If you have moderate or severe symptoms of fibroids, surgery may be the best treatment for you.
Surgical treatment can be a major procedure or a minor one. The type of surgery depends on the size, location, and number of fibroids present, and your desire to bear children in the future. Sometimes, there are a variety of surgical options to choose from. Talk to your health care provider about the different types of surgical treatments and about the possible risks, side effects, and recovery time of each procedure.
Endometrial ablation (pronounced en-doh-MEE-tree-ul ah-BLAY-shun) destroys the lining of the uterus. It is used to treat small fibroids inside the uterus. Two common ways of doing an ablation are with a heated balloon, and with a tool that uses microwave energy to destroy the uterine lining and fibroids.
Pregnancy is unlikely after this procedure, but it can happen. Women who get pregnant after endometrial ablation are at higher risk for miscarriage and other problems. If you are going to have this treatment, talk to your health care provider about the risks of getting pregnant after the procedure. You might want to use birth control to prevent pregnancy until after you go through menopause.5,6
This procedure removes only the fibroids and leaves the healthy areas of the uterus intact. It can preserve your ability to get pregnant.
Myomectomy can be performed in one of three ways. The method you need will depend on the location and size of your fibroids.
- Hysteroscopy (pronounced hiss-tur-AH-skoh-pee). For this procedure, the surgeon inserts a long, thin telescope with a light through the vagina and cervix (the opening of the uterus). The doctor then uses electricity or a mechanical device to cut or destroy the fibroids. The doctor will inject a fluid into the uterus to make it easier to see before trying to remove the fibroids.
- Laparotomy (pronounced lap-are-AH-toh-mee). The surgeon removes the fibroids through a cut in the abdomen.
- Laparoscopy (pronounced lap-are-AH-skoh-pee). The surgeon uses a long, thin telescope to see inside the pelvic area, and then removes the fibroids using another tool. This procedure usually involves two small cuts in the abdomen.
Studies show that myomectomy can relieve fibroid-related symptoms in 80% to 90% percent of patients.2 The original fibroids do not regrow after surgery, but new fibroids may develop.
Hysterectomy is the only sure way to cure uterine fibroids completely. Health care providers usually recommend this option if your fibroids are large, you have very heavy bleeding, and you are near or past menopause.
During a hysterectomy, the whole uterus or just part of it is removed. The types of hysterectomy include:
- Subtotal, or partial, hysterectomy. In this procedure, only the upper part of the uterus is removed.
- Total hysterectomy. The entire uterus and the cervix are removed. Sometimes the ovaries and fallopian tubes are also removed. This procedure is called a total hysterectomy with bilateral salpingo-oophorectomy (pronounced bye-LATT-ur-el sal-PING-go ooh-for-EK-toh-mee).
- Radical hysterectomy. This procedure removes the uterus, the tissue on both sides of the cervix, and the upper part of the vagina.7
Figure 2. Types of Hysterectomies. A subtotal hysterectomy involves removing the upper portion of the uterus above the cervix. In a total hysterectomy, the surgeon removes the entire uterus, including the cervix. A radical hysterectomy includes the complete removal of the uterus, cervix, upper vagina, and surrounding tissue.
There are several approaches to doing a hysterectomy:
- Abdominal hysterectomy. The surgeon removes the uterus through a cut in the abdomen. This incision may be similar to what is done during a cesarean section. Full recovery time from an abdominal hysterectomy is one to two months.6 Removal of the ovaries is not required for treatment of fibroid symptoms. Similarly, some women may desire to preserve the cervix, if there is no history of abnormal pap smears.
- Vaginal hysterectomy. Instead of making a cut into the abdomen, the surgeon removes the uterus through the vagina. This method is less invasive than an abdominal hysterectomy, so recovery time is usually shorter. Vaginal hysterectomy may not be an option if your fibroids are very large.
- Laparoscopic hysterectomy. Minimally invasive approaches may include laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, or robotic-assisted laparoscopic hysterectomy. Not all cases of uterine fibroids can be treated with such approaches, but these methods may result in reduced postoperative recovery time.
- Robotic hysterectomy. Robotic hysterectomy is becoming more common. The surgeon sits at a console near the patient and guides a robotic arm to perform laparoscopic surgery. Like laparoscopic myomectomies, this technique requires only small incisions in the uterus and abdomen. As a result, recovery can be shorter than with more invasive procedures. More research is needed to understand how (and how well) these procedures work and to compare the outcomes with those of other established surgical treatments.
If you have not gone through menopause and are considering a hysterectomy for your fibroids, talk to your health care provider about keeping your ovaries. The ovaries make hormones that help maintain bone density and sexual health even if the uterus is removed. If your body can continue to make these hormones on its own, you might not need hormone replacement after the hysterectomy.
Having a hysterectomy means that you will no longer be able to get pregnant. Talk to your partner or spouse before deciding to have a hysterectomy. This process cannot be reversed, so be certain about your choice before having the surgery.
- Evans, P., & Brunsell, S. (2007). Uterine fibroid tumors: Diagnosis and treatment. American Family Physician 75(10), 1503-1508. Retrieved from http://www.aafp.org/afp/2007/0515/p1503.html .
- Agency for Healthcare Research and Quality (AHRQ). (2005). The FIBROID Registry: Report of Structure, Methods, and Initial Results. (AHRQ Publication No. 05-RG008). Retrieved from http://archive.ahrq.gov/research/fibroid/fibsum.htm.
- American Congress of Obstetricians and Gynecologists (ACOG). (2009). Uterine fibroids. Retrieved from http://www.acog.org/~/media/For%20Patients/faq074.pdf?dmc=1&ts=20121015T1425097855 (PDF - 366 KB).
- Berger, L. (2008, October 23). A Decade of Developments in Fibroid Research. New York Times. Retrieved from http://www.nytimes.com/ref/health/healthguide/esn-fibroids-expert.html .
- National Library of Medicine. (2011, January 11). Uterine fibroids. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000914.htm.
- Wallach, E. E., & Eisenberg, E. (2003). Hysterectomy, Exploring Your Options. The Johns Hopkins University Press: Baltimore, MD.
- Office on Women's Health. (2009). Hysterectomy fact sheet. Retrieved July 19, 2013, from http://womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html.