Ask an Expert: What Types of Procedures Treat Fibroids?

This article is part of Uterine Fibroids and Black Women, a destination in our Health Divide series.

Uterine fibroids are growths in the uterus that can occur in people of childbearing age. Not every person who has fibroids has any problems with them, or the symptoms might be mild enough that treatment with over-the-counter pain (OTC) relievers like ibuprofen can treat the condition until the start of menopause, at which time fibroids tend to shrink.

If fibroids are causing painful cramps, excessive bleeding, and other symptoms, medications can sometimes be helpful. A doctor can prescribe oral contraceptives and a class of drugs called gonadotropin-releasing hormone (GnRH) agonists to minimize discomfort until a person reaches menopause.

However, some people have serious symptoms related to fibroids and menopause is too far off for them to wait for relief. In these cases, surgery to remove the fibroid or even the uterus itself is necessary.

Some procedures only take out the fibroid and leave the uterus (myomectomy). This procedure is minimally invasive and can sometimes be performed using instruments that are inserted into the vagina rather than the surgeon making an incision in the abdomen.

There are also treatments that can be applied to a fibroid to shrink it. Uterine artery embolization blocks the artery that supplies blood to a fibroid. When its blood supply is cut off, it can no longer grow. Other techniques apply an electrical current, heat, a freezing compound, or radiofrequency energy directly on the fibroid to reduce its size.

The most extensive surgery for fibroids is surgery to remove the uterus (hysterectomy). At one time it was the most common solution for fibroid symptoms, but having a hysterectomy is major surgery and not a decision that is taken lightly. A hysterectomy has a longer recovery time than procedures that only involve the fibroid, and it also means that a person will no longer be able to get pregnant.

Jessica Shepherd, MD, an OBGYN and Chief Medical Officer of Verywell Health, explains the pros and cons of each surgical procedure for treating fibroids.

Verywell Health: Why would a hysterectomy be considered when there are less invasive options available for fibroids?

Dr. Shepherd: Hysterectomies were historically the way that doctors dealt with a lot of issues, whether that was fibroids or heavy bleeding or discomfort. More recently, through technology and innovation, we really have seen a shift toward options that don't involve a hysterectomy and that allow the patient to keep the uterus.

But just because we have more options that are not hysterectomy it doesn’t mean that hysterectomy is a bad option. There are some patients who feel the hysterectomy would be best for them. There are some instances where it helps a patient's overall health status, such as for people who have severe anemia and are constantly getting blood transfusions.

A hysterectomy is also an option for a patient who shows any early signs of cancer or in whom precancerous cells are found. In that case, hysterectomy is curative.

When we counsel patients who have an issue, we definitely look into what they want. What are the outcomes that they're looking for? For example, fertility is one. If a patient really desires fertility in the future then we need to be able to offer them options.

Verywell Health: What are other factors that might go into the decision to have a hysterectomy?

Dr. Shepherd: Patients may not want a procedure with a long recovery period. A hysterectomy has a recovery time as long as 12 weeks, depending on the extent of the surgery. Many people cannot take that long off from work or from other obligations like caring for their families. Other treatments may have recovery times of a few days to one or two weeks.

Verywell Health: Are there different types of hysterectomy?

Dr. Shepherd: Hysterectomies can be performed vaginally (where the uterus is taken out through the vagina) or abdominally (where it is removed through an incision on the abdomen).

Either way, the procedure can be performed laparoscopically (a minimally invasive hysterectomy), with surgical instruments that are inserted, along with a video device, through small incisions. Laparoscopic hysterectomies usually have a shorter recovery period than an open hysterectomy, partly because these smaller incisions heal faster than the long incision that is needed for an open abdominal hysterectomy.

Many gynecologists are trained to perform laparoscopic hysterectomies with the assistance of robotic devices that they can control. A 2014 study found that about 13% of hysterectomies were done laparoscopically. Less than 1% were robotically assisted, but both types of laparoscopy have been growing in use since then.

However, there are some regional differences in which procedures are used—for example, open hysterectomies are done more frequently in the South.

The type of hysterectomy may depend on the size of the uterus, as it is sometimes too large for a vaginal route. Sometimes, a surgeon may need to do an open abdominal hysterectomy because they need to get a wider view of the uterus. 

Verywell Health: Which procedures spare the uterus?

Dr. Shepherd: A myomectomy removes only the fibroids. The intent is to go in and take out the fibroid(s) and keep the uterus intact. It can be done vaginally or abdominally, and can be done laparoscopically with or without robotic assistance. If done laparoscopically, the patient will need small incisions, but sometimes an open procedure is needed with a larger incision.

Even a large fibroid can be taken out through the small incisions used with laparoscopy—but it requires a skilled surgeon.

Which approach to use—vaginal or abdominal—might depend on where in the uterus the fibroids arelocated. They could be on the outside of the uterus, in the middle of the muscle wall of the uterus, or on the inner lining of the uterus. A fibroid that's on the outside of the uterus may need to be removed abdominally, while one that is in the inner cavity of the uterus can often be taken out vaginally. While the approaches are different, both can preserve the rest of the uterus.

There are other procedures that also allow a patient to keep their uterus. For example, uterine artery embolization blocks blood supply to the fibroid. The fibroid is then not able to sustain itself because it's cut off from the blood supply that it needs to thrive.

There are also laparoscopic radiofrequency ablation techniques. These sort of deactivate the fibroid tissue so that can’t thrive and therefore shrinks.

Verywell Health: What are the risks of complication with these procedures?

Dr. Shepherd: The complications are similar to those seen with any surgery and can include excess bleeding, a reaction to anesthesia, damage to nearby organs, or infection.

The highest risk of a complication come with the more extensive forms of hysterectomy, and occur less than 5% of the time.

Verywell Health: What kind of questions should patients with fibroids be asking their doctors?

Dr. Shepherd: Patients usually come in with an idea of what they want to do. I may have a patient who says, “I want a myomectomy." I say “Okay. What are your specific issues?” Sometimes we can actually find better options for them.

I tell them their options from the least invasive to the most invasive. I also discuss the various recovery times—which range from five to seven days with the least invasive methods to up to 12 weeks with the most invasive. A long recovery time can be an issue for many patients.

Interview conducted by Valerie DeBenedette, health writer.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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