Q. My friend was diagnosed with fibroids. Are they treatable and will it have to involve surgery?
Expert answer by Dr Kigondu Simon. Dr Kigondu has practiced medicine for 20 years, 13 of which he has been an Obstetrician -Gynaecologist. He currently practices at Excella Healthcare, Upperhill Mara, Nairobi.
Uterine fibroids (leiomyomas or myomas) are muscular tumors that can grow on a uterus. Fibroids can vary in size, shape and location. They can be on the uterine wall or on its surface or can attach to the uterus by a stalk.
There’s no single best approach to uterine fibroid treatment — many treatment options exist. The treatment approaches to fibroids are determined by symptoms and availability of the treatment modalities.
If the fibroids are just incidental findings on ultrasound and are not causing problems, then no treatment is needed. The approach is a wait and see. The options of treatment are treatment of symptoms (symptom relief) or definitive treatment of the fibroids by removal of the fibroids or of the uterus. It is reported that they may shrink once menopause sets in due to decrease in reproductive hormones.
Gonadotropin-releasing hormone (GnRH) agonists
Medications do not eliminate fibroids. The medicines target hormones that regulate the menstrual cycle and therefore treat fibroid symptoms like heavy menstrual bleeding and pelvic pressure. Gonadotropin-releasing hormone (GnRH) agonists block the production of estrogen and progesterone. They give a temporary menopause-like state. The fibroids may shrink, and anemia often improves. GnRH agonists include leuprolide, goserelin and triptorelin. Significant hot flashes are a side effect. GnRH agonists are used normally used for a short time. The symptoms return when the medication is stopped. Over the long-term they can cause loss of bone. GnRH agonist are used to shrink the size of your fibroids before a planned surgery or to help transition to menopause.
Progestin-releasing intrauterine device (IUD)
A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. It does not shrink fibroids or make them disappear, but it will also serve to prevent pregnancy.
This is taken to ease heavy menstrual periods. It is taken only on heavy bleeding days.
Oral contraceptives don’t reduce fibroid size but can help control menstrual bleeding.
Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t reduce bleeding caused by fibroids but may relieve pain related to fibroids.
Vitamins and iron can also be used as supplement due to heavy menstrual bleeding and anemia.
Focused ultrasound surgery
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option that preserves your uterus. It requires no incision and is done on an outpatient basis.
Minimally invasive procedures
Uterine artery embolization
Laparoscopic radiofrequency ablation
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
Uterine artery embolization.
Small particles (embolic agents) are injected into the uterine arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. Embolization is effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.
Radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. This can be done during a laparoscopic or transcervical procedure. A similar procedure called cryomyolysis freezes the fibroids.
Laparoscopic or robotic myomectomy. In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place.
Hysteroscopic myomectomy. This is used for fibroids are contained inside the uterus (submucosal). Accesses and removal of fibroids is done using instruments inserted through the vagina and cervix into the uterus.
Endometrial ablation. A specialized instrument inserted into the uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing menstrual flow.
Traditional surgical procedures
Surgical procedures include:
Abdominal myomectomy. An open abdominal surgical procedure is used to remove the fibroids. It is used where there are multiple fibroids, very large fibroids or very deep fibroids and where the lady has not reached desired family size.
Hysterectomy The removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. Hysterectomy ends ability to bear children.