All that stress and worry about an operation, the pain! and weeks of impaired immobility only to find myself back to square one within about 5 years!
It is vitally important that you explore all the options open to you. I would recommend that you do your 'homework' before discussing any treatments with your doctor/surgeon, that way you will be better able to understand and evaluate what he or she recommends as the most suitable treatment for you.
Below I outline some of the medical treatments for fibroids and their potential risks and side effects.
As you will see none of them are without risks and possible side effects and none really offer a quick fix solution. Most of the procedures with the exception of a hysterectomy will not eliminate or prevent the re occurrence of fibroids for good.
Estrogen - American English spelling
Oestrogen - British English spelling
Medicines
To date there is no medicine that cures fibroids. However, hormone-based treatments can help relieve your symptoms.
Treatment with medicines called gonadotropin-releasing hormone analogues (GnRH analogues) can lower your estrogen level. This usually shrinks fibroids.
If you're having surgery to remove fibroids, you may be prescribed GnRH analogues such as goserelin or leuprorelin acetate, to take three to four months before your operation to make it easier for your surgeon to remove fibroids.
Side effects/risks
The side effects of the GnRH agonists are largely the result of the low levels of estrogen in the body, so they are usually confined to the symptoms associated with the menopause.
Side effects are common, and most women will experience at least one or two. The severity of the side effects varies from mild to severe, and some women will find them intolerable.
GnRH analogues can cause side-effects including hot flashes/flushes, mood swings, vaginal dryness, decreased breast size, headaches, decreased libido, insomnia, dizziness, depression etc...
The most serious side effect of treatment with a GnRH agonist is thinning of the bones, particularly the bones of the spine.
Therefore, you can only take GnRH analogues for a maximum of six months. Your doctor may prescribe progestogen hormone replacement therapy medicines or a medicine called tibolone for you to take at the same time as GnRH analogues. This is to reduce the chances of you having side-effects.
GnRH agonists may interact with other medicines. Let your doctor know about any medication you are taking, including non-prescribed drugs such as complimentary therapies or herbal medicine.
Surgery
There are a number of surgical options for treating fibroids, including those outlined below.
Uterine artery embolisation (UAE)
A uterine artery embolisation is a non-surgical procedure used to treat fibroids. The arteries that supply your fibroids with blood are called uterine arteries. A uterine artery embolisation blocks off the blood supply to your fibroids, causing them to shrink.
UAE is performed under local anaesthesia, meaning that feeling in the area will be completely blocked but you will stay awake during the operation.
The procedure is done by a specially trained radiologist called an interventional radiologist, in the X-ray department of a hospital and can take up to two hours depending on your fibroids.
Most women find that their fibroids shrink to at least half their size after having a uterine artery embolisation, and that symptoms such as heavy bleeding and pain are reduced.
However, the procedure is not suitable for women who want to get pregnant because it may increase the risk of problems during pregnancy and birth.
UAE gives relief from symptoms such as bleeding and pain for at least six in every 10 women treated.
Side effects/risks
You will probably have some pain, especially for the first 12 hours after the procedure. When you're in hospital, the nurses will give you some painkillers.
Side-effects are the unwanted but mostly temporary effects you may get after having this procedure. These can include extreme tiredness, especially in the first few days, and pain similar to period pains or cramps.
You may also notice that you have vaginal discharge which may have some blood in it. This usually stops around two weeks after the procedure, but can sometimes go on for a few months. You may need to wear sanitary towels.
If the discharge has an unpleasant smell, contact your GP as soon as possible because this may indicate that you have an infection.
After your procedure you may pass a fibroid, or part of one, through your vagina. If this happens, it will be between six weeks and three months after your procedure and can be accompanied by period pains and bleeding. If this happens, you will need to wear a sanitary towel.
Your periods may stop but this is rare.
There is a risk that you may develop an infection after the procedure has been carried out.
Signs of an infection are:
- feeling unwell
- developing a high fever
- feeling a lot of pain
- having a sore and tender lower abdomen (tummy)
- having a vaginal discharge with an unpleasant smell
If you have any of these symptoms, contact your GP as soon as possible.
Infections can usually be treated with antibiotics. However, there is a small chance that if you develop a serious infection it could, in extreme cases, lead to a hysterectomy.
Endometrial ablation or resection
Endometrial ablation is routinely done as a day-case procedure. This means you have the procedure and go home the same day. But depending on the type of ablation you have, you may have the operation done under either local or general anaesthesia.
Endometrial ablation is a procedure to remove most of the lining of your womb or to destroy or remove an individual fibroid using energy such as microwaves or heat. During an endometrial resection, the lining of your womb or the fibroid is actually cut away.
There are several different methods of endometrial ablation. The main ones are listed below.
- Electrocautery (or diathermy). A small electric current is passed through a wire loop or ball-shaped sensor, which heats up.
- Laser ablation. This uses a high-energy beam of light.
- Heated fluid. A deflated balloon is placed inside your womb and filled with a heated fluid.
- Microwave endometrial ablation (MEA). A microwave probe is put into your womb and moved from side to side.
- Radio waves. A probe is placed inside your womb which uses radio waves.
Risks/side effects
Endometrial ablation is commonly performed and generally safe.
