For a discussion of the nature, location, causes, and symptoms of uterine fibroids, see our Q&A called Uterine Fibroids. In the absence of treatment, asymptomatic (i.e., not causing symptoms) or symptomatic fibroids may shrink due to a decrease in either blood supply or level of estrogen.
An estimated 10% to 20% of women with fibroids have symptoms significant enough to require treatment.[2] A variety of options to treat symptomatic fibroids are available. See our Q&A called Nonsurgical Treatment of Fibroids for a discussion of naturopathic and hormonal approaches to treatment, chelation therapy, interventional procedure to stop nourishing the fibroid, laser treatment of the fibroid,
and treatment of the lining of the uterus.
For surgical treatment of uterine fibroids, several types of surgery are available, including:
Hysteroscopic surgery to remove the fibroid tumor
Surgical removal (myomectomy) of the fibroid tumor
Surgical removal of the uterus (hysterectomy)
For treatment of bleeding from a small submucosal fibroid, surgery may be performed with the aid of a hysteroscope, a lighted instrument that is inserted into the vagina, cervix, and endometrial cavity inside the uterus.[10] The hysteroscope allows the physician to view the inside of the uterus. Then the submucosal fibroid tumor is surgically removed. Hysteroscopic surgery may be performed alone or in combination with endometrial ablation.
Advantages of hysteroscopic surgery are: [10]
Outpatient, rather than inpatient, procedure
Short recovery time
Possible complications of hysteroscopic surgery include:[10]
Infection
Formation of a type of adhesion (scar tissue) called synechiae, which occurs in 13% of patients who undergo hysteroscopic surgery without endometrial ablation
Surgical removal of the fibroid tumor is called myomectomy. The main advantage of myomectomy compared to surgical removal of the uterus is the preservation of the uterus.[3] Depending on the size and location of the fibroid, either laparascopic myomectomy (involving a small incision) to remove a small fibroid or abdominal myomectomy (involving a larger incision) may be performed.[3, 10]
After abdominal myomectomy, the usual recovery period is 6 weeks, whereas recovery is shorter following laparoscopic myomectomy.[5, 10] Advantage of myomectomy compared to UFE are:[16]
Removal of existing fibroid
Possible ability to bear children, depending upon whether the wall of the uterus was weakened by the surgery
Disadvantages of myomectomy compared to surgical removal of the uterus are:[3, 4, 10, 18]
Inability of laparoscopic myomectomy to be used when women have large, deep, or multiple fibroids
Theoretical re-occurrence of same fibroid, if all of the fibroid tissue was not removed surgically. Approximately 10% to 27% of women who undergo abdominal myomectomy experience recurrence of fibroids.
Possible growth of new fibroids
Because of these disadvantages. myomectomy is not a common surgical procedure for treatment of fibroids.[4] Possible complications of myomectomy are:[10]
Pain
Fever
Infection
Blood clot at site of incision
Bleeding from site of incision
Uterine bleeding.
Formation of uterine adhesions (scar tissue)
Infertility due to impaired function of uterus
Difficulty in achieving orgasm
If you are considering myomectomy, consult with your gynecologist to determine whether myomectomy is appropriate for you.
Hysterectomies (i.e., surgeries to remove the uterus) are the most invasive type of therapy that is used to treat women with fibroids.[3, 21] Currently, many physicians consider hysterectomies, especially those performed for treatment of fibroids, to be the most over-used (i.e., unnecessary) type of gynecological surgery.
Various types of hysterectomies involving incisions through the abdomen or laparascopic (small) incisions through the cervical area may be performed. Following a hysterectomy, the usual recovery period before the is 6 to 8 weeks before the patient can return to normal activities.[5] For some women, however, full recovery after a hysterectomy can take at least a year.
