Treatment options for Uterine Fibroids
Some women know at least one woman who has had a hysterectomy. They would also have heard of the reason a hysterectomy was done and in a number of cases it is because of fibroids. But is the removal of the uterus (hysterectomy) always the only option available?
According to Dr Anthony Mullings, Lecturer and Consultant in Obstetrics & Gynaecology at the University Hospital of the West Indies, fibroids only need to be treated if they are causing symptoms. These symptoms are typically pain, heavy bleeding during the menstrual period and a large abdominal mass. He explained that the treatment that is administered to patients is done on a case-by-case basis.
“There is no blanket choice for a hysterectomy versus other procedures. There is a role for each,” he said.
He stressed that treatment choices would have to be outlined in the context of a woman’s circumstances. Certain factors however determine the most appropriate treatment for each woman, he said. Factors such as the type, location and size of the fibroids, the patient’s age (is she of child-bearing age), whether or not the patient wishes to retain her childbearing capability or her uterus even after childbearing, and whether or not the fibroids are causing symptoms.
Research show three approaches to treating fibroids – medical regimens, surgery and uterine artery embolization.
Medical regimens involve administering medicines to help control fibroid-related symptoms. Options include non-steroidal anti-inflammatory medication such as ibuprofen for pain, birth control pills to reduce blood loss, and treatments with drugs such as gonadotropin-releasing hormone (GnRH) agonists to reduce uterine mass. Surgical options include myomectomy (removal of the fibroid) or hysterectomy (removal of the uterus).
Another important factor is the patient’s medical history and based on this, the potential risks for her of a given procedure.
The primary treatment for patients with large or symptomatic fibroids is surgery. Hysterectomy is the most frequent operative technique used and there are a variety of these, including abdominal hysterectomy, supracervical hysterectomy, laparoscopically-assisted vaginal hysterectomy, and vaginal hysterectomy. The type that is chosen depends on the patient’s medical history, the size of her uterus and the surgeon’s skills. Hysterectomy is a more suitable option for patients who are not planning future pregnancies. The benefit of this option is that there can never be a recurrence of the condition.
For women who wish to preserve their childbearing potential or their uterus, a myomectomy may be performed. Most myomectomies are performed through an abdominal incision. However, certain types of fibroids can be removed through the vagina without an abdominal incision, a procedure termed hysteroscopic myomectomy as it involves a special instrument called a hysteroscope. Certain other types of fibroids can be removed abdominally during a procedure called laparoscopic myomectomy, which involves use of a laparoscope (an instrument through which structures within the abdomen and pelvis can be seen). The use of the drug Pitresin (a practice pioneered in Jamaica in 1994 by four local doctors of Obstetrics and Gynaecology) during myomectomies significantly reduces the amount of blood loss during surgery. Myomectomy generally diminishes prolonged and/or heavy menstrual flows, medical literature says in as much as 80% of patients presenting with this symptom. However, there is a risk of recurrence of fibroids after myomectomy.
Uterine artery embolization is a fairly new approach to treating fibroids. The procedure, performed by a radiologist trained in using X-rays to guide interventions within the arteries, involves gaining access to the arterial tree through a very small cut in the skin at the top of the leg. A thin tube or catheter is then guided to the artery that takes blood to the uterus, and very small particles are injected through the catheter to block the blood supply to the fibroid. This causes the fibroids to shrink. Data shows that 90% of women who have had this procedure feel that their symptoms have improved significantly. On average, fibroids shrink by approximately 50% and the uterus by 40% in three months.
As with any procedure, there are certain risks involved with uterine artery embolization and a woman needs to carefully discuss these with her doctor.
Other innovative techniques being looked at are myolysis, delivering electric current by way of needles to a fibroid at the time of laparoscopy, and cryomyolysis, using a freezing probe in a similar manner as with myolysis.
Women can then take heart that there are options open to them and the presence of uterine fibroids does not necessarily indicate the need for a hysterectomy.
Treatment options for fibroids will be among the issues focused on at an exposition, Caribbean Woman 2004 – Addressing Uterine Fibroids, to be held March 13 and 14, 2004 at the Hilton Kingston Hotel. Fibroids affect about 50 per cent of Jamaican women.
Shelly Anglin Smith is a freelance writer
