While fibroids are noncancerous, they cause significant physical and emotional impairment. For these very reasons, fibroids remain the leading indication for hysterectomies in the USA. Once upon a time, carrying the diagnosis of fibroids meant choosing between suffering in silence or a death sentence for your uterus. We think we speak for all of the Empirelistas out there when we say,
We have empires to build and don’t have time to lose dealing with the pain and bleeding due to fibroids!
There are now many options available to women! Fortunately, the idea of surgery as first line management is of the distant past. Here is a quick look at available options to manage fibroids, from less to more invasive:
1. Hormornal birth control
Fibroids are extremely hormone sensitive and therefore fluctuate in size according to estrogen levels. The benefit of birth control is that it helps to stabilize estrogen levels – resulting in lighter periods or even shrinking the size of the fibroid.
Cons: It just treats the symptoms and does not resolve the problem.
2. MRI focused ultrasound ablation
This method utilizes focused high-energy ultrasound waves to target and shrink small fibroids. It may be a good option for women with small fibroids contained within the pelvis.
Cons: It’s not widely available and very few women are ideal candidates.
3. Uterine artery embolization
This is a minimally invasive procedure where a catheter is tunneled from your groin to the uterine artery; the main artery and blood supply to the uterus. The blood supply to the fibroid is blocked off and the fibroid is starved.
Cons: It also decreases the blood supply to other parts of your uterus not affected by the fibroid, thereby possibly restricting fertility capabilities. It’s not the best treatment for those considering childbearing.
This technique combines hot or cold energy and laparoscopic surgery, small incisions along the abdomen, to shrink small to medium size fibroids.
Cons: It weakens the uterus and is not a good option for women desiring childbirth. It’s also not widely available.
Very common surgery used to remove the fibroids while keeping the uterus intact and preserving fertility. It can be performed one of three ways: hysteroscopic (through the vagina and cervix avoiding an abdominal incision), laparoscopic and robotic (small quarter size incisions abdominal incisions) or open (eight inch long bikini line incision).
Cons: Fibroids recur 25% of the time.
This is the most invasive procedure and involves complete removal of the uterus, completely resolving the issue. Hysterectomies can be performed via hysteroscopy, laparoscopy and open as well. If performed via laparoscopy, it is likely combined with a morcellation technique that breaks the uterus into smaller pieces for removal through the small abdominal incisions. There have been some reports of spreading undiagnosed uterine cancer with the morcellation technique. You can reduce your risk by having an endometrial biopsy before the procedure to confirm the absence of uterine cancer.
Cons: Infertility and longer post-op recovery.
Ultimately the decision whether to manage symptoms with hormonal birth control versus treating with open hysterectomy is based on your symptoms, the amount of impairment, childbearing goals and a thorough discussion with your Gynecologist. Be empowered and explore all options. As you build your empire use this wisdom to help preserve your legacy.