The thought of treating Fibroids can be scary. Will you need surgery? How will it impact your life? Treating Fibroids does not necessarily mean a hospital stay, there are other treatments that you can try, depending on the type and extent of your Fibroids.
When do I need treatment?
If your fibroids cause no symptoms (are asymptomatic), then your doctor will probably adopt a course of watchful waiting. That means measuringÂ the fibroids once every six months to their detect growth, and asking you if your periods have changed.
Your doctor will probably advise you to leave your fibroids alone until they exceed 2.5 cm in size (less than one inch), orÂ if they start to produce symptoms that degrade your quality of life.
If your fibroids are large, they pressurize your other internal organs, so you should give serious consideration to their removal if they are symptomatic.
What is the first-line treatment?
Your doctor may prescribe a daily iron tablet to prevent anemia from heavy bleeding. (Paradoxically, the more anemic you are, the longer and more heavily you are likely to bleed.)
Your doctor may also suggest treating the fibroids with non- steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen or mefenamic acid, starting a few days before you expect to menstruate, to reduce the cramps and bleeding by 30%. Take these with meals to reduce stomach irritation.
Iron supplements and ibuprofen are both availableÂ over-the-counter. Generics are inexpensive, and will probably cost you less than $20 per month.
Remember, your fibroids will most likely shrink at menopause. First-line treatment only helps 25% of women with fibroids.
If you have a stomach ulcer or are allergic to NSAIDS, you cannot take first-line treatment.
What is the second-line treatment?
If you do not wish to conceive, your doctor may suggest you take combined birth control pills indefinitely to stop the rapid fluctuations of your hormones and estrogen dominance that encourage your fibroids to grow. If you are, obese, smoke, or have underlying heart or lung diseases, you are a poor candidate for The Pill.
If you wish to conceive, some doctors may suggest thinning the lining of your uterus with a six-month course of synthetic progesterone (progestin) before you attempt to have a child. Take the progestin from Day 5 of your menstrual cycle until just before your period begins, for a total of aboutÂ 23 days per month.
If the first course is unsuccessful in reducing your symptoms, you will be encouraged to take synthetic progesterone every day for a year to suppress your cycle and retard the growth of the fibroids.
Many women stop progestin therapy because of its unpleasantÂ side-effects. The use ofÂ bio-identical progesteroneÂ is far safer and hasÂ no side-effects compared to progestins. The onset of action may be aÂ little slower than progestin, however longer-term prognosis is much better.
Medroxyprogesterone acetate (MPA) is a cheap synthetic progestin that is similar to natural progesterone. It is sold as ProveraÂ®, and isÂ commonly used to treat heavy menstrual bleeding. MPA may cause birth defects if accidental pregnancy occurs. It passes into breast milk and
damages the infant, so it is not suitable for postnatal depression.
Medroxyprogesterone increases the risk of blood clots, especially if you smoke. It can cause depression, suicidal feelings, and dementia. It predisposes women to breast, ovarian, and uterine cancer. If medroxyprogesterone is used long term, it increases the risk of stroke and heart attack.
The minor side effects of synthetic medroxyprogesterone are weight gain, itchy skin rash, acne, hair loss, insomnia, bloating, menstrual irregularities, vaginal discharge and tender breasts.
Many women successfully control their fibroid symptoms with natural progesterone cream. Applying 2 units of a cream like ProFemeÂ® progesterone cream from Day 12 to Day 26 of your menstrual cycle can relieve heavy bleeding associated with uterine fibroids and reduce the size of small and medium sized fibroids.
What is the third-line treatment?
If the first and second line treatments did not work for you, and you are perimenopausal, anemic, and do not want surgery, you may opt for a gonadotropin-releasing hormone agonist (GnRH agonist). The most commonly prescribed GnRH agonist is LupronÂ® (leuprolide).
GnRH agonists are very powerful, and are also used to treat prostate cancer, precocious puberty, endometriosis, congenital adrenal hyperplasia, and for transsexualsâ€™ gender reassignment. GnRH agonists produce very unpleasant menopausal side-effects, such as headaches, hot flashes, and osteoporosis.
Your vaginal bleeding will be relieved, but vaginal drynessÂ may take its place. GnRH agonists are very expensive; expect to pay more than $200 per month. They also cannot be taken long-term because ofÂ the bone wastage, so if you are not very near menopause, then GnRHÂ agonists are unsuitable.
Your doctor may also give you a GnRH agonist for a few months before surgery to reduce the size of your fibroids and thus make the surgery easier. If your uterus is smaller than a three-month pregnancy, it may be possible for you to have a vaginal hysterectomy, rather than a large scar from an abdominal incision.
Treating Fibroids with Surgery -Â How are fibroids removed?
If the first, second, and third-line treatments failed and your fibroids become intolerable, or interfere with your fertility, then they can be surgically removed. If you are obese, smoke, or have kidney, lung, heart, or blood vessel disease, then you are a poor candidate for surgery. You may not want to risk surgery, so for personal reasons you may decide to stick with first and second-line treatment options.
