Curing Fibroids Without Hysterectomy

More than 99 percent of fibroid tumors of the uterus are benign, and most require no treatment. However, if these growths get very large, they can become uncomfortable, enlarge the abdomen and bring on loner, heavier menstrual periods. Even some tiny fibroids can cause abnormal bleeding. Until recently, a woman with troublesome fibroids almost always ended up with a hysterectomy.

Most women don't know they have fibroids until a gynecologist make the discovery in a routine pelvic examination. However, fibroids are very common: About 25 percent of women over 35 have them. Fibroids range in size from microscopic to giant masses that fill the pelvis and abdominal cavities." explains Charles M. March, M.D., professor of obstetrics and gynecology at the University of Southern California School of Medicine. No one knows what causes hem, but they seem to need estrogen to grow." Since the fibroids usually shrink after menopause, when estrogen production declines, many doctors advise against treatment when a women is approaching menopause.

New Treatments

While hysterectomy has been the most commonly performed treatment for troublesome fibroids, occasionally an abdominal operation, called myomectomy, is done to remove just the fibroids, leaving the uterus intact. Traditionally, myomectomy has been reserve for young women who have not had children or for those who have trouble conceiving because fibroids obstruct the path sperm must travel to meet the egg.

The good news is that new treatments for fibroids may mean fewer hysterectomies. These include some new drugs which can shrink fibroids, at least temporarily. One, Lupron, suppresses estrogen production, thus depriving fibroids of the hormone that seems to nourish them. Unfortunately, Lupron causes hot flashes, vaginal dryness and more seriously, bone loss that lead to osteoporosis. Because the of the bone loss, you cannot take Lupron indefinitely; once you stop, the fibroids begin to grow. Another disadvantage; Lupron must be given by injection. Still, the drug is useful since shrinking fibroids prior to surgery make myomectomy more feasible.

New Surgical Techniques

Doctors can now remove small fibroids that are the source of bleeding problems with the aid of the hysteroscope-resectoscope, an instrument that is inserted into the uterus via the vagina. Using this instrument, doctors can examine the inside of the uterus and excise these small fibroids.

The surgery takes about 30 minutes and can be done on an outpatient basis. A hysterectomy usually requires spending five to seven days in the hospital and six weeks recuperating at home. So far, the new procedure is routinely available only at a few major medical centers in big cities but most gynecologists can arrange it for any woman who requests it.

Another surgical innovation, called myoma coagulation, spares the patient major surgery and works on the theory that fibroids need estrogen and constant supply of blood to survive. "Cutting off these two vital elements will cause a fibroid to wither and die," explains Herbert A. Goldfarb, M.D., director of the Department of Gynecology at Montclair Community Hospital in N.J., who pioneered the method. This strategy first requires three of four monthly injections of Lupron to shrink the fibroids. Then, a small incision is made in the abdomen to permit insertion of a laparoscope, a long, thin instrument with a tiny viewing scope and laser attachment. The laser pierces the fibroid to destroy its blood vessels.

Because long-term effects on fertility are not known, myoma coagulation is considered suitable only for women in their forties who don't want more children and whose fibroids are less that 10 centimeters in size. Myoma coagulation, done as an outpatient procedure, is now generally available.

The laparoscope also enables surgeons to remove small fibroids not accessible via the hysteroscope. Because the required incision is so small, women usually spend only one night in the hospital.

Removing large fibroids still requires major surgery, however there is no limit to the size or number of fibroids that can removed via myomectomy. However, because this operation often entails blood loss that may require multiple transfusions, many doctors opt of hysterectomy when fibroids are very large.

Dr. Herbert A. Goldfarb is the director of the Montclair Reproductive Center and an advocate of alternative solutions to hysterectomy.