Uterine fibroids are benign tumors which more frequently grow in African-American women of childbearing years. However, any woman who has her uterus is a candidate for uterine fibroids. These tumors are benign and almost never grow or change into cancer. The symptoms, for those women who do experience symptoms, can be debilitating and life altering. Women who experience symptoms from uterine fibroids may suffer from heavy bleeding, decreased bladder capacity, anemia and back pain or pelvic heaviness.
Treatment options include both those which are surgical and those which are less invasive. At this time the only curative treatment for fibroids is a hysterectomy, because even if the fibroids are removed from the uterus to maintain fertility, these women have a higher incidence of recurrence several years later. Fortunately, many women under the age of 45 are able to keep their ovaries which prevents the immediate effect of menopause.
Surgeons consider surgical intervention and treatment options for uterine fibroids that meet certain criteria. Those tumors which significantly impact a woman’s life, in women who are outside of childbearing years, for women who have significantly heavy bleeding leading to chronic anemia and for women who have debilitating pain and discomfort, surgical intervention may be an option. The surgeon will also take into account your reproductive wishes and the size and location of the fibroids.
Currently there are two surgical techniques which are accepted for hysterectomy. The first is a total abdominal hysterectomy in which the surgeon makes a horizontal cut above the pubic bone and removes the uterus while maintaining the integrity of the ovaries and cervix. This procedure will require at least one night stay in the hospital until the surgeon is satisfied that the patient is recovering well and the bowels have once again begun to move.
Complications from a total abdominal hysterectomy will include bleeding, infection and potentially, an ileus in the bowel. This is a condition where the bowel does not begin to work and move food but instead remains dormant because of manipulation during the surgery. While this can result in further treatments, it is usually not life threatening.
The second option is a minimally invasive procedure where the uterus is removed either through the vagina or laparoscopically. Both of these procedures result in less recovery time, less time in the hospital, less pain and less scarring. However if the fibroids are too large to be removed through either a laparoscope or the vagina then a total abdominal hysterectomy will be necessary in order to surgically remove the uterine fibroids.
Vaginal hysterectomies or laparoscopic hysterectomies have been performed for approximately a decade and these side effects and complications are significantly less than a total abdominal hysterectomy because these are minimally invasive.
In either case, preparation for the woman prior to surgery should include blood work to determine if she has any other medical conditions which would significantly impact her recovery and to ascertain her blood count ruling out anemia secondary to chronic monthly blood loss. Women should also prepare their families for her extended one to three-week recovery time necessary after surgery. While she may feel able to perform daily duties after only several days it is important that women follow the recommendations of their physician and surgeon to avoid any complications from over extending themselves after surgery.
Resources:
WomentoWomen: Hysterectomy and Alternatives
http://www.womentowomen.com/hysterectomyandalternatives/vaginalandpartialhysterectomyoptions.aspx
National Womens Health Network: Fibroids “new” options Not enough Answers
http://nwhn.org/fibroids-%E2%80%9Cnew%E2%80%9D-options-not-enough-answers
BJOG: Uterine Artery Embolization or Hysterectomy for the treatment of symptomatic uterine Fibroids and Cost -utility analysis of the HOPEFUL study
http://www.ncbi.nlm.nih.gov/pubmed/17949377
John C. Lincoln Health Network: Treating Uterine Fibroids
http://www.jcl.com/medical-services/uterine-fibroid-treatment/hysterectomy-versus-fibroid-embolization
University of California San Francisco: Fibroids Treatment
http://www.ucsfhealth.org/conditions/fibroids/treatment.html
University of North Carolina School of Medicine: Computer and Robotic Enhanced Surgery Center
https://www.med.unc.edu/cares/gynecologic-surgery/uterine-fibroids-treatment
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