Uterine-preserving and Fertility-preserving Alternatives to Hysterectomy When Treating Fibroids
May 20, 2013
For women who wish to preserve their fertility or preserve their uterus regardless of fertility issues, hysterectomy should be a last resort.
When fertility preservation is the goal, it is important for the gynecologist to know the number, sizes and exact positions of the fibroids in order to guide the best treatment. Fibroids that change the shape of the uterine cavity can decrease fertility and will be best detected using saline-infusion ultrasound, hysteroscopy (telescope looking into the uterine cavity) or MRI (most accurate).
If the cavity is misshapen, myomectomy should be considered. Hysteroscopic myomectomy can remove fibroids that are mostly inside the cavity. If there are fibroids inside the uterine muscle wall, but slightly indenting the cavity, then laparoscopic or robotic myomectomy can be offered by a surgeon with experience in these techniques. Abdominal myomectomy (bikini incision) may be necessary for large or numerous fibroids.
For women who have bothersome symptoms from fibroids but do not wish any, or any more children, there are many uterine-preserving procedures available. For women with primarily heavy bleeding and small fibroids, the progesterone-IUD (Mirena) or oral contraceptive pills taken in a continuous fashion (no placebos) may be effective. Hysteroscopic myomectomy (shaving out the fibroids with a telescope placed through the cervix) with or without endometrial ablation (cauterizing the uterine lining cells) is very effective. Patients go home the same day and have full recovery in a few days. Laparoscopic, robotic or abdominal myomectomy, depending on the sizes and number of fibroids, can always be performed by a gynecologist skilled in those procedures. Uterine Artery Embolization, performed by interventional radiologists, also has good results for treating discomfort and heavy bleeding due to fibroids.
As always, it is important for each woman to make a decision about which treatment is right for her, and to find a doctor who can skillfully provide the treatment option that you choose.