But now doctors can offer two new techniques that disarm these worrisome fibroids and still preserve the uterus–the most potent symbol of a woman’s fertility.
How?
Instead of surgically removing fibroids along with the uterus, these procedures destroy the fibroids internally by halting their blood supply.
“If you cut the blood supply, they should die,” said Dr. Steven Chavoustie, an obstetrician-gynecologist at Baptist Health Systems in Miami who is familiar with the procedures. “That’s the reasoning behind what we’re trying.”
Fibroids, which resemble baked potatoes, range from pea size to a mass so large a woman can appear seven months pregnant. They occur in 20 percent to 30 percent of women ages 35 to 55.
Because some fibroids produce no symptoms, treatment isn’t always necessary. In fact, women might not even know they have them. Some cause painful cramping, heavy bleeding and even threaten fertility. Of the estimated 200,000 hysterectomies performed annually, about a third are fibroid-related, says Dr. Paul Norris, assistant professor of obstetrics and gynecology at the University of Miami School of Medicine.
As a result, physicians keep looking for less drastic, less risky treatments.
Using a procedure known as myolyosis, a doctor, usually an ob-gyn, inserts a specially designed needle through a small incision in the lower abdomen. With this needle, the doctor repeatedly punctures the fibroids using an electrical current. As a result, the blood supply is cut off. The fibroid shrinks and only the devascularized tissue–that is, tissue that receives no blood–is left.
In another procedure called uterine artery embolization, a doctor makes a small incision in the groin and guides a small plastic tube to the artery that supplies blood to the fibroid. Then the doctor injects small plastic beads into the artery to cut off the blood flow. This procedure, which requires maneuvering the thin plastic tube through blood vessels, is generally performed by an interventional radiologist.
The procedures are less invasive than a hysterectomy or a similar option, a myomectomy, in which fibroids are removed but the uterus is left intact. Both require about five or six days to recover instead of six weeks, and both are generally covered by insurance.
Still, these techniques aren’t appropriate for everyone. The fibroids need to be small, less than four inches. Neither procedure is recommended for women who still want children because of potential damage to the uterus. Myolyosis can weaken the uterine wall. Embolization requires a great deal of technical skill because the uterus can be damaged easily.
Yet another concern: About 1 percent of fibroids are precancerous and should be carefully monitored, not manipulated. A fast-growing fibroid, one that doubles in size in six months, is a warning flag because cancer also grows quickly.
Women who aren’t candidates for these techniques still have the option of conventional treatment, which also has complications. A hysterectomy eliminates the possibility of childbirth and can interfere with sexual function. Another option, the supercervical hysterectomy, leaves the cervix intact but still removes the uterus.
Although the myomectomy is a popular choice for women in their child-bearing years, fibroids grow back about 50 percent of the time.
Because no ideal option for treatment exists, women face difficult decisions when fibroids appear to cause complications.
Diane Whittaker, 40, of Miami Shores, Fla., didn’t consider a hysterectomy an option. She’s the mother of 6-year-old Kenny and wants another child. So in January, after two miscarriages following the birth of her son, she opted for a myomectomy, fearing that the growing fibroid played havoc with her pregnancies.
“You always wonder if you did the right thing at the right time,” she said. “I’ve known women who’ve had hysterectomies, and I’ve known women who’ve had myomectomies and the fibroids grew back.”
Though doctors say that estrogen fuels fibroids, causing them to grow, so much about these growths remains a mystery. It’s not clear why some women develop them and others don’t or why African-Americans are at higher risk than Caucasians or why some have one fibroid and others as many as 30 or whether childbirth is a factor and what role, if any, a woman’s lifestyle plays or why some fibroids cause symptoms and others don’t.
What doctors can discuss with more certainty are treatment options and their risks, says Dr. Karen Simmons, assistant professor of obstetrics and gynecology at the University of Miami School of Medicine. “But the choice is up to the patient.”
