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Fibroids: Hysterectomies
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Ethnic background — Fibroids are three times more common in black women as compared to white, non-Hispanic women. In studies of women undergoing hysterectomy (removal of the uterus), black women were significantly more likely to have fibroids, were younger at the time of diagnosis and hysterectomy, and had more severe problems associated with fibroids as compared to white women.
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Depending on the symptoms which fibroids are causing, different medical therapies are available. Hormonal suppression may decrease the amount of blood loss caused by fibroids, at least temporarily. If the fibroids are causing pain and pressure, medicine is available which will shrink the uterus, again, lasting only short term. Surgery for fibroids is either removal of the uterus and fibroids together; this is called a hysterectomy. If fertility is desired, a myomectomy, or removal of the fibroids will preserve the chance of child bearing. Myomectomy carries with it the additional high risk of recurrence.
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The first thing you have to know about fibroids is that they are always benign. Approximately 40% of all women have fibroids. Fibroids are the most common indication for hysterectomy in the United States. But most women with fibroids need no surgery at all, and those who do require surgery certainly do not need hysterectomies.
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UFE works well for women who have fibroids that are causing heavy bleeding. If your fibroids are small, endometrial ablation may alleviate your symptoms. This outpatient procedure ... allows you to avoid hysterectomy and is painless, inexpensive, fast and has a one-day recovery period. However, ablation may not be technically possible if your fibroids are very large. Embolization works very well for women with bleeding and large fibroids
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Myomectomy - this is an operation to 'shell' the fibroids out of the wall of the womb. As the womb itself is preserved, this is an option for women still wanting children. It's often recommended to women with infertility that may be due to fibroids, although there may be scarring that can aggravate infertility problems. Other complications include serious haemorrhage that can only be stopped by a hysterectomy, and recurrence of the fibroids.
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There are some patients that may be better served by hysterectomy although their fibroids seem to be amenable to embolization. This subset of women includes those who have a strong family history of uterine cancer, or who suspect themselves to have symptoms of uterine cancer including bleeding between periods rather than heavy menstrual bleeding alone. An endometrial biopsy or D&C performed by a gynecologist may be needed in the assessment of these women.
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