With few exceptions, surgical treatment is more effective in relieving symptomatic uterine fibroids.
Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman preserves her uterus, she retains her ability to become pregnant. It is an effective treatment to reduce both bleeding, pain and pressure from uterine fibroids.
Fibroids do not re-grow after myomectomy, but new fibroids may develop. The 5-year recurrence rate after abdominal myomectomy for a single uterine fibroid is about 10% and 25% with multiple fibroids. The 10-year recurrence rate after single myomectomy is 27%. For this reason, myomectomy is not the best choice for women who no longer wish to have future pregnancies.
There are several ways to perform myomectomy. The “best” way depends on the location, size and number of fibroid in the uterus.
- abdominal myomectomy: an incision (cut) is made is the lower abdomen to remove the fibroids.
- laparoscopic or robotic myomectomy: several small incisions are made in the stomach to allow small instruments and a camera (laparoscope) to remove the fibroids. Robotic myomectomy is a variation of laparoscopic myomectomy where the surgery is assisted with a surgical robot.
- hysteroscopic myomectomy: this procedure is specific and effective for fibroids located inside the cavity of the uterus (submucosal fibroids). Small instruments and a camera (hysteroscope) are inserted into the uterine cavity through the cervix to remove the fibroids. Recovery is rapid because there is no incision on the stomach.
Endometrial ablation destroys the lining of the uterus. The treatment does not shrink the fibroids(s) but can help reduce heavy menstrual bleeding caused by fibroids (smaller than 3 centimeters). There are several ways to perform endometrial ablation.
Endometrial ablation is not a birth control. You need to use some form of birth control to prevent pregnancy after ablation. Women who do get pregnant after ablation are more likely to have an abnormal pregnancy.
Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is a permanent treatment that cures heavy menstrual bleeding, and the pressure and pain symptoms of fibroids. It is done when medical treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to become pregnant after having a hysterectomy.
Uterine artery embolization
In uterine artery embolization (also called UAE or uterine fibroid embolization, UFE), tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. However, the procedure is not recommended for large fibroids, submucosal fibroids or pedunculated fibroids.
Embolization is not recommended for women who desire to retain their fertility. When compared with myomectomy, embolization is associated with a higher rate of infertility and miscarriage.
Magnetic resonance guided focused ultrasound
This is the newest fibroid treatment option. A magnetic resonance mapping for heat is used to locate the uterine fibroids and high energy ultrasound is delivered to the fibroids to destroy them with instant necrosis. Injury to the skin and normal tissues in the pathway of the high-energy ultrasound are potential side effects. The technique is so new that safety and efficacy of this procedure remains to be established.