Gynecologic surgery options for women are better than ever

Over time those fibroids grew, some into the size of a cantaloupe.

Maria Johnson was tired all the time. “I just didn’t have any energy,” said the 44-year-old insurance recovery specialist. “I discovered that I had uterine fibroids about 15 years ago. On the advice of my doctors we kept tabs on them through regular ultrasounds.” Over time those fibroids grew, some into the size of a cantaloupe. “I was experiencing heavy cramping and bleeding, plus I was just so tired,” Johnson said. “It was time to do something.”

Fibroids are benign (noncancerous) tumors of the uterus that usually do not cause symptoms. However, depending on the number, size and location, they can cause complications such as those experienced by Johnson.

Johnson’s primary care physician and her gynecologist suggested a hysterectomy as the best option to her uterine fibroid problem, but she was opposed. “I am a breast cancer survivor. I went through a radical mastectomy, and I just didn’t want to go through another major procedure,” she said. That is when a friend told her about uterine fibroid embolization (UFE).

UFE is a minimally invasive, nonsurgical option for treating fibroids. It involves inserting a small tube, called a catheter, into the artery near the crease between the thigh and pelvis, and threading it into the blood vessels supplying the fibroids. Then, small pellets about the size of a grain of sand are injected into these vessels. The pellets plug up the blood supply to the fibroids, causing them to shrink. This leads to relief of the most common symptoms – heavy bleeding and pelvic pain – in the vast majority of patients.

Clifton Tatum, M.D., interventional radiology, was the first physician in the area to offer UFE. “Women now are more aware of treatment options,” Dr. Tatum said. “Uterine fibroid embolization is a less invasive alternative to major surgery.”

Following the one- to two hour procedure, most patients experience a short recovery time and few complications. “With most cases there is complete relief from symptoms within weeks to a few months,” Dr. Tatum said. However, patients should know that UFE is not for everyone.

When considering whether to move forward with any elective gynecologic surgery, the desire for future fertility should be first and foremost in the patient’s mind, said Jonathan Reinstine, M.D., obstetrics/ gynecology. “UFE is usually not recommended for patients who desire future pregnancy, but in some instances it may be the only hope they have. In fact, there have been many women who have gone on to have successful full-term pregnancies following UFE,” he said. Also, most UFE procedures are performed in patients beyond childbearing age, according to Dr. Reinstine.

Myomectomy, a procedure in which the uterine fibroids are surgically removed, is still a widely practiced option for patients interested in maintaining the best chance for fertility. Additionally, oral medications can have a positive effect in helping prevent fibroid growth; however, further studies are needed to properly evaluate their effectiveness.

For patients who do not consider future fertility a matter of importance, laparoscopic hysterectomy is a viable corrective option for problems caused by fibroids or other gynecologic problems.

Hysterectomy is considered the only proven permanent solution to the growth of uterine fibroids. Traditional hysterectomy typically results in a long recovery time and sometimes leads to postoperative complications due to the large incision needed to remove the uterus. Laparoscopic hysterectomy, however, has revolutionized the procedure, allowing surgeons to remove the uterus through a 5 to 10 mm port or through the vaginal canal. This approach lessens the postoperative effects. “What we are endeavoring to do is reduce the impact on the patient,” Dr. Reinstine said. “Laparoscopic hysterectomy does just that.”

The best news is that doctors continue to break ground on a variety of treatment options for women living with uterine fibroids and a variety of other gynecologic issues.

For Johnson, the success of this pioneering treatment could not be more evident. “I feel so much better,” Johnson said. “I have my energy back.”


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