Laparotomy with myomectomy.\u00a0<\/span>Laparotomy is performed by incision of the abdominal wall and conventional “open” surgery.\u00a0It is used for subserous fibroids that are very large, numerous, when cancer is suspected, or when laparoscopic techniques are unavailable or contraindicated.\u00a0Recovery after a standard abdominal myomectomy takes 6 to 8 weeks.\u00a0Open laparotomy carries a higher risk of scarring and blood loss, and the risk of recurrence of new fibroids is also higher than with less invasive procedures.<\/p>\nHysteroscopy.\u00a0<\/span>Hysteroscopic myomectomy can be used for submucosal or submucosal fibroids located in the uterine cavity.\u00a0In this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is inserted into the uterine cavity through the vagina and cervical canal, after which the doctor uses electrosurgical instruments to remove the tumor.<\/p>\nLaparoscopic myomectomy.\u00a0<\/span>Women whose uterus is no larger than it would be at 6 weeks pregnant and who have few subserous nodes may have laparoscopic surgery.\u00a0Laparoscopy requires only tiny incisions, is performed under image guidance, and requires much less recovery time than laparotomy.<\/p>\nComplications of myomectomy are generally the same as for other surgical procedures, including bleeding and infection.\u00a0This operation is not a 100% result method.\u00a0Fibroids may reappear after myomectomy.<\/p>\n
<\/span>Embolization of the uterine arteries<\/span><\/h3>\nUterine artery embolization (UAE), also called uterine fibroid embolization, is a relatively new treatment for fibroids. The EMA of the fibroid deprives it of its blood supply, causing the fibroid to contract. UAE is a minimally invasive and technically non-surgical therapy. It is much less invasive than hysterectomy and myomectomy and has a shorter recovery time than other procedures. The patient remains conscious, albeit under anesthesia, during the procedure, which takes about 60 – 90 minutes.<\/p>\n
This procedure is usually performed in the following order:<\/p>\n
The patient is sedated and a local anesthetic is applied to the skin around the groin.<\/p>\n
The interventional radiologist makes a small incision in the skin (about 1 cm) and inserts a catheter into the femoral artery, which feeds the fibroids.\u00a0Parts of a special embolization preparation are introduced through the catheter.\u00a0These particles block the blood supply to the tiny arteries that feed the fibroids, causing the fibroids to die and be replaced by connective tissue.\u00a0This leads to a significant reduction or disappearance of myomatous nodes.<\/p>\n
Patients usually stay overnight in the hospital after the procedure has been performed and pain medication has been given.\u00a0Pelvic cramps are common for the first 24 hours after the procedure.<\/p>\n
The recovery time after the procedure, until returning to work, is 1 to 2 weeks, but the reduction of fibroids can take from several months to several years.<\/p>\n
Most patients experience a brownish vaginal discharge for several days after UAE, which may last until the start of the next menstrual cycle.\u00a0Regular menstrual cycles resume within 2 to 3 months after the procedure.\u00a0Heavy menstrual bleeding decreases by the second or third cycle.<\/p>\n
<\/span>Can I Get Pregnant After Uterine Artery Embolization?<\/span><\/h4>\nIn general, UAE is considered to be an option only for women who do not plan to have children.\u00a0Although in clinical practice there have been cases of pregnancies after this procedure.\u00a0Some evidence suggests that UAE may increase the risk of miscarriage in women who become pregnant.\u00a0Some women who have had UAE have gone through menopause after the procedure.\u00a0And yet, menopause in women who have had UAE is more likely after age 45.<\/p>\n
Studies on uterine artery embolization show a high patient satisfaction rate (over 90%) and a low complication rate.\u00a0Symptoms of menorrhagia as well as pelvic pain improve in 85-95% of patients within 3 months of treatment.\u00a0Uterine artery embolization is an effective treatment for fibroids in most patients.\u00a0However, some patients may have recurrent fibroids requiring repeat embolization or hysterectomy.<\/p>\n
<\/span>Ablation of the endometrium<\/span><\/h4>\nEndometrial ablation destroys the lining of the uterus (endometrium) and is usually done to stop heavy menstrual bleeding. The destruction of the endometrium can be carried out using heat, cold, microwave radiation, or other methods.\u00a0This procedure is not appropriate for large fibroids or fibroids that have grown outside the lining of the uterus.\u00a0In some cases, it stops menstruation completely.\u00a0<\/span>For some women, menstrual bleeding does not stop, but decreases significantly.<\/p>\nThis procedure is usually done on an outpatient basis and can take as little as 10 minutes.\u00a0Recovery usually takes several days.<\/p>\n
Ablation of the endometrium significantly reduces the chance of getting pregnant.\u00a0However, pregnancy can still occur, although this procedure increases the risk of complications, including miscarriage.\u00a0Therefore, women who have had this procedure still need to use contraceptive methods.<\/p>\n
<\/span>Magnetic resonance focused ultrasound (HIFU-MRI)<\/span><\/span><\/h4>\nHIFU-MRI is a non-invasive procedure that uses high intensity ultrasound waves to heat and remove uterine fibroids. This is a kind of “thermal ablation”. The procedure is performed using a device, ExAblate, which combines magnetic resonance imaging (MRI) and ultrasound.<\/p>\n
During the 3-hour procedure, the patient lies inside the MRI machine.\u00a0He is given a mild sedative to help him relax but remain conscious throughout the procedure.\u00a0The radiologist uses MRI to accurately target the fibroid and sends an ultrasound beam to remove tissue from the fibroid.\u00a0MRI also helps monitor the temperature generated by the ultrasound.<\/p>\n
HIFU-MRI is only suitable for women who are on the verge of menopause or who are not planning a pregnancy. It should also be borne in mind that this procedure is not suitable for all types of fibroids. So, HIFU-MRI is not recommended if the distance between the uterine myoma and the skin exceeds 12 cm, if the access of the beam to the neoplasm is limited by scars or intestinal loops, the diameter of the fibroid should not exceed 10 cm, the number of formations should not exceed 6 fibroids. Pregnancy is a complete contraindication.<\/p>\n
<\/span>Hysterectomy<\/span><\/h4>\nHysterectomy\u00a0is the surgical removal of the uterus.\u00a0The ovaries may also be removed, although this is not necessary to treat fibroids.\u00a0<\/span>Hysterectomy is the only treatment that is 100% successful in getting rid of fibroids and is an option if other treatments have failed or are not possible.<\/p>\nAfter a hysterectomy, a woman permanently loses the opportunity to become pregnant, but if the ovaries are removed along with the uterus, the hysterectomy causes the immediate onset of menopause.<\/p>\n
Types of hysterectomy:<\/p>\n
\n- Abdominal hysterectomy<\/li>\n
- Vaginal hysterectomy<\/li>\n
- Laparoscopic hysterectomy<\/li>\n
- Robotic hysterectomy<\/li>\n<\/ul>\n
Abdominal hysterectomy is best for women with large fibroids when ovaries need to be removed or when cancer is present.<\/p>\n
A vaginal hysterectomy only requires a vaginal incision through which the uterus is removed<\/p>\n
Robotic hysterectomy is performed using special equipment.\u00a0This approach is most commonly used when the patient is diagnosed with cancer, is very overweight, and vaginal surgery is not safe.<\/p>\n
<\/span>Complications of uterine fibroids<\/span><\/h2>\n– Influence on fertility.\u00a0<\/span>Most fibroids have only a small effect on a woman’s fertility.\u00a0Female infertility is usually associated with other factors.<\/p>\n