Uterine fibroids are a common underlying cause for heavy menstrual bleeding, pain, and infertility concerns. Once the diagnosis is made, the next concern is controlling or eliminating the problem. There are several treatment strategies to help minimize problems associated with fibroids.
The least-invasive option for managing uterine fibroids is hormonal birth control methods. This usually involves progestin-only pills, shots, or an intrauterine device. Not only can hormonal birth control help shrink fibroids, but it can also alleviate some of the problems associated with uterine fibroids, such as heavy and painful periods. If you decide to have a child in the future, you can simply stop using the birth control method, and your fertility should return to normal within in a matter of months. Birth control is a good treatment option to try if you want to avoid more invasive or riskier procedures.
Treatments To Preserve Fertility
When women want to have children or additional children, any procedure to reduce the size or remove the fibroids may reduce symptoms, but these procedures are not guaranteed to preserve or increase fertility. Additionally, there is no guarantee that fibroids will not return. Often, women with large or numerous fibroids face problems with conceiving and carrying a pregnancy to term. Successful removal of fibroids may increase the chances of a healthy pregnancy, but issues such as scarring or other damage to the uterus caused by the fibroids or medical procedures can also contribute to fertility problems.
A uterine myomectomy is the procedure used to remove fibroids. Depending on the size, location, and number of fibroids, the procedure may be performed with minimally invasive methods, or it may require an open surgery. When large fibroids are removed from the uterus, there may be some concern about the integrity of the uterus. Large incisions in the uterus may increase the risk of uterine rupture during pregnancy or delivery. Women who become pregnant after a uterine myomectomy should be sure to discuss their risks with their obstetrician. They may require additional monitoring during pregnancy, and once the mother can safely deliver a healthy baby, it may be safer to induce labor than risk complications.
Procedures When Fertility Is Not Important
For some women, their treatment options for fibroids are heavily influenced by their symptoms, and reproductive goals are less of a concern. Although there may be less-invasive options available for fibroids, some women may opt to have a hysterectomy if they are finished having children. They may discuss with their doctor the benefits of preserving their ovaries to delay menopause and what, if any, additional risks occur with keeping their ovaries. For example, keeping the ovaries intact means the possibility of ovarian cancer remains. Women with certain gene markers or a family history of ovarian cancer may feel more confident about their health by having their ovaries removed at the same time and going through an abrupt menopause.
More gynecologists are trying to avoid hysterectomies in women with fibroids, especially since, in previous decades, the procedure was often used as a first-line treatment, without trying other options. Endometrial ablation is one such procedure that is minimally invasive, but it is only performed in women who have finished having children. The procedure destroys the uterine lining. It is the same procedure used for women with dangerously heavy periods without fibroids. Although it may not eliminate the fibroid itself, the procedure can limit or stop monthly bleeding. In some cases, the uterine lining does return and the procedure can be performed again.
Fibroid embolization is used to stop blood flow to fibroids and may be used before a hysterectomy is considered. The procedure is performed by threading a catheter through the leg and into the uterine arteries. Once the appropriate site of blood flow to one or more fibroids is located, the blood vessels are blocked. When fibroids no longer have a blood supply, they typically shrink and may die. Eventually, the fibroid tissue may come out through the vagina. Although the procedure is not guaranteed to decrease fertility, it is reserved for women who do not plan to become pregnant.
Uterine fibroids not only cause complications with becoming pregnant or having a healthy pregnancy, but they often cause considerable problems with each menstrual period. Fortunately, there are several ways to manage uterine fibroids and they do not always require a hysterectomy. For more information, contact an OB/GYN at a location such as Heart Of Florida OB/GYN Associates.