Other treatments for fibroids

Surgical removal of the womb (hysterectomy)

Hysterectomy is still one of the most common methods of treating women suffering from fibroids. It involves complete removal of the womb, sothereby, ruling out any reoccurrence of uterine fibroids. The surgeon can perform the operation via the abdominal cavity or vagina, possibly leaving the ovaries in place. Hysterectomy is often the preferred method of treatment for women with large fibroids or heavy periods. It should however only be used on women who do not want any more children.



 

Surgical removal of the fibroid (myomectomy)

Myomectomy involves removing fibroids from the wall of the uterus by means of surgery. While fibroids in the uterine cavity can be removed through the vagina and cervix, with fibroids in the wall or outer layer of the womb, an incision cannot be avoided. With a hysteroscopic myomectomy, one or more fibroids (generally in the uterine cavity) are removed using a hysteroscope introduced via the cervix. During a laparoscopic myomectomy, a small incision is made in the abdominal wall to remove fibroids (generally no more than 6 cm in size, depending on their position) on the outside of the uterus. A myomectomy via the abdominal cavity requires incisions to be made in the abdomen and uterus. A myomectomy does not affect the reproductive potential – after a sufficient recovery period patients are generally able to conceive without any risk. However, they may need to give birth via a Caesarean section.

Other treatment methods for fibroids are removal of the womb, fibroid excision, embolisation and hormone therapy.

Embolization

One alternative to surgical removal of the womb is fibroid embolisation. Since the mid-1990s this procedure, which was originally used to stop bleeding after childbirth, has increasingly become an established method of treating uterine fibroids. The physician positions a small catheter in the groin and inserts it in the artery of the thigh. X-ray images are then used to guide it to the arteries supplying the womb with blood. Little particles of plastic are introduced via the catheter into the blood vessels supplying the fibroid. These particles block the supply of blood to the fibroid. The fibroid will then shrink, and there is typically relief from symptoms in two or three month’s time. For women who want children fibroid embolisation is a treatment option which can be considered in consultation with an interventional radiologist.



 

Hormone Therapy

Hormone therapy makes use of contraceptive pills and treatment with hormones. One current development of hormone therapy involves the administration of synthetic GnRH agonists (gonadotropin-releasing hormone agonists), which reduce the amount of oestrogen produced by the body. Lower levels of oestrogen will make fibroids and the uterus to shrink, so alleviating symptoms. GnRH agonists will also cause the periods to stop and therefore help with anaemia. However, if treatment is interrupted, the fibroids will return to their original size within four to six months. Most hormone therapies have a contraceptive effect.

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