Every day, our gynecologists hear similar comments from patients: I thought my heavy periods were just normal. I’ve heard this bulky/bloating feeling is just part of being a woman.
Both concerns are common symptoms of uterine fibroids, noncancerous tissue growths on the uterus. July is Uterine Fibroid Awareness Month, so it’s a perfect time to remind women that just because a symptom occurs daily doesn’t mean it’s “normal.”
Approximately 70% of Caucasian women and 80% of African American women have uterine fibroids. These growths can be as small as your thumb or as large as a basketball.
In about a third of patients, uterine fibroids cause a range of symptoms that interfere with daily life, such as:
- Heavy periods that might include clots
- Iron-deficiency anemia from years of heavy periods
- Low-back pain
- Pelvic pain and a bulky feeling in the abdomen
- Reproductive issues, such as difficulty conceiving
- Frequent urination
Historically, the go-to uterine fibroid treatment was hysterectomy. According to the Fibroid Foundation, 300,000 women a year have hysterectomies due to uterine fibroids. However, this solution might be too permanent for many who still might want to become pregnant or simply don’t want to undergo major surgery or lose their uterus.
Today, women can consider a range of options, from non-invasive therapies to minimally invasive surgery, to manage uterine fibroids. If you have fibroid symptoms, consider discussing the following options with your gynecologist.
Historically, the go-to uterine fibroid treatment was hysterectomy. Today, women can consider a range of options, from non-invasive therapies to minimally invasive surgery, to manage uterine fibroids.
5 treatment options for uterine fibroids
In this two-part procedure, the surgeon uses one of three approaches to remove fibroids based on their size and location:
- Hysteroscopic: This minimally invasive procedure can remove small fibroids that are totally contained inside the cavity of the uterus. The surgeon reaches the uterus through the vagina and cervix and uses a tiny camera and mechanical or energized devices to remove the growths.
- Laparoscopic: This approach can remove small and large fibroids growing in the wall or along the outside surface of the uterus. Through a few small incisions, the surgeon accesses the uterus through the abdomen and removes the fibroids. Sometimes, surgeons will use robotic assistance to perform this procedure.
- Traditional open surgery: A surgeon might use this procedure in the presence of very large fibroids or other conditions. The surgeon makes a larger incision in the abdomen to reach the uterus, removes the fibroids, then surgically closes the uterus and abdomen.
Depending on the approach, recovery ranges from one to six weeks. Patients who have hysteroscopic or laparoscopic procedures tend to recover more quickly due to smaller incisions.
2. Radiofrequency ablation
This advanced procedure combines ultrasound mapping of the fibroids with a laparoscopic device that applies specific amounts of heat to the individual fibroids to shrink fibroid tissue. Once we locate each growth, the surgeon makes small incisions in the patient’s abdomen and uses tiny instruments to individually heat each fibroid with targeted energy, while sparing healthy surrounding tissue.
Fibroids will begin to shrink right away; the goal is to reduce their volume by up to 50% over a few months. Recovery typically takes one to two weeks. Gynecologic surgeons at UT Southwestern now offer the Acessa procedure, which is approved by the U.S. Food and Drug Administration and typically only requires day surgery (outpatient) and a short recovery.
3. Uterine fibroid embolization
Another minimally invasive procedure, uterine fibroid embolization essentially starves fibroids of blood so they shrink over time. An interventional radiologist inserts a thin, flexible tube called a catheter into a patient’s artery and guides it to the uterus. Then, tiny particles are passed through the catheter to the blood vessels in the uterus.
The particles wedge into the blood vessels, blocking blood flow to the fibroids so they can no longer thrive. Over a few months, the growths should shrink by 40% to 60%.
This more permanent procedure removes the uterus and, in some cases, the fallopian tubes and ovaries. For uterine fibroid treatment, we typically recommend hysterectomy only for women who do not want to become pregnant in the future. Our surgeons can perform three types of minimally invasive hysterectomy – through the vagina, laparoscopic, or robot-assisted approaches – as well as traditional open hysterectomy when appropriate.
5. Medical management
Some women can manage their uterine fibroid symptoms with prescription medications or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Women with iron-deficiency anemia from heavy periods also might benefit from iron supplements. A gynecologist can recommend medications based on specific symptoms. If symptoms are not well controlled with NSAIDs, we frequently offer hormonal medications, such as birth control pills or other hormonal treatments that can help with symptom management Additionally, for patients whose main issue is bleeding, an oral medication called Lysteda (tranexamic acid) can be taken during menses to reduce menstrual blood loss.
You don’t have to live with fibroids and heavy bleeding
Many patients come to us after struggling with symptoms for years – and sometimes decades. We as women tend to put our own health behind our careers, caring for our families, and other responsibilities.
Ladies, please remember: Your health is important, and you deserve to live free of pain and heavy bleeding. When your symptoms improve, you’ll be able to do more for those who depend on you and enjoy a better quality of life.
Diagnosing uterine fibroids is generally quick and simple. Your gynecologist can help you find out what’s going on in your uterus and recommend a personalized care plan to help you feel like yourself again.
Modern Treatments in Gynecology
Dr. Kimberly Kho presented “Accelerating Recovery: Modern Treatments in Gynecology” at the 2018 Carolyn P. Horchow Women's Health Symposium, UT Southwestern Medical Center’s signature health care educational program for women.