In my last blog, I discussed fibroid tumors of the uterus and different medical treatments. Today, I will discuss procedural treatments. Remember, fibroids grow due to hormonal influence, but are fed through a blood supply. They cannot survive without the blood supply, much like any muscle in the body, including the heart.
Depending on the location of the fibroid, it can be accessed by going through the vagina into the uterus (hysteroscopically) or by entering the abdomen and removing it from the outside of the uterus or by cutting into the uterus. This procedure is called a myomectomy. An abdominal myomectomy can be done through a large incision on the abdomen or via the laparoscope or the robot. A myomectomy is usually reserved for women who want to keep their uterus, either because they want children or they just aren’t comfortable having the entire uterus removed.
If a myomectomy is to be done through a small incision, the fibroid needs to be small enough to get out through that incision. We have an instrument called the morcellator that is similar to an apple peeler. It allows larger fibroids to be removed through a small incision. Recently, this instrument was removed from the market due to fears about spreading cancer. Your provider can discuss this in more detail with you if you decide to have a myomectomy.
Another option is to have the entire uterus removed (a hysterectomy). This is an option for women who are finished having babies and don’t want to go through the risk of more fibroids growing. Remember, just because the uterus is removed doesn’t mean the ovaries will be removed. So a hysterectomy does not equate to menopause.
There is a procedure called Uterine Artery Embolization that occludes the blood supply to the fibroid. This is performed by an Interventional Radiologist. The physician accesses the artery that supplies the fibroid through the patient’s groin. There are no incisions. The patient spends the night in the hospital for pain management and the fibroid shrinks due to loss of blood supply over the next several weeks.
There are other ways to destroy a fibroid using various energy sources guided by imaging techniques such as ultrasound and MRI. These procedures can be done through small incisions on the abdomen. These are not necessarily done at all institutions, so you may need to seek out a physician who routinely does one of these modalities.
Let me reiterate, fibroids do not necessarily need any treatment. Unfortunately, many women are affected by heavy bleeding and are interested in definitive therapy.