Uterine Fibroids: Surgical Options and Treatment Insights

Multiple uterine fibroids

Hello, I live in Japan.
I recently underwent an examination and found that I have a uterine fibroid measuring 6.4 cm, with others close to 5 cm, and there are three in total.
Symptoms such as lower back pain, abdominal pain, and constipation have made me feel overwhelmed.
My doctor recommended surgical treatment, and since I do not plan to have children, a hysterectomy was suggested.
However, I would like to understand why a traditional open surgery (laparotomy) is necessary, which is why I declined that surgical approach.
I will be referred for further treatment next Tuesday, and I would like to inquire if my condition truly cannot be treated with laparoscopic surgery.
Thank you for your time and assistance.

maki, 40~49 year old female. Ask Date: 2015/07/19

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, for the treatment of uterine fibroids through hysterectomy, there are two methods: traditional open surgery (laparotomy) and laparoscopic surgery.
These two approaches complement each other, and neither is absolutely better than the other; the choice depends on the specific situation.
Therefore, it is important to have a thorough discussion with your physician before making a decision.
Wishing you good health.

Reply Date: 2015/07/19

More Info

Uterine fibroids, also known as leiomyomas, are benign tumors that develop in the muscular wall of the uterus. They can vary in size, number, and location, and while many women with fibroids experience no symptoms, others may suffer from significant discomfort and complications, such as abdominal pain, heavy menstrual bleeding, and pressure symptoms affecting the bladder and bowel, as you have described.

In your case, with fibroids measuring up to 6.4 cm and associated symptoms like back pain, abdominal pain, and constipation, surgical intervention may indeed be warranted. The traditional surgical approach for fibroids is a hysterectomy, which involves the removal of the uterus. This is often recommended for women who do not wish to preserve their fertility and have significant symptoms that are not manageable through other means.

However, there are several minimally invasive options available for treating uterine fibroids that you may want to consider, especially since you have expressed a desire to avoid traditional open surgery (laparotomy). Here are some of the most common minimally invasive techniques:
1. Laparoscopic Myomectomy: This procedure involves the removal of fibroids through small incisions in the abdomen using a laparoscope. It is less invasive than a traditional hysterectomy and allows for a quicker recovery time. If your fibroids are accessible and your surgeon is skilled in laparoscopic techniques, this could be a viable option.

2. Hysteroscopic Myomectomy: If the fibroids are located within the uterine cavity (submucosal fibroids), they can be removed using a hysteroscope, which is inserted through the vagina and cervix. This method is also minimally invasive and preserves the uterus.

3. Uterine Artery Embolization (UAE): This is a non-surgical procedure that involves blocking the blood supply to the fibroids, causing them to shrink. It is performed by an interventional radiologist and can significantly reduce symptoms. However, it may not be suitable for all patients, especially those who may want to conceive in the future.

4. MRI-guided Focused Ultrasound Surgery (FUS): This is a newer, non-invasive technique that uses ultrasound waves to heat and destroy fibroid tissue. It is performed under MRI guidance and is suitable for certain types of fibroids.

5. Medications: While not a surgical option, medications such as GnRH agonists can help shrink fibroids and manage symptoms temporarily. However, they are not a long-term solution and can have side effects.

It's essential to have a thorough discussion with your healthcare provider about your specific situation, including the size and location of your fibroids, your symptoms, and your preferences regarding fertility. They can help you weigh the benefits and risks of each option and determine the most appropriate treatment plan for you.

In conclusion, while a traditional hysterectomy is a common recommendation for symptomatic fibroids, there are several minimally invasive alternatives that may be suitable for your case. It’s crucial to consult with a gynecologist who specializes in fibroid treatment to explore all available options and make an informed decision that aligns with your health needs and personal preferences.

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