Fibroid Relief: Top 3 Newest Treatments

UFE MRI Before After

Not so long ago, women typically had babies in their 20s, developed fibroids in their 30s, and underwent hysterectomies in their 40s. For most, at least, that was the typical progression. But these days, as more women hold demanding jobs, many delay childbearing — and most expect to be more involved in their health care decisions. Hysterectomy is just one choice in a growing menu of treatments for uterine fibroids: one of the most common and least discussed of female afflictions.

With myomectomy, for example, doctors cut out the fibroids but leave the uterus intact. A technique called uterine artery embolization shrinks fibroids by blocking their blood supply.

Moreover, new medicines are in development, including a class of drugs called progesterone receptor modulators that may shrink fibroids without inducing menopause and bone loss, as existing medications do.

All the new treatments, as well as more sophisticated diagnostic techniques, are part of a growing interest in a condition long considered too unpleasant and embarrassing to talk about, even though nearly three-quarters of women are affected.

Fibroids, which are abnormal, multi-shaped growths of tissue and fat, appear in only one place in the body: the uterus. The tumors are almost always benign but can grow to the size of a football and cause menstrual bleeding and pelvic pain so severe that some women plan their schedules around their monthly periods. The excessive bleeding is not only disruptive but can also lead to anemiaDepending on their size and location, fibroids can also reduce fertility by as much as 70 percent and cause several obstetric complications, including premature birth.

Alternative treatments continue to gain popularity and surgical techniques continue to be refined. Myomectomy, for example, once required surgery to open up the abdomen. Today it can be done laparoscopically through a small incision into the navel, or hysteroscopically (an endoscopic camera passed through the cervix). Submucosal or intracavitary fibroids are easily visualized and can be resected or removed using a wire loop or similar device. Generally only fibroids that are small and accessible through the cavity can be treated this way.

Uterine artery embolization (UAE) or uterine fibroid embolization (UFE), originally used to treat postpartum hemorrhage, was introduced in the United States in 1997 after first being used for fibroids in France. The patient is sedated, a catheter is inserted into her groin or wrist, and tiny acrylic-gelatin or polyvinyl beads are deployed until they plug up the blood vessels feeding the fibroids. The procedure can be done at an outpatient facility or hospital and the patient goes home the same day followed by a week of rest.

Once the fibroids are deprived of blood, they usually shrink within a few menstrual cycles. Symptoms like pain, heavy menstrual bleeding and frequent urination ease in 85 to 95 percent of patients.

“This is an incredibly interesting disease,” Dr. Wood said. “It’s the elephant in the room in that it has a huge impact on the lives of so many women, yet you almost never hear it discussed because it’s not cancer.

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