Cut That Out!

You've had it—it's time for those fibroids to come out. The only remaining question is how? Here's a rundown on the types of surgery used to treat uterine fibroids.

Hysterectomy used to be the only way to fly when it came to fibroid surgery. The truth is it's still the only permanent way to keep fibroids from coming back forever. But this is major surgery. Also, are you sure you're not going to have more children? Keep in mind that if you have your ovaries removed, you'll henceforth be dealing with menopause and all it entails.

Mymomectomy is the removal of the fibroids while leaving the uterus intact. If you think you may still want children, you might shoot for this option. But keep in mind that myomectomy means you may have a fibroid recurrence. Myomectomy can be done abdominally if there are many fibroids or they are quite large or set in deep. But if you just have a few small fibroids, laparoscopic myomectomy is the way to go. Today some hospitals even have robotic surgery and recovery is a breeze. A hysteroscopic mymectomy is chosen when the fibroids are inside of the uterus (submucosal). This is intravaginal surgery.

Shrink 'Em

Some procedures serve to shrink or obliterate fibroids, rather than to remove them. There's myolysis, a laparoscopic procedure in which a laser or electric current is shot through the fibroids, shrinking the blood vessels that nurture them. Then there's cryomyolysis that freezes the fibroids through the use of liquid nitrogen. But these procedures haven't been around long enough to know about the long-term results in terms of safety and recurrence rates.

Next on the list is endometrial ablation in which an instrument passes one of the following: hot water, heat, microwave energy, or electric current into the lining of your uterus. This ends menstruation forever, or at least reduces your flow. The technique should stop your persistent or abnormal bleeding, but won't help the fibroids except those that exist within the interior lining of your uterus (endometrium).

Somewhat new to the list is uterine artery embolization. In this procedure, small particles are injected into the arteries that supply the uterus, cutting off all blood flow to the fibroids which shrink in response. The technique is performed by a radiologist and has rather a good track record in symptom relief. There are other plusses, including the fact of no incision and quick recovery.

Noninvasive Treatment

Another noninvasive treatment that is promising is the focused ultrasound surgery or FUS. The technique employs MRI to allow doctors to pinpoint and destroy all fibroids without any need for incisions. High-frequency, high-energy sound waves are trained on the fibroids, obliterating them completely. FUS may take several hours with breaks in between. So far, the technique looks good, but again, its long-term effectiveness has yet to be established.

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