alternatives to a hysterectomy.
Alternatives to a Hysterectomy
Do nothing: If fibroids are present but not causing serious symptoms no treatment is needed. If there are moderate symptoms occurring in a pre-menopausal patient, they may abate spontaneously with the onset of menopause.
Myomectomy: This surgery removes individual fibroids, preserves the uterus and maintains childbearing potential – making it the treatment of choice for patients desiring to keep their fertility. The less invasive, laparoscopic myomectomy, is sometimes possible and has a much shorter recovery time. Standard myomectomy requires general anesthesia and involves more blood loss than a hysterectomy on average, with similar recovery time. Studies show that 27 percent of myomectomy patients need another myomectomy or hysterectomy when followed over 10 years. Some fibroids cannot be removed due to their position near other organs.
Hormone Therapy: GnRH agonists are drugs that block estrogen production and starve fibroids causing them to shrink. Lupron is the most commonly used drug causing shrinkage which making surgery easier, but results are temporary. The drug also is associated with menopause-like symptoms such as hot flashes, mood swings, insomnia, sexual dysfunction, and premature bone mineral loss.
Endometrial Ablation and Resection or "OPERA": This is an outpatient procedure where a scope is placed through the cervix into the uterine cavity to burn and scrape the lining and remove the fibroids that can be reached. The removal of the lining stops bleeding but not all fibroids can be removed with this technique. OPERA causes permanent infertility.
Myolysis or Cryomyolysis: Techniques in which fibroids are burned or frozen via laparoscopic surgery.
Uterine Fibroid Embolization: As a non-surgical treatment for uterine fibroids, it is a relatively safe and highly effective alternative for those who want to avoid a hysterectomy or who have the prospect of difficulty with myomectomy. Since this is a relatively new treatment, there are not long term results available for evaluation.
To learn more, visit us at www.virchicago.com or www.drfibroid.com.