Options for medical management focus on relieving suffering from symptoms of uterine fibroids, namely abnormal menstrual bleeding. Some options may reduce fibroid size. Hormonal medications exist in a variety of forms, but act as contraception, so pregnancy is not possible during therapy. Non-hormonal medications allow continued attempts at pregnancy with improvement of bleeding symptoms in many cases as well.
Uterine Fibroid Embolization
Uterine fibroid embolization (UFE) is a minimally invasive procedure to treat fibroid tumors. A form of real-time x-ray called fluoroscopy is used to guide the delivery of small plastic beads into the arteries feeding the fibroids. The result is decreased blood to the fibroids, causing them to shrink. Most women undergoing UFE report significant or complete resolution of their fibroid related symptoms. Uterine fibroid embolization requires only a small nick in the skin. Unlike surgery, general anesthesia is not required. Recovery times are typically under two weeks.
The question of how uterine fibroid embolization affects pregnancy has yet to be answered, however many healthy pregnancies after UFE have been reported. Due to this uncertainty, physicians may recommend that women wishing to have more children elect another option to treat fibroids. If not possible then UFE may still be an option.
Magnetic Resonance-guided Focused Ultrasound
Magnetic Resonance-guided Focused Ultrasound (MRgFUS) uses ultrasonic pulses, or sonications, to heat up and destroy fibroid tumors. MR guidance is used to accurately target the fibroids and spare the healthy tissue. Unlike surgery, MRgFUS does not require an incision or general anesthesia. Most patients can return to normal activities after a couple of days. As MRgFUS is a newer technique for treating fibroids, long-term data on fertility is not available, however available data supports use of this treatment in women desiring future fertility.
This procedure consists of the surgical removal of uterine fibroids. Minimally-invasive approaches include hysteroscopy, laparoscopy, or a combination of the two. Hysteroscopy involves placing a telescopic camera through the cervix to visualize the uterine cavity, and enables the surgeon to remove fibroids contained in the cavity. During laparoscopy, the surgeon will place a telescopic camera and instruments into your abdomen through small incisions. Through these incisions, the fibroids are removed from the uterus, and the uterus is repaired. Hysteroscopy alone has a 1-2 day recovery period, while laparoscopy requires up to six weeks of restrictions but most patients are back to work within 1-2 weeks. Pregnancy remains possible after a myomectomy from either approach.
A hysterectomy is the removal of the uterus, and often the cervix. All fibroids are removed with the uterus. If the uterus size is appropriate, a vaginal approach may be used (no abdominal scars), but if not, a laparoscopy will confer similar benefits of a quicker recovery time. Both have similar recovery times with ability to return to work after 1-2 weeks, but restrictions remain in place for 6-8 weeks after surgery. Most often, ovaries are not removed, allowing retention of natural hormones for health benefits. Pregnancy is not possible after a hysterectomy.