Choosing the Right Uterine Fibroid Treatment: Factors to Consider

Choosing the Right Uterine Fibroid Treatment: Factors to Consider
April 18, 2017 Roy Lazarovich
Choosing the Right Uterine Fibroid Treatment: Factors to Consider

Sometimes uterine fibroids are a minor inconvenience. A heavy period. Some stomach pain here and there.
But sometimes fibroids can interfere with the enjoyment of and the ability to handle everyday life and activities. Work. Leisure. Spending time with friends and family. It’s all overshadowed by the pain or discomfort that the fibroids cause.
It’s usually at that point that you may start looking into treatments, so that you can get your life back. There are many different treatment options available, however: how do you choose the right one for you?
Questions to Ask
Before you even investigate uterine fibroid treatment options, you’ll want to ask (and answer!) the following questions:
1) How do my symptoms manifest?
2) How bad are my symptoms?
3) How permanent do I want my solution to be?
4) Do I want the option of getting pregnant in the future?
5) How much time can I take off from work/other life commitments?

Finding Answers – Medications

Once you’ve answered those questions for yourself, it’s time to look into treatment options. The first level of treatment is often medication. Some of them might not be specific for uterine fibroids but could work for some of the symptoms.
Normally, the first treatment choice is oral contraceptives. Although they are not specific for any condition, they are often prescribed as a way to control abnormal uterine bleeding.

Other treatments include:

Progestin pills or intrauterine devices (IUDs)
These hormone-based pills and devices (usually used to prevent pregnancy) are often used to control heavy menstrual bleeding, which is a symptom of uterine fibroids.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● the primary symptom of your fibroids is heavy menstrual bleeding
● you want to avoid a medical procedure and the recovery time it entails
● you’re not interested in getting pregnant now or for the length of time you’re taking the medication but want to preserve your fertility for the future (once you stop taking the medication your menstrual bleeding will become heavier again)

Tranexamic acid
This non-hormonal medication is taken on days when you are bleeding heavily; the medication reduces the bleeding.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● the primary symptom of your fibroids is heavy menstrual bleeding
● you want to avoid a medical procedure and the recovery time it entails
● you are interested in getting pregnant now or in the near future (note: if you do get pregnant, you should likely stop taking tranexamic acid. Consult your doctor.)

Note that once you stop taking the medication your menstrual bleeding will become heavier again.

Gonadotropin-releasing hormone (Gn-RH) agonists
Gn-RH agonists stop the production of estrogen and progesterone and put you temporarily into a menopausal-like reversible state. The treatment is injectable, menstruation stops, eliminating the heavy bleeding issues, and fibroids shrink. A shrunken fibroid can mean significant relief of pressure. It’s important to note that Gn-RH agonists are typically used for a period of 3-6 months due to the potential side effects of longer-term use, including a decrease in bone mineral density.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● the primary symptom of your fibroids is heavy menstrual bleeding, pelvic pain and/or pressure, or incontinence from fibroids pushing on your bladder
● you want to avoid a medical procedure and the recovery time it entails
● you’re not interested in getting pregnant now or for the length of time you’re taking the medication (once you stop taking the medication, you will preserve your fertility, but your menstrual bleeding will become heavier again and the fibroids will once again be likely to grow)

SPRMs (selective progesterone receptor modulators)
This medication affects the way the body processes progesterone, one of the hormones that encourages fibroid growth, therefore shrinking existing fibroids, ultimately controlling both bleeding and pain.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● the primary symptom of your fibroids is heavy menstrual bleeding, pelvic pain and/or pressure, or incontinence from fibroids pushing on your bladder
● you want to avoid a surgical procedure and the recovery time it entails
● you’re not interested in getting pregnant now or for the length of time you’re taking the medication but you want to preserve your fertility for the future (once you stop taking the medication your menstrual bleeding will become heavier again and the fibroids will once again be likely to grow)

Finding Answers – Medical Procedures

If medications don’t answer your needs or produce the desired outcome, you may want to consider the following procedures:

Uterine artery embolization (UAE)
UAE is a procedure involving the injection of small particles to block the arteries which supply the fibroid with blood flow. With the arteries blocked, the fibroids shrink and die. UAE is usually an outpatient procedure, with full recovery taking 8 to 15 days.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication
● you want a minimally invasive procedure
● it’s acceptable to you to shrink the fibroids, not remove them entirely
● you want an outpatient procedure with moderate recovery time
● you’re not interested in getting pregnant in the near future (while it is possible to become pregnant, apparent higher rates and risks of complications cause physicians to advise other methods if you wish to conceive).

