Uterine Fibroid Treatment
What are Uterine Fibroids?
The medical term is leiomyoma, uterine fibroids are benign growths of the muscle of the uterus. Uterine fibroids are very common, more than half of American women will be diagnosed with a uterine fibroid at some point in their life.
What are the symptoms of uterine fibroids?
While each individual’s symptoms vary, the most common are:
- Heavy or long periods
- Pelvic cramping or pressure
- Lower back pain
- Constipation or urinary frequency
- Pain during sex
- Bleeding between your periods
Symptoms may vary from minimal to impacting on your life and/or work schedule. If individuals have no or minimal symptoms often watchful waiting and following fibroids is recommended. Follow up ultrasounds are recommended at 3-, 6-, or 12-month intervals depending on the size and types of fibroids.
How do you treat fibroids?
There are several different types of treatment options for uterine fibroids. At Arizona Gynecology Consultants we believe that each patient should choose the specific individualized treatment that works best for them. Treatment plans are developed based on the type of uterine fibroids, the number and sizes of uterine fibroids, the individual’s desire for future fertility, as well as the significance of the individual’s symptoms.
What are the different types of uterine fibroids?
Fibroids are classified under what is called a FIGO fibroid scoring system that informs both the providers and the patients about the types of fibroids they have. The FIGO fibroid score is based on how much of the fibroid is inside the uterine cavity, how much of the fibroid is in the muscle of the uterus, and/or how much the uterine fibroid is on the outside of the uterus.
The numbers above are annotated on imaging (ultrasound, MRI) reports as a “FIGO type III” to describe how much of the fibroid again is in the cavity (inside- submucosal), in the muscle (in the middle- intramural), or on the outside of the uterus (abdomen- subserosal).
How do you diagnose fibroids? How do you know what FIGO fibroid types you have?
Fibroids typically are diagnosed with a pelvic ultrasound. However, at times pelvic MRI’s, saline-infused sonogram, hysteroscopy, or hysterosalpingogram may be necessary to fully evaluate the uterine fibroid(s).
Transabdominal Ultrasound
A pelvic ultrasound has two parts – for the transabdominal part it is vital to have a full bladder. The full bladder helps the transducer be able to see the uterus and fibroids.
Transvaginal Ultrasound
The transvaginal ultrasound is done internally. This test is best done with an empty bladder. The test has multiple components-it can provide some of the most precise measurements of the fibroids, it can see where the blood flow is to the fibroid, it also can provide us with 3D images to be able to determine how much of the fibroids is in the uterine cavity (submucosal).
Sonohysterography
Another type of ultrasound that can be completed if the pelvic ultrasound alone does not provide enough of the answers is a sonohysterography or saline-infusion sonogram is where a small catheter is placed in the cervix and then a transvaginal ultrasound is done. The catheter allows the provider to push some fluid into the uterine cavity. This test is done to determine if any of the fibroids are in the cavity (submucosal).
Pelvic MRI
A pelvic MRI is completed at a Imaging Facility (SMIL, Simon Med, hospital) and uses contrast to help differentiate the fibroid tissue in the uterus.
Depending on the FIGO fibroid type you have there are several treatment options. If you have multiple fibroids sometimes cases are scheduled to do different treatment types at the same time.
Myomectomy (Removal of the Fibroid) Types
Hysteroscopic Myomectomy
The least invasive type of treatment for a fibroid is hysteroscopic myomectomy. A hysteroscopy is a device that allows for a camera inside the uterus through the vagina and cervix. Distention is then used with fluid to open the uterus. There are multiple types of devices that are then inserted to remove the uterine fibroid tissue. There are no cutting or incisions with this procedure. Anesthesia used is total IV anesthesia, you are asleep for this procedure but are often breathing on your own. This procedure is done out-patient at a surgery center or hospital. The procedure usually lasts about 20-90 minutes.The recovery is minimal, and most patients can go back to their usual activities the next day.
Laparoscopic Myomectomy
A laparoscopic myomectomy is the next least invasive myomectomy. It requires 3-5 incisions (small) in the abdomen then uses laparoscopic tools to remove the uterine fibroids. This is done under general anesthesia at an outpatient ambulatory surgery center or hospital. This procedure usually lasts about 1-4 hours. The recovery can take 2-4 weeks depending on the size and number of fibroids being removed.
Open Abdominal Myomectomy
An open abdominal myomectomy is the most invasive but is sometimes the safest approach if there are multiple fibroids or very large fibroids. This surgery requires an overnight stay at a hospital and is done under general anesthesia. The surgery usually lasts about 1-3 hours, and the incision is usually similar to a cesarean section incision (it may be vertical or horizontal). The recovery can take 4-6 weeks depending on the sizes and number of fibroids being removed.
Radio-frequency Ablation (Cauterizing the Fibroid(s) so they Shrink) Types
SONATA Procedure
The SONATA procedure is the least invasive treatment for radiofrequency ablation treatment of fibroids. During radiofrequency ablation treatment the fibroid tumor and its blood flow are cauterized (burned) promoting shrinking of the fibroid and improvement in your symptoms. This procedure does not remove the fibroid. There are no cutting or incisions for this procedure. This is done at an outpatient surgery center or hospital. This is done under total IV anesthesia. This procedure usually takes 30-60 minutes and the recovery is just the day of the procedure.
For more information about the SONATA visit their website.
ACESSA Procedure
TheACESSA procedure is a radiofrequency ablation laparoscopic treatment that requires 2-4 abdominal incisions (small) and is done under general anesthesia. During this radiofrequency ablation treatment, the fibroid tumor and its blood flow are cauterized (burned) promoting shrinking of the fibroid and improvement in your symptoms. This surgery usually lasts 1-3 hours and is done at an outpatient surgery center or hospital. The recovery for this procedure is usually 3-5 days.
For more information about the ACESSA procedure please visit their website.
Uterine Artery Embolization
Uterine Artery Embolization is done by an Interventional Radiologist and is done under CT guidance. This procedure is done with patients awake; although, they do give you some IV pain medication. Going through blood vessels (wrist or thigh vein) the Radiologist then under CT guidance put a catheter up to the arteries/veins of the uterus and inject multiple tiny particles (the size of sand) to occlude the blood flow to the uterus. This promotes shrinking of the fibroids and uterus over time. The downtime is minimal, usually only the day of the procedure.
Hysterectomy
Hysterectomy is the removal of the uterus (with the fibroids inside of it). There are several different types of hysterectomies. They can be done partially or completely (total). They can be done vaginally, laparoscopically, or open. Depending on the types of your fibroid, one approach over another may be recommended. This can be done at an outpatient surgery center or a hospital. It rarely requires an overnight stay. Most patients can go back to their usual activity in 1-2 weeks except for no lifting above 10 lbs and no intercourse (nothing in the vagina) for 6 weeks.
