Treatment Options for Uterine Fibroids

If you’re one of the many women who suffers from uterine fibroids, you may have experienced abdominal pain, heavy menstrual periods, urinary frequency, pain during intercourse, fertility problems or anemia. And if you think what you are going through is normal because your mother or sister has suffered similarly, or you believe there is nothing you can do about your discomfort, think again.

Experts at South Miami Hospital’s Fibroid Center say it’s important to be evaluated because there are numerous treatment options for fibroids ― from medications to surgery. The goal at the Center is to improve your quality of life.

Rafael Perez, M.D., medical director of the Fibroid Center and the Pelvic Health Program at South Miami Hospital.

“Fibroids can be smaller than a pea or as large as a football, and many women have more than one fibroid,” says Rafael Perez, M.D., medical director of the Fibroid Center and the Pelvic Health Program at South Miami Hospital. While nearly all fibroids are non-cancerous, or benign tumors, they can cause severe physical and psychological distress.

Some Fibroid Facts

• Up to 70 percent of women develop fibroids before age 50. They are very common in the childbearing years.
• Black women are three times more likely than whites to have fibroids. Researchers are still looking into the cause, but suspect things like vitamin D deficiency, obesity and ancestry play a role.
• Some fibroids cause no symptoms. Others cause severe problems such as anemia, pregnancy loss or infertility.
• Hormones can affect fibroids. When hormones surge, such as in pregnancy, fibroids often grow. After menopause, as estrogen and progesterone decrease, fibroids typically shrink.
• The size and location of your fibroids, as well as your symptoms, help drive treatment decisions.

Years ago, women with fibroids were told that a hysterectomy was often their only choice. “Today we don’t jump immediately to surgery, but we do like to monitor the fibroid size because if they become bothersome and they grow very large, the patient may not be a candidate for laparoscopic surgery, which is less invasive than an open procedure,” Perez says.

Minimally invasive approaches usually involve less bleeding, have a reduced chance of complications and have a faster time than open surgeries. During a robotic-assisted laparoscopic procedure, small instruments are inserted through tiny incisions in the abdomen.

One of the benefits of having an experienced team such as the one at the Fibroid Center is that it is a one-stop shop that includes gynecologic robotic surgeons, interventional radiologists, urologists, ob/gyns and nurse practitioners. Diagnostic testing is available on site, and a comprehensive evaluation that includes the woman’s plans ― such as the desire to have children ― helps determine treatment strategy.

In addition to surgery such as a hysterectomy, which removes the entire uterus, or a myomectomy, which removes just the fibroids, other treatment options include yearly monitoring of the fibroids with ultrasound or MRI; medications that suppress ovarian function, such as birth control; the use of an IUD, which can help minimize bleeding and other symptoms; and endometrial ablation, a procedure where a thin layer of tissue that lines the uterus is removed to stop heavy bleeding.

A growing number of women are opting for uterine fibroid embolization. In this minimally invasive procedure, an interventional radiologist threads a tiny catheter to the uterine artery that is supplying blood to a fibroid, allowing it to grow. Small particles are injected at the site to stop the blood supply, causing the fibroid to slowly shrink.

Dr. Perez stresses the importance of choosing the right treatment for each individual. “A woman who wants to get pregnant would not be put on birth control or use an IUD, or opt for an endometrial ablation, for example. We develop a very comprehensive and individualized treatment plan for each patient.” Treatment also depends upon the location of a fibroid ― whether it is inside the uterine cavity, in the muscle of the uterus or growing on the outside of the uterus.

He adds that seeking a second opinion is often valuable, as is utilizing a center with accredited physicians who have a high volume of cases. South Miami Hospital’s program is an SRC (Surgical Review Corporation)-accredited Center of Excellence in Robotic Surgery and in Minimally Invasive Gynecology. Its surgeons are also SRC-accredited.

“With our experience, we are able to use minimally invasive approaches to remove even very large fibroids,” Dr. Perez says. “Not all centers have that capability.”