Myolysis
Myolysis is a minimally invasive procedure in which radiofrequency energy, a laser, or an electric current is used to destroy fibroids and the blood vessels that feed them. Myolysis is usually performed under general anesthesia as an outpatient procedure, and full recovery takes about a week.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication
● you want a minimally invasive procedure
● you want an outpatient procedure with moderate recovery time
● you’re not interested in getting pregnant in the near future (while it is possible to become pregnant, apparent higher rates and risks of complications cause physicians to advise other methods if you wish to conceive, such as myomectomy)

MRI-guided focused ultrasound surgery
With this surgery, you lie inside an MRI so your doctor can see the precise location of the fibroids. Then the doctor uses a high-energy ultrasound transducer to focus sound waves directly on the fibroid tissue, heating and destroying them. Ultrasound surgery is usually an outpatient procedure and total recovery time takes 3-4 days.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication
● you want a noninvasive procedure
● you want an outpatient procedure with short recovery time
● you’re not interested in getting pregnant in the near future (data is still being collected on the safety of pregnancy after ultrasound surgery)

Endometrial ablation
This minimally invasive procedure uses heat, electric current or microwave energy to destroy the lining of your uterus. This option reduces the amount of menstrual bleeding or halts menstruation entirely.
The procedure is usually outpatient and takes about 45 minutes under local or spinal anesthesia. Post-procedure side effects include cramping and bloody discharge for a few days. Total recovery takes from a few days to 2 weeks.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● the primary symptom of your fibroids is heavy menstrual bleeding
● you want an outpatient procedure with shorter recovery time
● you’re not interested in getting pregnant at any point in the future

Hysteroscopic Myomectomy
Myomectomy is a surgical procedure to remove the fibroids. If fibroids are within the uterine cavity, they can be removed by hysteroscopy, entering the uterus through the vagina and cervix. Hysteroscopy is an outpatient procedure performed under anesthesia and requires a few days to 2 weeks for full recovery.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication
● your fibroids are located within the uterine cavity
● you want to permanently remove the fibroids (note: this will not prevent new fibroid growth in the future)
● you want an outpatient procedure with short recovery time
● you’re interested in getting pregnant in the near future

Laparoscopic Myomectomy
If your fibroids are outside the uterine cavity, but are small and few in number, they can be removed by laparoscopy, with instruments placed through small incisions in the abdomen. Laparoscopic myomectomy could be an outpatient procedure or may require a hospital stay. Full recovery time is 2-4 weeks.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication
● your fibroids are located outside the uterine cavity, but are small and few in number
● you want to permanently remove the fibroids (note: this will not prevent new fibroid growth in the future)
● you want an outpatient (or hospital stay) procedure with moderate recovery time
● you’re interested in getting pregnant in the near future

Abdominal (Laparotomic) Myomectomy
If you have numerous or large fibroids outside the uterine cavity, they can be removed in an open abdominal surgery. Abdominal myomectomy requires an average hospital stay of 1 to 4 days and a full recovery time of 4 to 6 weeks.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication
● you have numerous or large fibroids located outside the uterine cavity
● you want to permanently remove the fibroids (note: this will not prevent fibroid growth in the future)
● you are able to commit to a lengthy recovery process
● you’re interested in getting pregnant in the future

Hysterectomy
This major surgical procedure is the complete removal of the uterus. If the ovaries are removed as well, it will bring on menopause. Most women can choose to keep their ovaries – or undergo hormone replacement therapy – to push off the onset of menopause. Hysterectomy requires a hospital stay of 2-3 days and a complete recovery period of 6-8 weeks with restricted activity.

You may want to discuss this option with your doctor if you present these symptoms or have these needs or preferences:

● your fibroids symptoms have not responded to medication and/or other procedures
● you want to permanently remove the fibroids
● you want to permanently prevent any fibroid growth in the future
● you’re not interested in getting pregnant again (with the removal of the uterus, it is impossible to conceive)
● you are able to commit to a lengthy recovery process
● you understand and accept the medical implications of the procedure
Think wisely about your options and consult your doctor.
 Choosing the Right Uterine Fibroid Treatment: Factors to ConsiderThere are many options out there for women who are dealing with uterine fibroids. Know what is important to you, and be informed about your options. Speak to your doctor and express your thoughts and preferences.

In partnership with your doctor, select the option that is right for you – and you have a good chance at living the life you want and deserve.

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