Uterine fibroids may be small and asymptomatic in many women, but in some instances they can cause significant pain and heavy bleeding, or grow large enough to cause infertility and other problems. If you have problems related to fibroids, there are several surgical options depending on your long-term reproductive goals.
Destroying A Fibroid's Blood Supply
There are two procedures used to destroy the blood supply of fibroids. In the case of smaller fibroids, the blood supply to a specific fibroid can be destroyed by using different techniques, such as cauterization. For larger or more complicated fibroids, uterine artery embolization might be necessary to shrink fibroids. In this procedure, major arteries that service the uterus are occluded, which helps stop the blood supply to fibroids and causes them to eventually die. The goal of the procedure is to leave enough of a blood supply to prevent the uterus and other reproductive organs from dying. Both types of procedures can be performed with minimally invasive techniques, such as an interventional radiologist performing uterine artery embolization.
Removing Tissue Within The Uterus
Surgeries to remove specific tissues within the uterus can be used to treat fibroids, but the best option will depend on whether you want the option of having have children. For women who want to preserve their fertility, a myomectomy is the appropriate choice. This procedure can be performed in various ways, such as an open surgery, laparoscopically, or with an instrument inserted into the uterus. The goal of the myomectomy is to specifically remove the fibroids without causing damage to tissue necessary to become pregnant later. Your surgeon will likely base their surgical approach on the size, number, and accessibility of your fibroids. If you have several large fibroids, an open surgery may be necessary. For women who do not want to preserve their fertility, endometrial ablation can achieve similar benefits, while reducing or eliminating menstruation. With an endometrial ablation, the lining of the uterus is destroyed and with the destruction of this tissue, the fibroids are also destroyed.
The most extensive surgery used for fibroids is a hysterectomy. Generally, a hysterectomy is reserved for women with large fibroids and many symptoms that interfere with their life beyond their menstrual cycle. Women typically do not need a complete hysterectomy, which would include removal of the ovaries. They may have a partial hysterectomy that removes part of the uterus or the entire uterus. Ideally, women who are prone to having fibroids return would be better off having the entire uterus removed to eliminate the possibility of new fibroids. Fortunately, since the ovaries remain after a partial hysterectomy, women can transition into menopause naturally, instead of dealing with an abrupt menopause.
Fibroids can be problematic even if they do not cause obvious symptoms because they may compromise fertility. Fortunately, there are several surgical procedures that can be used to alleviate some or all the problems caused by fibroids. Talk to a surgical gynecology professional for more advice.