Because fibroids are estrogen dependent, they usually shrink after menopause. In some cases women who are close to menopause are able to wait out the problem and see their fibroids regress.
A physical examination can identify a fibroid tumor large enough to tilt the cervix out of position. Additionally, a gynecologist will typically order a number of tests, including an ultrasound and an MRI. Although heavy bleeding and fibroids are common as women near the end of their reproductive years, it’s important to rule out the possibility of a more serious condition such as uterine cancer.
Although hysterectomy could certainly address the problem, more conservative measures are typically recommended first. If those fail, a hysterectomy is indicated.
One out of every ten hysterectomies is performed to treat a cancerous condition. In those cases, the decision is usually clear. When there’s no cancer involved, however, there are usually other treatment options. These will always be specific to the woman’s diagnosis, age, preference, her desire to remain fertile and her physician’s recommendation.
Hormone and other drug therapies may be prescribed to address heavy bleeding. These include estrogen, progestin, and continuous low-dose birth control pills. If pills are not preferred, an intrauterine device, Mirena, which can be left in place for up to five years, was shown in a Finnish study to help relieve symptoms of heavy uterine bleeding in over half of the women studied over a five-year period.
Uterine fibroid embolization is a minimally invasive procedure designed to shrink the fibroid by inserting tiny sand-like particles into the small arteries that feed it. The particles block the flow of blood, causing the fibroids to shrivel and die. Uterine fibroid embolization was shown in one study to be successful in three of four women five years after treatment. This technique tends to work better when there is only one tumor rather than a number of smaller tumors responsible for the bleeding.
Myomectomy, surgery to remove only the fibroids, leaves the uterus intact and is a good option for women who still want to have children. There are a number of surgical procedures possible, depending on the location, number and type of fibroid.
Endometrial ablation, or destruction of the endometrial lining, can be done through cauterization, freezing or using microwave energy.
New technologies include both high intensity ultrasound and radiation that can be precisely guided to target and destroy tumors. Through MRI or CT imaging in real time, the surgeon can see that he’s zapping the tumor while sparing healthy tissue.
Hysterectomy: 3 Options Three types of hysterectomy are commonly performed:
- abdominal, which involves an external incision and has the longest recovery time;
- laparoscopic, which uses small incisions and allows a quicker return to normal activities than abdominal; and
- vaginal which has the quickest return to normal activities of the three methods.
Researchers who reviewed studies involving 3,643 participants found that laparoscopic hysterectomy had three times as many incidents of urinary tract injuries as abdominal hysterectomy. They concluded that vaginal hysterectomy, when possible, is preferable to abdominal because of the quicker return to normal activities as well as lower incidence of infection and fever after surgery. Laparoscopic ranked second because of the short recovery time, despite the higher incidence of injury to the bladder and ureter.
Heavy bleeding needs to be assessed and treated. But women should be wary about opting too quickly for a hysterectomy. Hysterectomy is a major surgical procedure and medical experts believe that many of the 600,000 American women who have hysterectomies each year could be treated with other, less drastic options.
Michelle Herbert Thomas, PharmD, CDE—Rev. 5/19/2010 TNK
