The treatment offered for fibroids will depend on whether or not the fibroids are causing any problems.
- If fibroids are not causing problems, they may need no treatment apart from regular medical checkups. This is called watchful waiting. The doctor examines a woman two or three times a year to see if the fibroids are growing and if they are beginning to cause problems. If the doctor cannot feel the woman's
ovariesduring a pelvic exam, ultrasound should be performed once a year.
- Surgery is the standard treatment for fibroids that are causing pain, heavy or lengthy menstrual bleeding, or other problems. The two kinds of surgery most commonly performed arehysterectomy and myomectomy.
- The two kinds of surgery most commonly performed arehysterectomy and myomectomy (see below).
- There are quite a few newer treatment options that offer alternatives to hysterectomy (click here to go to this section)
- There is also a role for special medications in the treatment of fibroids, either to shrink the fibroid to allow for a simpler type of surgery, or for women just before
menopause(fibroids shrink naturally during menopause). See Treatment with Medication
Hysterectomy is the surgical removal of the
Hysterectomy is often considered when the uterus reaches the size it would be at 12 weeks of pregnancy. In the past, many doctors recommended a hysterectomy because they feared that such large fibroids could hide the presence of cancer of the uterus.
Now, however, tests such as ultrasound and MRI can be used to see whether a fibroid is growing rapidly (a sign of cancer). Increased use of these tests has reduced the number of hysterectomies performed for fibroids.
How is a hysterectomy performed?
A hysterectomy is usually performed through an
What is a vaginal hysterectomy?
Sometimes, for smaller fibroids, the uterus can be removed through the
Occasionally a surgeon will perform a vaginal hysterectomy assisted by laparoscopy. This is called a laparoscopic-assisted vaginal hysterectomy.
What are the risks of a hysterectomy?
Like all operations, a hysterectomy has risks. These include:
- infection requiring treatment with antibiotics (1 in 5 women)
- internal bleeding (hemorrhage) requiring a
blood transfusion(1 in 15)
- injury to other pelvic organs such as the
bladder, bowel, or ureters (less than 1 in 100)
- death (1 in 2,000)
What happens after a hysterectomy?
A woman usually stays in the hospital for two to five days after an abdominal hysterectomy. Full recovery usually takes about six weeks. Women are generally advised to avoid driving and heavy lifting for two to four weeks after surgery. Light exercise may begin after four weeks. Vigorous exercise and sexual intercourse should be avoided for six weeks after surgery.
After a vaginal hysterectomy, a woman may stay in the hospital for two to four days and recover fully in three to four weeks. She can expect to have a light-brown vaginal discharge for about six weeks after surgery. Women are usually advised not to have sexual intercourse for six weeks after a vaginal hysterectomy. Intercourse should only resume after the surgeon has examined her vagina to assure that it has completely healed.
Myomectomy is the removal of fibroids without removing the uterus. This operation preserves a woman's ability to bear children. However, a successful pregnancy is not guaranteed. Only 4 or 5 out of 10 women become pregnant and give birth after a myomectomy.
Heavy bleeding can occur when the fibroids are removed. A woman is more likely to need a blood transfusion after a myomectomy than after a hysterectomy. She is also at higher risk for problems such as infection and blood clots in the legs.
Fibroids may grow back after a myomectomy, and another operation may be needed later to remove them. The risk of regrowth is related to the number, not the size, of fibroids removed. If more than three fibroids are removed, the risk of regrowth is about 50-50.
How is a myomectomy performed?
Like a hysterectomy, a myomectomy is usually performed through an incision in the abdomen. The risks and recovery time are about the same as for a hysterectomy. Sometimes a myomectomy can be performed with the assistance of a laparoscope or hysteroscope.
Why can it be difficult to become pregnant after a myomectomy?
When the uterus heals after surgery, scarring can occur. Scars may cover the ovaries or block one or both of the
A woman who becomes pregnant after a myomectomy may be advised by her doctor to have a