After a hysterectomy, a woman cannot bear children. Other side effects of hysterectomy in which only the uterus was removed include complications of surgery, as well as certain psychological effects, in some women.[3, 6, 10] Possible complications of hysterectomy include:
Pain
Fever, which occurs in 15% to 18% of patients
Infection
Blood clot at site of incision
Postoperative bleeding, which occurs in 2% of patients
Scarring
Formation of adhesions (internal scar tissue)
Difficulty becoming sexually aroused and difficulty achieving an orgasm or a satisfactory orgasm. These conditions, which can result from the psychological effects of surgery, as well as the lack of physiological response to stimulation due to removal of the uterus, have been reported in 25% of women who underwent hysterectomy.
Loss of tone in the muscle of the pelvic floor
Lack of bladder control (i.e., urinary incontinence)
Increase in cardiovascular disease, including angina (chest pain) and heart attacks
Depression
If the uterus and the ovaries were removed surgically, hysterectomy also leads to hormonal imbalance, leading to a variety of menopausal effects, including hot flashes and loss of libido.[3, 4, 6]
If you are considering a hysterectomy, be kind to yourself and first explore the less invasive options of integrative medical, alternative medical, and other standard medical therapies for achieving and maintaining good health. Be informed about all your health options, as well as learning about the potential side effects and possible complications of a hysterectomy surgery. Get many opinions from different healthcare professionals. Talk extensively with your gynecologist and your other healthcare professionals in advance to determine whether a hysterectomy or a less invasive type of treatment is appropriate for you.
REFERENCES
1. Life Extension Foundation Uterine Fibroids. In Disease Prevention and Treatment, 4th edition. Hollywood, FL: Life Extension Media.
2. Uterine fibroids symptoms and diagnosis. Society of Interventional Radiology. Accessed at www.airweb.org/patPub/uterine.shtml.
3. R. Preidt. Nonsurgical technique effective against fibroids: treatment avoids surgery, preserves uterus. HealthDay News. 04/01/05. Accessed at www.ivillage.com.
4. J. Reichenberg-Ullman. Homeopathy for uterine fibroids. Townsend Letter for Doctors and Patients. 11/04.
5. Uterine fibroid embolization: a new way to treat fibroids. Accessed at www.familydoctor.org.
6. I. Ikenze. Menopause & Homeopathy: A Guide for Women in Midlife. 1998. Berkeley, CA: North Atlantic Books.
7. J. Reichenberg-Ullman. Whole Womans Homeopathy. 2004. Edmonds, WA: Picnic Point Press.
8. Vitalzym. Accessed at www.energeticnutrition.com.
9. LupronDepot. Accessed at www.fibroidfacts.com.
10. S.J. Smith. Uterine fibroid emolization. American Family Physician. 2000; 61:3601-3607, 3611-3612.
11. Long term effects. Uterine Artery Embolization. Accessed at www.uterinearteryemolization.com.
12. A.B. DeMello. Uterine artery embolization. AORN Journal. 2001; 73(4):790-813.
13. Facts. Uterine Artery Embolization. Accessed at www.uterinearteryemolization.com.
14. Nonsurgical treatment of uterine fibroids. Accessed at www.drfibroid.com.
15. ACR RSNA. Uterine fibroid embolization. RadiologyInfo. Accessed at www.radiologyinfo.org/contentinterventional/
ufibroid-embol.hrm.
16. F.L. Hutchins, Jr., and R. Worthington-Kirsch. Embolotheraoy for myoma-induced menorrhagia. Obstetrics and Gynecology Clinics of North America. 2000; 27(2):387- 405.
17. Fibroid Medical Center of Northern California. Uterine fibroid embolization (uterine artery embolization. Accessed at www.fibroidworld.com/UAE.hrm.
18. Fibroid Treatment Collective. Treatments: Uterine artery embolization. FTC. Accessed at www.fibroids.com/uterine- artery-emboliztion.html.
19. Reported adverse effects. Uterine Artery Embolization. Accessed at www.uterinearteryemolization.com
20. Medical journal references. Uterine Artery Embolization. Accessed at www.uterinearteryemolization.com.
21. G.C.H. Wong, S.J.Muir, A.P.W. Lai, and S. C. Goodwin. Uterine artery embolization: a minimally-invasive technique for the treatment of uterine fibroids. Journal of Womens
Health and Gender-Based Medicine. 2000; 9(4):357-362.
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