Advances in uterine fibroid treatment

UTERINE FIBROIDS are noncancerous tumours that grow in the uterus. They are really common in women who have a menstrual cycle, especially black women. Fibroids do not always cause problems, but they can trigger symptoms like pelvic pain and heavy bleeding.

Treatment includes medical therapy, taking the uterus out, and a number of techniques in-between.

If your fibroids do not affect the inside of your uterus, the doctor might want you to try a progestin-releasing intrauterine device (IUD). That is a type of birth control that lasts for up to five years. Progestin-only IUDs do not help you feel better by getting rid of fibroids. Instead, they may lighten or stop your period. This might ease symptoms caused by fibroids, including pain and heavy bleeding.

You may also be prescribed Gonadotropin-Releasing Hormone (GnRH) agonists.

SHORT-TERM TREATMENT

These drugs block the hormone that triggers your menstrual cycle. As a result, your period stops and fibroids shrink. This is a short-term treatment, six months or less, sometimes used before surgery because smaller fibroids are easier to remove. GnRH agonists also block sex hormones like estrogen that can cause unwanted side effects. You may get menopause-like symptoms like bone loss, vaginal dryness, and hot flashes.

These drugs do not shrink fibroids, but they may treat abnormal bleeding for up to two years. You may need to take other lab-made hormones at the same time to lessen side effects like hot flashes and bone loss. This is called add-back therapy. Scientists continue to study other ways to manage fibroid symptoms, such as selective progesterone receptor modulators. These drugs may ease heavy bleeding as well as other symptoms.

Radiofrequency ablation (RFA) uses small needles to heat and destroy fibroids and their blood vessels. The tissue may continue to die for up to a year after surgery. RFA is commonly done one of two ways. You may get a laparoscopy, that is when your doctor makes two small cuts in your belly and uses a special camera to find the fibroids. Another way is to go through your vagina and cervix. RFA is generally considered safe.

ENDOMETRIAL ABLATION TREATMENT

Endometrial ablation treatment might be used to control heavy bleeding when medication is not enough. The doctor won’t make any cuts in your belly. Instead, they will get to your uterus through your vagina. The procedure thins the lining of your uterus with things like electricity, heat, or cold. You will go home the same day and should recover within a day or two. You may not be able to get pregnant or safely carry a baby after endometrial ablation.

Laparoscopic, or robotic myomectomy, removes fibroids but leaves your uterus. If you do not have very many, your doctor may only need to make small cuts in your belly (laparoscopy). Then they will use a special camera (laparoscope) to see inside your body. Once they find the fibroids, they will use small tools to cut them out. A robotic myomectomy is a type of laparoscopy, but your surgeon uses a special machine to get a zoomed-in view of your uterus.

Hysteroscopic myomectomy is another way to treat fibroids without making cuts in your belly. Your doctor can put a thin, hollow tube (hysteroscope) through your vagina into your uterus. Other tools slide through this tube. One is called a resectoscope and it can destroy fibroids by blasting them with laser beams. A hysteroscopy can shrink fibroids inside your uterus, but it cannot treat the ones deep in the uterine walls.

Abdominal myomectomy lets you keep your uterus, but your doctor will need to remove fibroids through a big cut in your belly. This kind of surgery is more likely if your fibroids are really big, hard to get to, or you have lots of them. Go over the pros and cons of an abdominal myomectomy with your doctor. It may cause scarring that will hurt your chances of getting pregnant later.

THE BEST CHOICE

Most people with fibroids do not need to remove their uterus, but a hysterectomy is sometimes the best choice if you have large fibroids or serious bleeding that is hard to control with other treatments. This procedure is the only sure way to get rid of fibroids for good. While you will not be able to get pregnant afterwards, you may be able to keep your ovaries. Ask your doctor what is right for you.

Tell your doctor if you have heavy menstrual bleeding or vaginal bleeding outside of your period. Also, tell them if you have pelvic pain that does not go away, swelling or a feeling of fullness in your lower belly, the urge to pee a lot, or trouble pooping. Fibroids are usually harmless, but they can affect your health and quality of life. Your doctor can help you figure out what kind of treatment, if any, is best for you.

Scientists do not know how to stop fibroids from forming. However, there is ongoing research in this area. But certain healthy lifestyle choices may lower your odds of getting them. That includes eating less red meat and more fruits and vegetables. Ask your doctor to check how much vitamin D you have in your blood. People who do not have enough of this key nutrient seem to have a greater chance of fibroids.

SOURCE:WebMd, Harvard Medical Review, World Health Organization