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Fibroids: Treatments
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More specifically, clinical studies suggest progesterone facilitates the growth of fibroids. For example, fibroid size increases during treatment with synthetic progesterones. Combination GnRH agonist and progesterone therapy has been shown to have no effect on uterine volume, in contrast to GnRH agonist therapy alone which has been shown to reduce uterine volume. The observation that fibroids regress with the antiprogesterone agent, RU-486, further supports the role of progesterone as a promoter of fibroid growth. Histologically, fibroids from patients treated with progesterone show more cellular growth than those from patients without progesterone therapy. Biochemically, fibroids have higher progesterone receptor concentrations than normal myometrium.
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Hysteroscopy can be used to remove fibroids that protrude into the cavity of the uterus. In this procedure, a hysteroscope is inserted into the uterus through the cervix. The fibroids may be removed with a resectoscope, a tiny wire loop that uses electric power, with a needle point electrode (Versapoint) or Vaporprobe which vaporizes the tumor, or with a laser. New instruments which can be used in saline based surgical media have recently been introduced which makes the removal of these tumors safer and faster than the older methods. These instruments can be inserted through the hysteroscope. If you are not intending to become pregnant, this can be combined with a uterine ablation which destroys the entire lining of the uterus so that menstruation stops or is reduced to a bare minimum. This type of treatment is often done with general anesthesia, but you typically do not need to stay in the hospital.
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From 20 percent to 40 percent of women age 35 and older — and as many as 50 percent of African-American women — have uterine fibroids of a significant size. Most women do not experience serious problems and do not seek treatment and some can be treated with medication. In addition to hystectomy, myomectomy, the surgical removal of the fibroids, is often recommended to relieve their fibroid symptoms. Typically... the more fibroids a patient has, the less successful the myomectomy. Additionally, fibroids grow back several years after the surgery in 10 percent to 30 percent of cases.
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A generation ago, doctors almost uniformly recommended a hysterectomy — removal of the uterus — for treatment of uterine fibroids. This operation remains the only proven permanent solution for this condition. Nearly 600,000 women have a hysterectomy each year in the United States, and more than one-third of these operations are performed to treat fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you have your ovaries removed along with your uterus, you will develop symptoms of menopause and face the question of whether to take hormone therapy.
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Research has ... shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children. The National Institute of Child Health and Human Development is conducting further research on this topic and other factors that may affect the diagnosis and treatment of fibroids.
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Not all fibroids can be treated with UFE. All patients must first be evaluated with ultrasound or MRI to make sure the fibroids will respond well to this treatment. Doctors called interventional radiologists perform UFE. The best candidates for UFE are women who:
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