Treatment

Treatment for uterine fibroids depends on:

• whether or not you are having symptoms from the fibroids
• if you might want to become pregnant
• the size of the fibroids
• the location of the fibroids
• your age

If you have fibroids, but do not have any symptoms, you may not need any treatment. But your doctor will check during your regular exams to see if they have grown.

Medications

If you have fibroids and have mild symptoms, your doctor might only suggest pain medication. Over-the-counter anti-inflammatory drugs, such as ibuprofen, or other painkillers such as acetaminophen can be used for mild pain. If pain becomes worse, your doctor can prescribe a stronger painkiller.

Other drugs used to treat fibroids are called gonadotropin releasing hormone agonists (GnRHa). These drugs can decrease the size of the fibroids. Sometimes they are used before surgery, to shrink the fibroids, making them easier to remove. Side effects can include hot flushes, depression, not being able to sleep, decreased sex drive, and joint pain. Anti-hormonal agents, such as a drug called mifepristone, also can stop or slow the growth of fibroids. These drugs only offer temporary relief from the symptoms of fibroids; once you stop the therapy, the fibroids often grow back.

Surgery

If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:

• Myomectomy - a surgery to remove fibroids without taking out the healthy tissue of the uterus. There are many ways a surgeon can perform this procedure. It can be major surgery (with an abdominal incision) or minor surgery. The type, size, and location of the fibroids will determine what type of procedure will be done. Talk with your doctor about the different types of this surgery.
• Hysterectomy - a surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. This surgery is used when a woman's fibroids are large, or if she has heavy bleeding, and is either near or past menopause and does not want children. There are various types of hysterectomy that differ in how invasive they are. Sometimes, if the fibroids are large, a woman might need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the surgeon might be able to reach the uterus through the vagina, instead of making a cut in the abdomen.
• Endometrial ablation ?the endometrial lining of the uterus is destroyed. This surgery controls very heavy bleeding, but afterwards a woman cannot have children.
• Myolysis ?a procedure in which an electrical needle is inserted into the uterus through a small incision in the abdomen to destroy the blood vessels feeding the fibroids.

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) is a treatment that cuts off the blood supply to the uterus and the fibroids so they shrink (more info). UFE is proving to be an alternative to hysterectomy and myomectomy. The recovery time is also shorter, and there is a much lower risk of needing a blood transfusion than for these surgeries. Many women can have UFE and go home the same day. There is a small risk of infection in the treated fibroid, but these are usually managed with antibiotics. Recent studies also suggest that most fibroid tumors are not likely to re-grow after UFE, although more long-term data is needed.

Not all fibroids can be treated with UFE. All patients must first be evaluated with ultrasound or MRI to make sure the fibroids will respond well to this treatment. Doctors called interventional radiologists perform UFE. The best candidates for UFE are women who:

• have fibroid tumors that are causing heavy bleeding
• have fibroid tumors that are causing pain or pressing on the bladder or rectum
• don’t want to have a hysterectomy
• don’t want to have more children

Sometimes after UFE, the particles that are put into the fibroids to cut off their blood supply have traveled to the ovaries. In a few women, the ovaries then stop working for a short time or permanently. Although researchers know that UFE may affect how ovaries function, they are unsure of how exactly UFE affects fertility. If you want to have children in the future, you should talk with your doctors about the small, but definite risk of UFE causing you to go into early menopause. Too few women have gotten pregnant after UFE for researchers to know if there is an increased risk of pregnancy complications.

ExAblate?2000 System

ExAblate?2000 is a medical device that uses magnetic resonance image guided focused ultrasound to target and destroy uterine fibroids. The device is intended to treat women who have completed child bearing or do not intend to become pregnant. ExAblate?2000 is non-invasive surgery. It spares the uterus and is an alternative to myomectomy, hysterectomy, watchful waiting, hormone therapy, or uterine fibroid embolization.

ExAblate combines two systems ?a magnetic resonance imaging (MRI) machine to visualize patient anatomy, map the volume of fibroid tissue to be treated, and monitor the temperature of the uterine tissue after heating, and a focused ultrasound beam that heats and destroys the fibroid tissue using high frequency, high-energy sound waves.

The treatment requires repeated targeting and heating of fibroid tissue while the patient lies inside the MRI machine. The procedure can last as long as three hours.

The new device can be used to treat some ?but not all ?fibroids. Fibroids close to sensitive organs such as the bowel or bladder and those outside the image area cannot be treated.

InSightec, the manufacturer, is conducting more research to assess the long-term safety and effectiveness of the treatment.

How does Uterine Fibroid Embolization (UFE) work?

Reference:

National Women's Health Information Center, USA