What Are My Treatment Options?

There are a variety of options for treating or eliminating uterine fibroids:

• Hormone Therapy
• Hysterectomy
• Myomectomy
• Uterine Fibroid Embolization
• MR-Guided Focused Ultrasound Ablation Using ExAblate Technology

Hormone Therapy

Some women undergo hormone therapy to reduce the size of their uterine fibroids by lowering the amount of estrogen in the body. This decreased amount of estrogen causes drug-induced menopause. As a result, women going through hormone therapy often experience the side effects associated with menopause, such as

• hot flashes,
• headaches,
• vaginal dryness,
• emotional lability,
• decreased libido,
• acne, or
• muscle pain or tenderness.*

While hormone therapy means no surgery, it does require that you take the prescribed hormone constantly, as the tumors will return to their original size once the hormone therapy ceases. The most commonly used hormone therapy, Lupron, cannot be used for longer than six months due to a risk of bone mineral density loss.

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Hysterectomy

The most common surgical treatment for uterine fibroids is hysterectomy—the surgical removal of the uterus. This is the only method that guarantees an end to the discomfort of uterine fibroids.*

The decision to have a hysterectomy can be a very difficult one. The procedure requires a lengthy recovery time—as much as eight weeks. In addition, women who have had hysterectomies cannot have children.

Hysterectomies often cause premature menopause accompanied by all of the associated side effects, like hot flashes, fatigue, and vaginal dryness. In addition, there are the risks associated with surgery, such as

• infection,
• blood loss,
• adverse reactions to anesthesia,
• an average of a 20 percent chance of complication,** and
• a death rate estimated in 10 to 20 cases out of every 1,000 operations.

Also, if a woman’s ovaries are removed as part of the hysterectomy, her risk of developing osteoporosis is higher.

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Myomectomy

Many women choose myomectomy over hysterectomy because, instead of removing the whole uterus, in myomectomy, only the fibroid tumors are surgically removed.

However, up to 40 percent of women who have a myomectomy must undergo uterine fibroid treatment again in the future.** Like hysterectomy, myomectomy requires a significant amount of recovery time. And, as with any surgery, there is always a risk of complications. In fact, myomectomy has a complication rate of 25 percent, including things such as

• infection,
• blood loss,
• adverse reactions to anesthesia,
• more than 50 percent risk of new fibroid formation,
• postoperative adhesions that may impair fertility,**
• heavy bleeding requiring a hysterectomy,** and
• a weakened uterus related to the incision.**

In addition, 17 to 26 percent of women who have myomectomy require hysterectomy or another myomectomy within 5 years.**

The surgery can also lead to adhesions which result in severe (and often permanent) abdominal pain that requires a separate course of treatment. And women who have myomectomy are at a risk of developing a hernia during the first weeks of recovery.

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Uterine Fibroid Embolization

In uterine fibroid embolization (also known as uterine artery embolization), a catheter is inserted into the arteries of your groin. These arteries supply blood to the uterus. From there, small particles that block the flow of blood are injected into the smaller arteries that supply blood to your fibroid tumors. Without blood, the cells of the fibroid tumors die and the tumors shrink.

While uterine fibroid embolization requires less recovery time than other methods of treatment, women who undergo uterine fibroid embolization indicate that the pain involved is rather severe. A hospital stay to manage the pain is involved.

Uterine fibroid embolization also comes with significant potential side effects, such as

• infection (sepsis),
• infertility related to adhesions,
• ovarian damage (occuring most often in women in their late 40s),
• early menopause,
• severe pain,
• vaginal bleeding,
• significant incidence of morbidity (complications) and mortality (death),*** and
• postembolism syndrome (flu-like illness) with high temperature, general fatigue, and increased white blood cell count, requiring antibiotic treatment.**

Uterine fibroid embolization can also cause multiple organ failure which, in turn, can result in death.

In addition, uterine fibroid embolization involves radiation, which is a known carcinogen. Also, the arteries are injected with a radiographic contrast material to make them more visible on the x-rays used to visually guide radiologists during the procedure. Contrast materials can cause adverse effects in some patients, such as hives or shortness of breath.

It is important that the radiologists performing these procedures are experienced and have the appropriate equipment.

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MR-Guided Focused Ultrasound Ablation Using ExAblate Technology

MR-guided focused ultrasound ablation (MRgFUS) is the latest treatment for fibroids. This noninvasive outpatient procedure uses highly focused ultrasonic waves to destroy fibroids and requires virtually no recovery time.

Like all treatments other than hysterectomy, women who undergo MRgFUS may have fibroid tumors again in the future. Should this occur, SightLine will be glad to evaluate the new fibroids for treatment as well.

Unlike other procedures, MRgFUS

• is an outpatient procedure,
• does not require a lengthy recovery time,
• involves no surgery,
• does not require constant medication, and
• does not involve radiation.

Learn more about the benefits of MRgFUS from SightLine.

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* U.S. Department of Health and Human Services
** Orentstein, Beth. “Radiology Treats Uterine Fibroids,” Radiology Today, December 6, 2004.
*** “Study indicates that uterine Fibroid Embolization may be safer than abdominal myomectomy.” Business Wire, September 29, 2005.
**** Liuprolide acetate for depot suspension. (Feb. 2004) www.tap.com