Surgical options for fibroid removal include myomectomy, hysterectomy and uterine artery embolization. The choice of treatment depends on factors such as your own wishes and your doctor's medical advice about the size and location of the fibroids.
Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal the need for treatment:
Heavy or painful menstrual periods that cause anemia or that disrupt a woman's normal activities
Bleeding between periods
Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
Rapid increase in growth of the fibroid
A myomectomy is the surgical removal of the fibroids only. This can be accomplished through hysteroscopy, laparoscopy, or, less frequently, an open procedure (an incision in the abdomen). The surgical approach depends on the size and location of the fibroid. Pretreatment with GnRH analogs has been shown to decrease blood loss and operative time in women undergoing myomectomy. Myomectomy has also been shown to have a decreased likelihood of injury to the bowel, bladder, or ureter than hysterectomy. The uterus is left intact in this type of procedure, and the patient may be able to become pregnant.
A hysterectomy is the surgical removal of the uterus (and fibroids). It is the most commonly performed surgical procedure in the treatment of fibroids and is considered a cure. Depending on the size of the fibroid, hysterectomy can be performed with incisions through the vagina or abdomen. In some cases the procedure may be performed using laparoscopy.
Uterine artery embolization, or clotting of the arterial blood supply to the fibroid, is an innovative approach that has shown promising results. This procedure is done by inserting a catheter (small tube) into an artery of the leg (the femoral artery), using special X-ray video to trace the arterial blood supply to the uterus, then clotting the artery with tiny plastic or gelatin sponge particles the size of grains of sand. This material blocks blood flow to the fibroid and shrinks it. This method may prove to be a good option for women if other methods have not worked, she does not want surgery, or may not be good candidates for surgery.