Uterine fibroids
are quite common with 25-30% of women having a fibroid. Fortunately
most fibroids never lead to any problems. The vast majority
of patients with fibroids do not need any type of treatment,
only reassurance.
In the minority of women who have problems,
some of the common complaints that result from problematic fibroids
include heavy and uncomfortable menstrual periods, pelvic and
abdominal pressure due to uterine enlargement, having to urinate
more frequently, infertility and miscarriage.
In some cases women with fibroids (also called myomas) are
encouraged to undergo a hysterectomy when they actually want
to conserve their uterus. It is very unlikely that if you
have fibroids in your uterus that a conservative approach
cannot be offered to you. If your physician only offers you
a hysterectomy for your uterine fibroids and you still want
to have a child then you should seek a second opinion.
Myomectomy most often describes making an incision in the
abdomen (similar to a cesarean section). The uterus is then
opened and the fibroids are shelled out. The uterus is then
carefully reconstructed. This technique has been around for
decades and is an excellent option that should not compromise
fertility in most cases. In some cases Drs. Bateman and Williams
can do the myomectomy through a small incision, called a mini-laparotomy.
This may allow discharge home the same day and a hospital
stay is unnecessary.
Some fibroids reside in the uterine cavity or have grown
into the uterine cavity which allows a minimally invasive
approach called hysteroscopy. This is a wonderful option when
available because it involves no incisions at all. During
a hysteroscopic myomectomy a camera mounted on a 5 mm wide
lens is inserted through the vagina and cervical canal into
the uterus.
Through the end of the lens specialized instruments
are used to remove the fibroid(s). Some practitioners do not
offer a hysteroscopic approach to amenable fibroids. This
is usually due to limited training but may also be because
their operating room does not have the specialized equipment
required to offer this technique.
In some circumstances we can offer a laparoscopic approach
to myomectomy. This means that with a few 5 mm incisions in
the abdomen the fibroids can be removed during a same-day
procedure. No larger incision is required and the recovery
is less than a week. Most physicians do not offer a laparoscopic
approach to amenable fibroids. This is usually due to limited
training but may also be because their operating room does
not have the specialized equipment required to offer this
technique.
Uterine Artery Embolization for fibroids (UAE) is another excellent
minimally invasive technique for treating fibroids. However,
radiologists and reproductive endocrinologists, fertility specialists agree that this
is not a good option in someone who wants to get pregnant in
the future. There is some information that the embolization
can compromise ovarian function. We do not recommend this technique
unless you do not want to have a pregnancy in the future. To
learn more about UAE go to: www.crlradiology.com |