The standard treatment for a woman with fibroids who wants to retain her fertility is myomectomy (surgical removal of the fibroids). Myomectomy must be performed by a gynecologist who has had prior specialized training, because it is a delicate, involved, and time-consuming procedure.
Myomectomy costs about $5,700. Stop smoking at least two weeks before surgery. Do not take Vitamin E, herbs, aspirin, and anti-inflammatories for two weeks before the surgery because they increase bleeding.
You will receive a general anesthetic, meaning you will be unconscious during the procedure. The gynecologist slices the covering of each fibroid with a scalpel andÂ shells it out, as if removing a bean from its pod. Few gynecologists have extensive experience with myomectomy because it is so time-consuming. Myomectomy can decrease a womanâ€™s fertility by 40% because it produces so much scar tissue. Recurrence of the fibroids after myomectomy is common. You will require a Caesarean section if you give birth after a myomectomy because of the trauma to the uterine lining (endometrium).
Even after your fibroids have been successfully treated by myomectomy, you may have difficulty conceiving because pressure from the fibroids damaged your fallopian tubes.
The cost of Assisted Reproductive Technology (ART) presently ranges from $8,000 to $15,000 per cycle, depending on the complexity of the method the doctor uses. ART is usually successful in three cycles. Ask your doctor to define â€˜successâ€™ before you make your down payment, because some clinics define success as any conception, and others define it as taking home a baby.
Uterine fibroid embolization (UFE) is becoming more popular as a method of treating fibroids for women who do not intend to conceive later, because it is less invasive and time-consuming than myomectomy. UFE is usually performed by an interventional radiologist, rather than a gynecologist, since it only requires injections.
UFE costs about $2,800.Â It requires at least an overnight stay in the hospital, and a week of recovery at home.
You will be given sedation, but will not be put to sleep. Using an ultrasound to guide the tip of a cannula, the radiologist plugs the uterine arteries with tiny plastic spheres or particles. The fibroids disintegrate over the course of one to six months because their blood supply has been cut off. You will require narcotic pain-killers, such as OxyContinÂ®, after theÂ UFE procedure.
Five years after UFE, 75% of women are fibroid-free and require no subsequent treatment. Your abdomen may still slightly protrude following UFE.
UFE is inadvisable for women who subsequently wish to conceive, because UFE can cause early menopause if the plastic plugs move from their injection site and cut off the blood supply to the ovaries. Very few gynecologists are experienced with delivering babies of mothers who underwent UFE. However, of patients under 40 who wanted children after a UFE procedure, one-third conceived, experienced a normal pregnancy, and delivered vaginally.
It is more realistic to accept that you will likely require a Caesarian section if you give birth after a UFE, because the scars may burst if you go into labour. You will require follow-up measurements of the fibroids every three to six months for the next three years.
If you have very small fibroids, are near menopause, and do not desire future children, endometrial ablation is an option. Endometrial ablation burns off most of the lining of the womb with an electric roller-ball, or a hot water balloon, or freezing. Less endometrium means less bleeding but it will leave you sterile.
Endometrial ablation preserves the ovaries and cervix, does not leave a visible scar, and is safer than hysterectomy. Endometrial ablation costs about $3,750 and can be performed in an out-patient clinic. Frequently, a spinal or epidural anesthetic is used.
It is probably unsuitable for very young women, as there is a chance the endometrium will grow back and heavy bleeding will resume, so a second treatment might be necessary. Endometrial ablation cannot be performed if your fibroids are large.
One-third of all hysterectomies are performed to treat fibroid tumors. If you are past childbearing and have large fibroids, your doctor will probably advise you to have your uterus removed.
If you are in your lateÂ 50â€™s or 60â€™s with confirmed fibroids and have postmenopausal vaginal bleeding, you require a hysterectomy because there is a chance of cancer of the muscle layer of the uterus (leiomyosarcomas). Your surgeon will likely suggest removal of your ovaries and fallopian tubes at the same time (oophorectomy and salpingectomy) to limit the chance of cancer spread (metastasis).
Removal of your entire internal reproductive systemÂ is referred to as TAHBSO (total abdominal hysterectomy and bilateral salpingo-oophorectomy). It costs about $5,700. Ask your doctor if it is safe to have a supracervical hysterectomy, where you retain your cervix, so that you continue to have normal sexual response.
Keeping the cervix requires a procedure called worrelling, and you may need to search major teaching hospitals for a gynecologist who has this particular surgical skill.
Be fully conversant with the ramifications of prophylactic removal of the ovaries. Many women are totally unprepared and often uninformed of the consequences of removal of the ovaries and the immediate onset of menopause and associated symptoms.
Understand more on Fibroids:
Â The information in this article has been taken with permission from the official Lawley booklet onÂ Understanding Fibroids.