Fibroid Treatment at Houston Fibroids
If you and your care provider determine that you have uterine fibroids, it is a good idea to discuss the various alternative treatment options for fibroids including uterine fibroid embolization (UFE).
Fibroids are still the leading cause for a woman to undergo a hysterectomy. Many women prefer a non-invasive treatment option to spare the uterus and avoid surgery. UFE is a non-surgical, outpatient treatment option for fibroids with a very high success rate and high level of patient satisfaction.
At Houston Fibroids, we recognize that providing you with all treatment options available allows you to make an informed decision that meets the goals and needs of your health and wellness journey.
Let’s discuss the various non-invasive and surgical treatment options available for uterine fibroids.
If your fibroids do not cause symptoms, there is no need to treat them. Your doctor may want to perform routine monitoring to check for signs of fibroid growth.
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids but may lessen the severity of symptoms.
The side effects of using these medications are similar to the symptoms experienced as a result of hormonal changes during and after menopause which may include:
- weight gain
- hot flashes
- vaginal dryness
- mood swings
- changes in metabolism
In most instances, once hormone therapy has been stopped, fibroids tend to grow back and often reach their initial size. This change occurs if hormone therapy is not accompanied by another treatment.
Magnetic Resonance Guided Focused Ultrasound (MRgFUS)
This non-invasive technique uses a special ultrasound transducer to focus a beam of ultrasound energy on a fibroid, causing localized tissue destruction. The transducer is integrated with a magnetic resonance imaging (MRI) scanner. MRI is used for anatomical treatment planning, ultrasound beam guidance, and assessment upon completion of treatment.
The procedure can take 3-4 hours and requires lying on your stomach. Sedation and pain-relieving medication are given to help patients relax.
After treatment, patients may experience some abdominal pain, cramping, nausea, shoulder or back pain that may last a few days after the procedure. Most women can return to work within 1-2 days.
The main drawbacks of MR-guided focused ultrasound:
- Not readily available except in specialized, tertiary care facilities.
- Not covered by most insurance plans.
- Only 40% of women are candidates due to anatomical considerations.
- High recurrence rates–additional fibroid treatments needed in 10%, 30%, and 45% of patients within 1 year, 2 years, and 3 years, respectively.
Less Invasive Treatment Options
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization begins with inserting a slender access sheath (tube) into an artery in the wrist or groin.
Through this access sheath, a long slender catheter (tube) a little over a millimeter in diameter is guided with real-time X-ray into the pelvis. Angiograms are performed to demonstrate the arteries in the pelvis. The catheter is then advanced into the blood vessels supplying the fibroids, and tiny particles are injected that permanently block the blood flow to all of the uterine fibroids. Once the blood flow is shut off to all of the fibroids, the catheters are removed and the arterial puncture is sealed with gentle pressure over the access site.
UFE treatment typically takes less than one hour and is performed as outpatient therapy, allowing patients to leave the same day and recover in their own home.
Endometrial ablation destroys the endometrium, the inner lining of your uterus, with an overall goal of reducing menstrual flow. In some women, menstrual flow may stop altogether.
No incisions are needed for endometrial ablation. A gynecologist inserts slender tools through your cervix. The tools vary, depending on the method used to destroy the endometrium. Some types of endometrial ablation use extreme cold, while other methods depend on heated fluids, microwave energy, or high-energy radio frequencies.
Women with fibroids should only consider endometrial ablation as a treatment option if they only have small (less than one inch in diameter) submucosal fibroids.
During this procedure, a long, thin scope with a light and camera is passed through the vagina and cervix into the uterus. No incision is needed.
Submucosal or intracavitary fibroids are easily visualized and respected or removed using a wire loop or similar device. A hospital stay can last from 30 minutes to 2 hours, and recovery time is generally 1-2 days.
This treatment option is usually recommended only for fibroids that are small and accessible through the vaginal cavity.
In this operation, your surgeon enters the pelvic cavity through an incision in the abdominal wall below the belly button. A horizontal bikini-line incision may be used for smaller fibroids, which can be hidden with a bathing suit.
For larger fibroids, a vertical incision is sometimes required. A vertical incision is made from the middle of your abdomen, which extends just below your navel and just above your pubic bone. A vertical incision is recommended if your uterus has reached or exceeded the size comparable to if it were carrying a sixteen-week pregnancy. This type of incision may also be used if a fibroid is in a ligament between your uterus and pelvic wall.
Abdominal myomectomy usually requires a hospital stay of two to three days. Full recovery takes four to six weeks.
During this surgical procedure, the entire uterus is removed through the vaginal opening.
This procedure is most often used in cases of uterine prolapse or when vaginal repairs are necessary for related conditions.
During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes, and upper vagina, as well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vagina.
If your uterus is enlarged due to fibroids or other factors, vaginal hysterectomy may not be possible.
Because this is a more extensive surgery, recovery time is about 6-8 weeks.
Laparoscope-Assisted Vaginal Hysterectomy (LAVH)
Laparoscopically-assisted vaginal hysterectomy is a surgical procedure using a laparoscope (a thin, flexible tube containing a video camera) to guide the removal of the uterus and fallopian tubes and ovaries through the vagina.
During LAVH, several small incisions are made in the abdominal wall through which slender metal tubes are inserted to provide passage for a laparoscope and other microsurgical tools.
Next, the uterus is detached from the ligaments that attach it to other structures in the pelvis using laparoscopic instruments. The fallopian tubes and ovaries are also separated from their ligaments and blood supply. The organs and tissue are then removed through an incision in the vagina. If the uterus is enlarged due to fibroids, this type of surgery may not be possible.
LAVH typically requires a one to three-day hospital stay. Complete recovery time is usually four weeks.
Robotic-Assisted Laparoscopic Hysterectomy
A robotic-assisted laparoscopic hysterectomy uses a computer to control the surgical instruments during the surgery. The surgeon controls the movements of the computer from a computer station in the operating room.
Three or four small incisions will be made during surgery near your belly button. Gas may be pumped into your belly to distend it to give your surgeon a better view and more room to work. The laparoscope is inserted into your abdomen, while other surgical instruments will be inserted through the other incisions. The surgeon will attach the laparoscope and the instruments to the robotic arms of the computer and then move to the control area to remotely control the surgery.
Your uterus will be cut into small pieces that can be removed through small incisions. Depending on the reasons for your hysterectomy, the whole uterus may be removed or just the part above the cervix. The fallopian tubes and ovaries attached to the uterus may also be removed.
Most women stay in the hospital for a few days after surgery. Complete recovery may take anywhere from a few weeks to a few months.
Considered one of the most extensive surgery options, an abdominal hysterectomy involves the removal of the uterus through the abdomen via a surgical incision about six to eight inches long. The main surgical incision can be made either vertically, from the navel down to the pubic bone, or horizontally, along the top of the pubic hairline.
After the incision has been made through the layers of skin, muscle, and other tissue, the tissues connecting the uterus to blood vessels and other structures in the pelvis will be carefully cut away. The uterus will be removed, along with any other structures such as the ovaries, fallopian tubes, and cervix.
An abdominal hysterectomy usually requires a hospital stay of a few days. The recovery period is usually about six to eight weeks.