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Uterine fibroids are non-cancerous smooth muscle tumors in the uterus. They can develop along the inner lining of the uterus, within the uterine wall, or along the outside of the uterus. The most common symptoms of uterine fibroids are heavy or prolonged periods and pelvic discomfort.
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Women have options when it comes to how they manage their fibroids. Over-the-counter supplements and prescription drugs are available that may help with bleeding or pain, but many with symptomatic fibroids find these medications to be insufficient and seek the care of a fibroid specialist. Depending on the specialty and training of the fibroid specialist, they will typically present one of four options for managing fibroid symptoms:
- Hysterectomy: remove the uterus, taking out the fibroids with it
- Myomectomy: remove the fibroids while keeping the uterus intact
- Embolization: shrink the fibroids while keeping the uterus intact
- Endometrial Ablation: destroy the inner lining of the uterus
In this article, we provide an overview of each of these approaches, and important attributes to consider when comparing surgical vs. minimally invasive fibroid treatment.
Surgery
Hysterectomy and myomectomy are surgical approaches that require major incisions to access the uterus. A substantial amount of cutting is required to remove the uterus in the case of hysterectomy, or the fibroids in the case of myomectomy.
Hysterectomy
A hysterectomy is a major surgical procedure that is usually performed by a gynecologist or a general surgeon. The procedure involves the complete or partial removal of the uterus, by which the fibroids within the uterus are also removed. A hysterectomy may be performed through the abdomen, through the vagina, or laparoscopically. Hysterectomy scars tend to be an important consideration for women, especially in the case of abdominal hysterectomy.
There are pros and cons of hysterectomy that women should be mindful of when deciding which treatment makes the most sense for them. While hysterectomy is the only permanent ‘cure’ for fibroids, it does eliminate the possibility of becoming pregnant in the future. Depending on the surgical approach, hysterectomy can require extensive recovery period. Patients can expect spend anywhere from 1 to 3 days in the hospital after their procedure, and an additional 2 to 6 weeks recovering before returning to normal activities.
Myomectomy
A myomectomy is the surgical removal of fibroids from the uterus. Like hysterectomy, myomectomy is a major surgical procedure, but unlike hysterectomy, it is still possible to become pregnant after myomectomy.
Myomectomy can be performed through the abdomen, through the vagina, laparoscopically, or with robotic-assisted surgical equipment. Recovery time depends on which surgical technique is used, but generally women can expect a recovery period similar to hysterectomy.
Minimally Invasive Therapies
Unlike surgical approaches, minimally invasive approaches do not require any major incisions. In the case of embolization, fibroids are accessed via the vascular system. On the other hand, endometrial ablation is performed through the vaginal canal.
Embolization
Uterine fibroid embolization is a minimally invasive image-guided procedure that is typically performed by an interventional radiologist. The procedure is performed through a single puncture in the groin or in the arm, through which a catheter is guided to the uterine arteries to deliver embolic particles to the fibroids. These micro-sized particles occlude the blood vessels that supply the fibroids with blood and nutrients, thereby causing them to starve and shrink.
Clinical studies have demonstrated that embolization is as effective as surgery in treating fibroids, with the added benefit of minimizing recovery time, minimizing the risk of major complications, and maintaining the ability to become pregnant in the future.
Endometrial Ablation
Endometrial ablation is a minimally invasive treatment that involves the destruction of the inner lining of the uterus using an instrument that delivers thermal energy. In the case of fibroids, the intent of endometrial ablation is to alleviate excessive bleeding. However, this therapy is only effective in the case of fibroids along the inner lining of the uterus, and does not address other symptoms.