All patients with heavy and painful menstrual bleeding can be helped with minimally-invasive options. It is not, however, one-size-fits-all. You must carefully review the options available and, along with your physician, figure out which treatment option is best for you. Below are some of the treatment options available.
Endometrial ablation reduces the number of cells that line the endometrial cavity. This leaves behind less tissue that needs to slough off each month, and thus, less bleeding with menses. Ablation does not remove or slow down the growth of fibroids, but by burning the endometrial cells around the fibroid bleeding may be controlled. A number of modalities are available for endometrial ablation, including Novasure (as seen in the picture below) which uses a fan-like instrument with electric current to burn the lining and Thermachoice which uses a flexible balloon to fill the cavity with heated fluid. There are specific advantages to each of these modalities. The modality recommended to you may depend on your particular problem as well as your physician’s experience / preference.
Advantages: No incisions; Minimal post-operative pain; immediate return to normal activities; Can be done in the office with minimal anesthesia
Disadvantages: Pregnancy is not recommended after endometrial ablation; Fibroids may continue to grow and symptoms may return
Some fibroids can be removed with no incisions by inserting a special instrument called a resectoscope into the endometrial cavity through the cervix (accessed through the vagina). Various kinds of resectoscope tools (like the special loop you see in the picture to the left) can be used to resect and / or vaporize the fibroids if they can be accessed this way.
Advantages: No incisions; Minimal post-operative pain; Immediate return to normal activities; Preservation of fertility in most cases
Disadvantages: Can only treat fibroids that bulge directly into endometrial cavity; May require more than one operative procedure to remove entire fibroid; Fibroids may recur
For patients who desire to preserve their fertility removal of the fibroids (myomectomy) may be the best surgical option. Most myomectomies cna be done laparoscopically, often with assistance of the da Vinci Surgical System.
In rare cases a myomectomy can not be safely performed laparoscopically and a laparotomy (traditional skin incision) must be performed. When a laparotomy is performed recovery is significantly increased. Recovery from laparoscopic myomectomy takes 7-14 days versus traditional myomectomy with laparotomy which requires about 6-8 weeks for recovery.
Advantages: Preservation of fertility in most cases; fibroids are completely removed
Disadvantages: Fibroids can recur. In rare cases, abnormal bleeding continues following myomectomy.
For some women hysterectomy may in fact be the best option. Most hysterectomies can be done in a minially-invasive way using standard laparoscopy or the da Vinci Surgical System. With this type of hysterectomy patients may still be back home the same day or next day after surgery. Recovery typically takes 7-10 days for resumption of most normal activities. Terminology of hysterectomy can be confusing. Here is an explanation of some of the terms. Make sure you understand them and ask your physician to go over these options with you carefully before moving forward with any surgery.
Total Hysterectomy: The entire uterus, including the cervix is removed. The cervix is the lowest portion of the uterus. It is the part that hangs into the vagina. The cervix is what your gynecologist is inspecting and screening for cancer during your yearly pap test. Removal of your cervix may mean that you no longer have to have a pap test, depending on your personal medical history (ask your physician). The term “total hysterectomy” does not imply that the ovaries are being removed.
Supracervical (partial) hysterectomy: In a partial hysterectomy most of the uterus is removed, but the cervix is left in place. Some doctors think that leaving the cervix behind helps preserve some of the pelvic support, however, this has not been proven to be true. Some women feel that the cervix is somewhat involved in their sexual function, lubrication and orgasm. This has not been shown to be true in scientific studies. In fact, numerous studies, including both total and partial hysterectomy, have shown that sexual function is typically better after hysterectomy than before.
Hysterectomy with BSO (Bilateral Salpingoophorectomy): BSO is the term used by physicians to describe removal of the ovaries and tubes. Regardless of whether you have a total or partial hysterectomy the choice is still yours regarding removal of the ovaries. Whether or not removal of your ovaries is right for you will depend on the reason for your surgery and whether or not you are yet in menopause. It is important for you to speak with your physician to weigh the pros and cons of BSO carefully.