Guide | Preserving the uterus is possible: treatment options for uterine fibroids
The word “tumor” can be alarming. However, when the diagnosis is a uterine fibroid, U.S. experts note that it is usually not the bad news many patients fear.
“Uterine fibroids carry almost no risk of malignancy. There are many treatment options, and in some cases no treatment is needed, so there is no reason for excessive anxiety,” said Dr. Steve Goldstein, professor of obstetrics and gynecology at New York University Medical Center.
Fibroids are benign growths caused by abnormal growth of uterine smooth-muscle cells. They are generally classified as submucosal, beneath the uterine lining; intramural, within the uterine wall; or subserosal, projecting outward into the pelvis. They are most common between ages 30 and 40, have a particularly high incidence among Black women, and show some hereditary tendency.
Some women have no symptoms. When symptoms occur, they commonly include heavy or prolonged menstrual bleeding, pelvic pain, bloating, and frequent urination.
Dr. Aydin Arici, professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, said treatment should consider fibroid size, number, and location; symptom severity; age; and fertility plans.
Concerningly, a survey led by the American College of Obstetricians and Gynecologists (ACOG) found that as many as 76% of hysterectomies did not meet medical criteria and were considered unnecessary.
“Many women undergo hysterectomy because they are led to believe it is the only option. That misconception must be corrected,” said Dr. Ernst Bartsich, associate professor of obstetrics and gynecology at NewYork-Cornell Medical Center.
Professor Goldstein also noted that not all hysterectomies should be viewed negatively. A newer supracervical hysterectomy removes the uterine body while retaining the cervix, ovaries, fallopian tubes, and pelvic support tissues. It therefore avoids some bladder dysfunction, sexual problems, and premature menopause associated with traditional surgery.
Recovery is also rapid: most patients leave the hospital within two days and resume normal activities within two weeks.
“My principle is always to minimize surgery, but for some patients this procedure is a low-risk, high-benefit option,” Goldstein said.
The author summarized five alternatives for treating uterine fibroids to support informed decisions:
Option 1: Myomectomy
Method: Fibroids are removed while preserving the uterus through open surgery, laparoscopy, or hysteroscopy;
Suitable for: Women who wish to preserve fertility;
Considerations: Postoperative adhesions may affect natural conception, and some patients may later need IVF.
Arici emphasized that hysteroscopy is most effective for bleeding or recurrent miscarriage caused by fibroids.
Option 2: Uterine Artery Embolization
Method: A catheter delivers particles that block the fibroid’s blood supply, causing it to shrink;
Suitable for: Women who do not plan future pregnancies;
Considerations: Caution is advised for those planning pregnancy, as studies show higher rates of preterm birth and complications.
Bartsich noted that although the procedure can effectively destroy fibroids, it also affects blood flow throughout the uterus and may affect pregnancy safety.
Option 3: MRI-Guided Focused Ultrasound
Method: MRI guidance is used to convert ultrasound energy into heat that destroys fibroids;
Suitable for: Women who do not plan future pregnancies;
Considerations: Durability and effects on future pregnancy remain under study, and surrounding tissue may be burned.
Option 4: Medical Management
Method: Medications such as Lupron suppress steroid hormone secretion;
Suitable for: Patients with smaller fibroids or those preparing for surgery;
Considerations: Use is limited to nine months, fibroids often recur after treatment stops, and it may offer short-term bleeding control for women approaching menopause.
Option 5: Medical Monitoring
Method: Periodic ultrasound and anemia testing track fibroid progression;
Suitable for: Women with mild symptoms who have completed childbearing and are approaching menopause;
Considerations: If fibroids do not cause severe pain or bleeding, they may be observed even if they grow.
Goldstein emphasized: “If fibroids are not seriously affecting daily life, there is no need to rush into treatment. Doing nothing may be appropriate.”
Guide | Preserving the uterus is possible: treatment options for uterine fibroids
Guide | Preserving the uterus is possible: treatment options for uterine fibroids
The word “tumor” can be alarming. However, when the diagnosis is a uterine fibroid, U.S. experts note that it is usually not the bad news many patients fear.
“Uterine fibroids carry almost no risk of malignancy. There are many treatment options, and in some cases no treatment is needed, so there is no reason for excessive anxiety,” said Dr. Steve Goldstein, professor of obstetrics and gynecology at New York University Medical Center.
Fibroids are benign growths caused by abnormal growth of uterine smooth-muscle cells. They are generally classified as submucosal, beneath the uterine lining; intramural, within the uterine wall; or subserosal, projecting outward into the pelvis. They are most common between ages 30 and 40, have a particularly high incidence among Black women, and show some hereditary tendency.
Some women have no symptoms. When symptoms occur, they commonly include heavy or prolonged menstrual bleeding, pelvic pain, bloating, and frequent urination.
Dr. Aydin Arici, professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, said treatment should consider fibroid size, number, and location; symptom severity; age; and fertility plans.
Concerningly, a survey led by the American College of Obstetricians and Gynecologists (ACOG) found that as many as 76% of hysterectomies did not meet medical criteria and were considered unnecessary.
“Many women undergo hysterectomy because they are led to believe it is the only option. That misconception must be corrected,” said Dr. Ernst Bartsich, associate professor of obstetrics and gynecology at NewYork-Cornell Medical Center.
Professor Goldstein also noted that not all hysterectomies should be viewed negatively. A newer supracervical hysterectomy removes the uterine body while retaining the cervix, ovaries, fallopian tubes, and pelvic support tissues. It therefore avoids some bladder dysfunction, sexual problems, and premature menopause associated with traditional surgery.
Recovery is also rapid: most patients leave the hospital within two days and resume normal activities within two weeks.
“My principle is always to minimize surgery, but for some patients this procedure is a low-risk, high-benefit option,” Goldstein said.
The author summarized five alternatives for treating uterine fibroids to support informed decisions:
Option 1: Myomectomy
Method: Fibroids are removed while preserving the uterus through open surgery, laparoscopy, or hysteroscopy;
Suitable for: Women who wish to preserve fertility;
Considerations: Postoperative adhesions may affect natural conception, and some patients may later need IVF.
Arici emphasized that hysteroscopy is most effective for bleeding or recurrent miscarriage caused by fibroids.
Option 2: Uterine Artery Embolization
Method: A catheter delivers particles that block the fibroid’s blood supply, causing it to shrink;
Suitable for: Women who do not plan future pregnancies;
Considerations: Caution is advised for those planning pregnancy, as studies show higher rates of preterm birth and complications.
Bartsich noted that although the procedure can effectively destroy fibroids, it also affects blood flow throughout the uterus and may affect pregnancy safety.
Option 3: MRI-Guided Focused Ultrasound
Method: MRI guidance is used to convert ultrasound energy into heat that destroys fibroids;
Suitable for: Women who do not plan future pregnancies;
Considerations: Durability and effects on future pregnancy remain under study, and surrounding tissue may be burned.
Option 4: Medical Management
Method: Medications such as Lupron suppress steroid hormone secretion;
Suitable for: Patients with smaller fibroids or those preparing for surgery;
Considerations: Use is limited to nine months, fibroids often recur after treatment stops, and it may offer short-term bleeding control for women approaching menopause.
Option 5: Medical Monitoring
Method: Periodic ultrasound and anemia testing track fibroid progression;
Suitable for: Women with mild symptoms who have completed childbearing and are approaching menopause;
Considerations: If fibroids do not cause severe pain or bleeding, they may be observed even if they grow.
Goldstein emphasized: “If fibroids are not seriously affecting daily life, there is no need to rush into treatment. Doing nothing may be appropriate.”
Source:
Collected online