Ask the Doctor at Saint John’s: Fibroid Treatment Options

Q. I am a 48 year old woman and have fibroids that are bothering me. I have been advised to have a hysterectomy and remove my ovaries at that time too. Are there any alternatives?

A. By William H. Parker, MD, a gynecologist and Chair of Obstetrics and Gynecology at Saint John’s Health Center

First, it is important to know that fibroids are very common, and they are never cancerous. Treatment is only necessary if the symptoms are causing you enough discomfort or distress that you would consider one of the treatments mentioned below, rather than waiting until menopause occurs when the fibroids naturally shrink, and symptoms almost always resolve.

But, if your symptoms are bothersome, there are a number of options you can consider that are less invasive than hysterectomy. If heavy bleeding is your main problem, a procedure called endometrial ablation cauterizes the uterine lining cells and controls bleeding in 90% of women. This procedure is performed as an outpatient without any incisions or discomfort, and full recovery takes a day or two.

If your symptoms are pain or pressure because the fibroids are making the uterus enlarged, then removal of just the fibroids, called myomectomy, can also be considered. In some situations, removal of the fibroids can be performed using a telescope through the navel (laparoscopic myomectomy), and for other women an abdominal bikini-type incision may be needed.

Uterine artery embolization is a newer procedure that uses plastic particles to
block off the flow of blood to the fibroids. Normal uterine muscle survives, but the fibroids die, are partially reabsorbed by the body, and shrink by about 50 percent. Women stay in the hospital overnight and full recovery takes a week or two.

For women who have tried other options without success, hysterectomy may be the appropriate treatment for their fibroids. New surgical techniques allow the procedure to be performed by laparoscopy for many women with fibroids. This has the benefit of only a one night hospital stay and two weeks until full recovery.

For most women, keeping your ovaries promotes better long-term health and survival as shown in a study a group of gynecologists and I just published in the renowned journal Obstetrics and Gynecology. We found that since the ovaries continue to make hormones until very late in life that protect the heart and bones, women who do not have a strong family history of ovarian cancer should consider keeping their ovaries when hysterectomy is needed.

Dr. Parker is a gynecologist at Saint John’s Health Center who is internationally recognized for laparoscopic surgery and research. For more information about Dr. Parker or other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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