You may feel sick, or be sick after your operation. You may have some cramping pains or discomfort, similar to period pains. You will also have some vaginal bleeding and discharge, which may last for a few weeks.
Complications are when problems occur during or after the operation. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complications specific to endometrial ablation are rare but can include:
- inflammation of the lining of your womb
- infection of your urinary tract (bladder)
- damage to your womb or bowel - you may need further surgery to repair the damage
- burns to your womb, vagina or skin when heated liquids are used.
Endometrial ablation doesn't work successfully for everyone and you may need to have the operation again. The exact risks are specific to you and differ for every person.
Hysterectomy
A hysterectomy is a major operation to remove your entire womb, usually via a 'bikini-line' cut in your abdomen or, if the fibroids aren't too large, via your vagina.
A hysterectomy should only be recommended if other treatments, such as medicines or other surgery, are unsuitable or haven't worked.
Alternative hysterectomy techniques to an abdominal hysterectomy are:
- vaginal hysterectomy where the procedure is done through your vagina
- keyhole hysterectomy, where the procedure is done through small cuts in your abdomen and often in combination with vaginal hysterectomy
Please note that is if you have large fibroids the above procedures may not be possible or practical.
The removal of large fibroids may require the surgeon to make a vertical incision from your belly button to your pubic hairline and not a discreet bikini line cut!
A hysterectomy is the only surgical procedure that will eliminate fibroids permanently.
Side effects/ risks
The possible complications of any operation include an unexpected reaction to the anaesthetic, infection see above (signs of infection), excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
You may need pain relief to help with any discomfort as the anaesthetic wears off.
It's usual to feel some initial discomfort when you pass urine, but you should let your nurse or surgeon know if you are finding it difficult to pass urine or are having problems with bladder control. This should be temporary, but if it continues you may need to use a catheter for about two to three weeks.
You may also find that you don't have any bowel movements for a few days after the procedure and this can cause you to have painful wind. Taking laxatives will help you to avoid straining and stop you getting constipation.
Your nurse will give you advice about getting out of bed, bathing and your diet. You may see a physiotherapist who can explain some exercises that you can do to help your recovery.
The clips or stitches will usually be taken out by your practice nurse at your GP surgery about five to seven days after your operation. The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about two weeks.
Most women stay in hospital for two to four days. Before you go home, your nurse will advise you about caring for your wounds and may arrange a date for a follow-up appointment.
Specific complications of an abdominal hysterectomy include:
- blood loss – you may need further treatment, such as a second operation to stop the bleeding
- damage to other organs and tissues in your abdomen, particularly your bladder and ureters (the tubes that carry urine from your kidneys to your bladder) – this can cause incontinence or a frequent need to urinate
- damage to your bowel
- an infection, such as a urinary tract infection or an abscess in your pelvis
- premature ovarian failure – there is a chance your ovaries won’t function properly because they receive some of their blood supply through the uterus, which is removed during the operation
If your ovaries have been removed during the procedure, you will have menopausal symptoms such as hot flushes and vaginal dryness etc...
It usually takes about four to 12 weeks to make a full recovery from an abdominal hysterectomy, but this varies between individuals and their level of fitness, so it's important to follow your surgeon's advice.
Most women are able to return to work between four and eight weeks after the operation but it will depend on the type of job you have and how physical it is. If you had a keyhole procedure, you will usually be able to return to your usual activities sooner than if you’ve had an open procedure.
Myomectomy
A myomectomy is an operation to remove fibroids, leaving your womb in place. It may be done through a cut in your tummy, or sometimes it may be possible for your surgeon to use keyhole surgery.
Myomectomy is usually only offered to women who would like the option to become pregnant in the future. Because your womb isn't removed there is a chance that more fibroids will grow in the future, so you may need to have further treatment.
Risks and recovery times can be very similar to a hysterectomy, further more if you wish to go on to have children you may find that you will not be able to deliver naturally and may require a caesarean section delivery.
If a surgeon is unable to stem any heavy bleeding during your operation then in rare cases your myomectomy can turn into a hysterectomy. Myomectomies can result in a loss of blood and some patients will require transfusions during surgery.
If a surgeon is unable to stem any heavy bleeding during your operation then in rare cases your myomectomy can turn into a hysterectomy. Myomectomies can result in a loss of blood and some patients will require transfusions during surgery.
Further more the removal of large fibroids may require the surgeon to make a vertical incision from your belly button to your pubic hairline and not a discreet bikini line cut!
Conclusion
All of the above medical/surgical procedures, with the exception of a hysterectomy, will not permanently remove or eliminate fibroids.
Further more if the underlying causes of fibroids are not addressed then many women may go on to develop potentially life threatening diseases.
Further more if the underlying causes of fibroids are not addressed then many women may go on to develop potentially life threatening diseases.
The only way to manage and control your underlying causes is through lifestyle changes, that is through the food you eat, the exercise you take and the careful management of stress in your life.
In the time that it takes a healthy woman to recover from a myomectomy you could be well on your way to reducing the underlying causes and symptoms of fibroids within as little as 6 weeks through lifestyle changes alone! No pain, no risks, no side effects!
In the time that it takes a healthy woman to recover from a myomectomy you could be well on your way to reducing the underlying causes and symptoms of fibroids within as little as 6 weeks through lifestyle changes alone! No pain, no risks, no side effects!
