Traditional methods for treating uterine fibroids__________________________________________________________________________
Myomectomy is a procedure in which uterine fibroids are surgically removed from the uterus. There are both advantages and disadvantages to myomectomy. There are three types of myomectomy: abdominal, laparoscopic, and hysteroscopic.
Abdominal myomectomy: removal of fibroids through an incision in the abdomen, usually a “bikini incision.” There is no limit to te size or number of fibroids that can be removed. Abdominal myomectomy is done at a hospital, and women can usually go home within 48 hours. There is less blood loss and better repair of the uterus because the surgeon can actually feel the uterus to find the fibroids, remove them, and repair the uterus after fibroid removal. The disadvantages are the larger incision and longer recovery period (2-6 weeks).
Laparoscopic myomectomy: has the advantage of using several small incisions, which cause less pain and lead to a quicker recovery. The disadvantages are that surgeons cannot feel the fibroids with their hands for removal, and suturing is more difficult and often less precise; however, Dr. Taylor uses the laparoscopic suturing technique pioneered by Dr. Nelson Stringer. Recovery is usually 1-2 weeks.
Hysteroscopic myomectomy:submucous fibroids can often be removed using an instrument called a resectoscope. This instrument goes through the vagina and cervix into the intrauterine cavity to allow the surgeon to remove the fibroids. There are no incisions, the patient goes home the same day, and may return to work in 1-2 days.
Before myomectomy, a gynecologist may place you on Lupron™ to shrink the uterine fibroids and make them easier to remove. This drug is known as a GnRH analog. The effectiveness of Lupron™ is considered temporary, as studies show that when the drug is stopped, the fibroids regrow.
GnRH hormones also may cause side effects that mimic menopause, including hot flashes, mood swings, decreased bone density (osteoporosis), and vaginal dryness.
Other drug therapies might include non-steroidal anti-inflammatory drugs (such as ibuprofen or naproxen sodium), birth control pills, or hormone therapy.
Hysterectomy—the removal of the uterus—is rarely required for the treatment of fibroids. Nevertheless, it can be a reasonable option for women who do not want to remain fertile.
Hysterectomy is the only treatment with a guarantee that there will be no further menstrual bleeding and no recurrence of fibroids.
Some women want to have these guarantees but wish to have as little removed as possible, choose to have a supracervical hysterectomy, a procedure in which the body of the uterus with the fibroids is removed and the cervix and ovaries are left in place. This affords pelvic support and avoids surgical menopause with the need for hormone replacement.
If you have a history of dysplasia (pre-cancerous cells in the cervix), it’s better to remove the cervix, such as with a laparoscopic assisted vaginal hysterectomy (LAVH).
For more information on laparoscopic assisted vaginal hysterectomy compared to other types of hysterectomy, please click here
If you have a prolapse with incontinence with your fibroids, you can have a vaginal hysterectomy with a sling procedure (TVT). Please click here
A quick, outpatient treatment for heavy bleeding, it is the removal or destruction of the endometrium or lining of the uterus. It does not require hospitalization and most women return to normal activities in a day or two.
Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding and fibroids who wish to avoid major surgery.