Fibroids

How Are Fibroids Treated?

The treatment offered for fibroids will depend on whether or not the fibroids are causing any problems.

• If fibroids are not causing problems, they may need no treatment apart from regular medical checkups. This is called watchful waiting. The doctor examines a woman two or three times a year to see if the fibroids are growing and if they are beginning to cause problems. If the doctor cannot feel the woman’s ovaries during a pelvic exam, ultrasound should be performed once a year.
• Surgery is the standard treatment for fibroids that are causing pain, heavy or lengthy menstrual bleeding, or other problems. The two kinds of surgery most commonly performed arehysterectomy and myomectomy.
• The two kinds of surgery most commonly performed arehysterectomy and myomectomy (see below).
• There are quite a few newer treatment options that offer alternatives to hysterectomy (click here to go to this section)
• There is also a role for special medications in the treatment of fibroids, either to shrink the fibroid to allow for a simpler type of surgery, or for women just before menopause (fibroids shrink naturally during menopause). See Treatment with Medication

Hysterectomy

Hysterectomy is the surgical removal of the uterus (and usually of the cervix as well). It is the most common treatment for fibroids. Three out of every 10 hysterectomies in the United States are performed because of fibroids. Currently, hysterectomy is the only permanent cure for fibroids. However, a woman cannot become pregnant or carry a baby after having a hysterectomy.

Hysterectomy is often considered when the uterus reaches the size it would be at 12 weeks of pregnancy. In the past, many doctors recommended a hysterectomy because they feared that such large fibroids could hide the presence of cancer of the uterus.

Now, however, tests such as ultrasound and MRI can be used to see whether a fibroid is growing rapidly (a sign of cancer). Increased use of these tests has reduced the number of hysterectomies performed for fibroids.

How is a hysterectomy performed?

A hysterectomy is usually performed through an incision in the abdomen. Sometimes the ovaries are removed in addition to the uterus and cervix. The decision to remove the ovaries depends on the woman’s age and on whether the ovaries are diseased. (The ovaries are responsible for producing hormones such as estrogen. After menopause, however, the ovaries produce much less estrogen than they did before.)

What is a vaginal hysterectomy?

Sometimes, for smaller fibroids, the uterus can be removed through the vagina. This is known as a vaginal hysterectomy. After a vaginal hysterectomy, the only stitches are inside the vagina. The body absorbs the stitches in four to six weeks.

Occasionally a surgeon will perform a vaginal hysterectomy assisted by laparoscopy. This is called a laparoscopic-assisted vaginal hysterectomy.

What are the risks of a hysterectomy?

Like all operations, a hysterectomy has risks. These include:

• infection requiring treatment with antibiotics (1 in 5 women)
• internal bleeding (hemorrhage) requiring a blood transfusion (1 in 15)
• injury to other pelvic organs such as the bladder, bowel, or ureters (less than 1 in 100)
• death (1 in 2,000)

What happens after a hysterectomy?

A woman usually stays in the hospital for two to five days after an abdominal hysterectomy. Full recovery usually takes about six weeks. Women are generally advised to avoid driving and heavy lifting for two to four weeks after surgery. Light exercise may begin after four weeks. Vigorous exercise and sexual intercourse should be avoided for six weeks after surgery.

After a vaginal hysterectomy, a woman may stay in the hospital for two to four days and recover fully in three to four weeks. She can expect to have a light-brown vaginal discharge for about six weeks after surgery. Women are usually advised not to have sexual intercourse for six weeks after a vaginal hysterectomy. Intercourse should only resume after the surgeon has examined her vagina to assure that it has completely healed.

Myomectomy

Myomectomy is the removal of fibroids without removing the uterus. This operation preserves a woman’s ability to bear children. However, a successful pregnancy is not guaranteed. Only 4 or 5 out of 10 women become pregnant and give birth after a myomectomy.

Heavy bleeding can occur when the fibroids are removed. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy. She is also at higher risk for problems such as infection and blood clots in the legs.

Fibroids may grow back after a myomectomy, and another operation may be needed later to remove them. The risk of regrowth is related to the number, not the size, of fibroids removed. If more than three fibroids are removed, the risk of regrowth is about 50-50.

How is a myomectomy performed?

Like a hysterectomy, a myomectomy is usually performed through an incision in the abdomen. The risks and recovery time are about the same as for a hysterectomy. Sometimes a myomectomy can be performed with the assistance of a laparoscope or hysteroscope.

Why can it be difficult to become pregnant after a myomectomy?

When the uterus heals after surgery, scarring can occur. Scars may cover the ovaries or block one or both of the fallopian tubes (the tubes through which eggs travel from the ovaries to the uterus). Scarring can make it impossible for the tubes to pick up the eggs after their release from the ovaries (ovulation).

A woman who becomes pregnant after a myomectomy may be advised by her doctor to have a cesarean section without going into labor. This is because the surgery can weaken the wall of the uterus. The doctor may be concerned that labor contractions could tear or rupture the wall.