It’s not uncommon for women in their 20s to 40s to seek treatment for heavy periods and pelvic pain from conditions such as endometriosis or fibroids. However, when women in that age range are considering becoming pregnant, many will avoid seeking treatment for fear that surgery could result in infertility.
Fibroids are smooth muscle tumors (usually noncancerous) that grow in the uterus from the muscle layers of the womb. Endometriosis, meanwhile, is when tissue around the uterus grows abnormally, which can create cysts on the ovaries, irritate surrounding tissue, or cause a scar that binds reproductive organs. Both of these conditions can cause heavy periods, pelvic pain, and difficulty getting pregnant, and traditional treatments (such as hysterectomy) can cause infertility. However, women can find advanced, fertility-sparing treatment options at UT Southwestern.
We use advanced imaging and diagnostic techniques and have the experience to know precisely what tissue to remove – if any should be removed at all.
"Women have a variety of fertility-preserving treatment options for endometriosis and uterine fibroids. We use advanced imaging and diagnostic techniques and have the experience to know precisely what tissue to remove – if any should be removed at all."
Diagnosing and treating fibroids and endometriosis
Women typically are diagnosed with fibroids after a discussion with a doctor about their symptoms and a physical examination that includes a pelvic ultrasound or magnetic resonance imaging (MRI), both of which create detailed images that show the number of fibroids a woman has and their locations.
Treatment options depend on the size and location of the fibroids. Some women with small fibroids will not need surgery and can manage their symptoms with medication. Women with large or multiple fibroids might require surgery. If a woman does not want to get pregnant in the future, we can remove the uterus through a hysterectomy or starve the fibroids through uterine fibroid embolization.
Women who want to get pregnant in the future can opt for myomectomy, an effective, minimally invasive surgery to remove fibroids using three to four small incisions. We do not remove the uterus, and fertility is preserved. Patients usually go home the same day of a myomectomy procedure.
Like fibroids, endometriosis generally is suspected through a discussion of symptoms with a doctor followed by a pelvic exam, pelvic ultrasound, and occasionally an MRI to gather detailed information about the location and size of endometriosis in the pelvis. The only true way to know if you have endometriosis is to have a surgery to visualize the lesions, otherwise it is simply an assumption.
Treating endometriosis might start with medication such as ibuprofen or naproxen (Aleve) and hormone therapy such as birth control pills. If these first-line treatments are ineffective, women who want to become pregnant in the future can opt for minimally invasive surgery called laparoscopy. The surgeon can precisely remove endometriosis tissue through small incisions in the abdomen without affecting the uterus and ovaries. Most women can go home the same day and return to work within three to seven days.
For severe cases, some women will elect to have a hysterectomy, a more invasive surgery in which we remove the endometriosis tissue and the uterus.
The heavy periods and pelvic pain that women with fibroids and endometriosis have can take a toll on their everyday lives. If you are concerned about future fertility when it comes to your condition or potential treatment, or if a doctor has told you the only treatment option is radical surgery, make an appointment to talk to a reproductive endocrinologist or Ob/Gyn. Fertility-sparing treatment options are available to effectively manage your condition and provide hope for future pregnancies.