Treatment options for Uterine Fibroid

It is well established that women are looking for less invasive procedures and often delay treatment in the hope that they will reach menopause without needing a treatment. In the meantime however, they utilize many medical resources- including drugs, medical visits and medical tests.

The following treatment options are available for management of uterine fibroids:

• expectant management;
• drug or hormone therapy;
• hysterectomy (radical/partial/total; (open) abdominal/laparoscopic/vaginal);
• myomectomy (abdominal/laparoscopic/hysteroscopic);
• uterine artery embolisation [UAE];
• ExAblate.

Treatments for symptomatic fibroids have until recently been entirely invasive. Two less invasive uterine-sparing treatments have become available: UAE and ExAblate. The objectives of treatment are to reduce menstrual bleeding; reduce pressure symptoms; reduce pelvic pain; and induce a change in fertility status, with minimal adverse effects.

Medical/Drug Treatment

Medical treatment includes drugs, NSAIDs and GnRH agonists and may be useful pre-operatively to shrink UF but is not effective long-term and has significant side-effects.

Surgical Procedures

Hysterectomy

Hysterectomy involves removal of the uterus. It is a permanent solution to uterine fibroids, but is associated with non-negligible mortality, and substantial morbidity with procedure-specific adverse effects and those associated with major surgery. Hysterectomy may lead to long-term psychological effects – depression and self-perceived loss of femininity. It takes some months to recover completely and return to normal activities. Hysterectomy rules out the possibility of future pregnancy, an important consideration given the peak incidence of UF in the 40-44 year age group and the social trend to postpone child-bearing.

Myomectomy

Myomectomy is a surgical procedure whereby the fibroid is removed from the uterine wall. It is often a more complex procedure than hysterectomy, with the risks of major surgery. It is uterine-sparing and therefore preferred to hysterectomy fertility preservation is desired, although adhesions – which may lead to infertility – occur in 50-90% of patients have a myomectomy. UF recurs or persists in many patients. Additional surgery is required in up to 35% of myomectomy patients. Complications of myomectomy include: bleeding, infection, visceral damage, thromboembolism, haemorrhage, uterine perforation, damage to the cervix, and excessive absorption of the distention media into the vascular system, which can cause metabolic disturbances.

Uterine Artery Embolization

UAE is a minimally invasive surgical alternative to hysterectomy and myomectomy. However, a high proportion of patients have post-embolisation syndrome – pain, nausea and pyrexia – which require treatment with narcotics or NSAIDs. UAE usually requires an overnight stay in hospital. It is associated with significant short-, medium- and long-term adverse effects, including ovarian failure and various female reproductive system disorders.