ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Topics in Gynecology - Uterine Fibroids

Updated on January 26, 2012
Drjacki profile image

Jacqueline Thompson is a practicing physician currently residing in North Carolina.

Multiple large uterine fibroid tumors
Multiple large uterine fibroid tumors

Uterine Fibroids: Is hysterectomy the only way?

Uterine fibroids are the most common reason why women in the United States seek removal of the uterus (hysterectomy), and each year around 600,000 are performed for all causes. But there are alternative means of dealing with this common, non-cancerous condition. The "right" treatment depends the size and number of the fibroids, the degree of debilitation they are causing, and wishes of the woman who has them.

Fibroids are benign uterine muscle tumors without any known specific cause although heredity and hormonal factors have been implicated. They have a number of associated symptoms including heavy menstrual flow, cramps and pelvic pain. When the tumors are small, there may be few or no symptoms; however, as the fibroids grow with the stimulation of ovarian estrogen production, the symptoms escalate over the course of years. In rare cases, very large fibroids cause obstruction of surrounding structures like the bowel or ureters.

A relatively new, specialized radiological procedure known as uterine artery embolization (UAE) can be an alternative to hysterectomy for some women. The objective of this procedure is to cut off the main blood supply to the uterus and thereby starve the fibroids of nutrient. Over time, they are seen to shrink and become much less symptomatic. To perform this treatment, an interventional radiology specialist inserts a catheter through the blood vessels of the groin and threads it through to the uterine blood vessels followed by placement of a blocking agent. UAE is not actually considered a surgery but rather a radiologic procedure. Nevertheless, it has potentially serious complications and drawbacks including embolization of the wrong vessels/tissues. Patients are usually admitted at least briefly for observation and pain management with intravenous medication.

Myomectomy, or removal of the individual tumors from the uterine wall, is another potential treatment option that leaves the majority of the uterus intact. Minimally invasive surgery including robotic myomectomy is available at some treatment centers, but the most common method still involves an open abdominal incision. The removal of multiple fibroid tumors from the uterine wall can preserve fertility in women who desire future childbirth potential, but it can also weaken the muscle such that future labor with a pregnancy is not recommended. Cesarean delivery is the only way to lessen the risk of uterine wall rupture with contractions. For women who no longer wish to become pregnant, myomectomy may have more drawbacks than advantages.

Another treatment option for the heavy bleeding associated with fibroids is ablation (destruction) of the uterine lining. Even though the fibroids are minimally affected directly by this technique, the overall effect is that the amount of monthly bleeding is much less. Through a variety of methods including radiothermal ablation, hydrothermal ablation or freezing, the lining of the uterus is significantly destroyed. The fibroids can continue to grow despite this type of therapy, and even if bleeding symptoms do not return, pain from enlarging fibroids may still be a problem.

Drug therapy for fibroids, either as an adjunct to a planned surgery or as a stand-alone treatment is often attempted. Medications of the class known as GnRH agonists (ex. Depo-Lupron) will attack the fibroids hormonally by blocking the effects of estrogen on the growth of the tumors. This temporary effect will shrink the fibroids and allow the patient time to plan surgery. However, this class of medication is expensive and causes some menopause-like side-effects that are unpleasant, so it is usually only used for 2-6 months prior to surgery. Once the medication is stopped, the fibroids will return to their original size in fairly short order unless the patient is already at the time of menopause.

Birth control pills are used more commonly in younger women with fibroids, but these can also be used in women closer to menopause to control bleeding symptoms of fibroids as long as not other health issues are a problem (i.e. high blood pressure, diabetes, stroke). Despite the fact that birth control pills contain estrogen as well as progesterone, the fibroid tumors do not seem to enlarge more just because of the medication.

Medication that specifically targets the blood clotting mechanism can also be beneficial for relieving the worst bleeding symptoms during the monthly menses with uterine fibroids. Tranexamic acid (trade name Lysteda) is such a medication. This drug is taken only for a 5-day course during the worst flow days, and the net effect is to lessen the large clots and associated cramps via non-hormonal means. There are some potentially serious adverse effects of taking this medication in women with blood clotting disorders or who are taking oral contraceptives or other hormone medication, and caution is needed before using this as a longterm treatment option.

Before any specific treatment option is fully explored, it is important to note that cancer of the uterine lining (endometrial cancer) needs to be ruled out with a directed biopsy. The treatment of uterine cancer is completely different from that of benign uterine fibroids or other benign cause of uterine bleeding.

In conclusion, total removal of the uterus for fibroids is still the most commonly chosen route of therapy for women with severe symptoms of bleeding/pain, but there are clearly viable alternatives to hysterectomy. Discuss all the options with your healthcare provider and weigh what is best for you.

Types of uterine fibroids
Types of uterine fibroids

Uterine Artery Embolization Therapy


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)