Mobolaji Ajao, MD, Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital, discusses treatment options for women with uterine fibroids.
Fibroids are very common muscle tumors of the uterus. Over the course of a lifetime, close to 70 percent of Caucasian women and more than 80 percent, of African American women will develop fibroids. Up to a quarter of women will actually have symptoms that will bring them in to seek a physician's evaluation.
Symptoms of fibroids include heavy bleeding, pain or pressure symptoms and, occasionally, increased urinary frequency. Fibroid treatment options include watching and waiting, medical management, interventional radiology procedures and surgery. Brigham and Women's Hospital offers all of these treatment options.
Most fibroids are discovered during a pelvic exam and this often triggers an ultrasound or some imaging modality to get a sense of the size and location of the fibroids. Alternatively, some women will present with symptoms such as heavy bleeding, pressure or pelvic pain that will trigger an imaging test.
Most patients will respond to medical management of fibroids, but their symptoms return once they discontinue medication and they will end up needing some other intervention.
Procedures performed by interventional radiologists may also used to treat fibroids. The most common procedure is uterine artery embolization (UAE) or uterine fibroid embolization which targets the blood vessels that feed the uterus. UAE leads to a decrease in the blood supply to the fibroid and overall shrinkage of the fibroid and the size of the uterus.
The other option performed by interventional radiologists is magnetic resonance guided focused ultrasound. Focused ultrasound is limited to patients who meet certain criteria.
Options for surgery include removing the fibroid or removing the uterus. Removing the fibroid can be approached in several different ways. If the fibroid is located completely inside the cavity of the uterus, it can be removed by an approach called hysteroscopy, where a camera and equipment are inserted through the cervix into the uterus; the fibroid is then shaved down from inside the uterus. If the fibroid is located in the wall of the uterus, fibroid removal can be approached by either an abdominal incision, similar to an incision for a c-section, side to side in the skin or up and down in the skin.
Alternative surgical approaches include laparoscopic or robotic surgery. Both of these techniques include placing a small incision in the wall of the abdomen to remove the fibroids. The other surgical option for fibroids is hysterectomy. A hysterectomy can be performed vaginally, if the size of a fibroid is small enough.
Learn more about minimally invasive surgery for uterine fibroids:
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