Hysterectomy alternative: An innovative treatment for uterine fibroids
May 9, 2019
Up to 80 percent of women have uterine fibroids, and a third might suffer from problems associated with them. Until recently, doctors could offer only a few options: medication, myomectomy to remove the fibroids, uterine fibroid embolization to starve the growths, MRI-guided focused ultrasound, or hysterectomy to remove the entire uterus.
Options were limited, too, to help ease symptoms such as abdominal pain, bulky discomfort, bleeding, and iron-deficiency anemia.
But today, UT Southwestern is among only a handful of medical centers in the region to offer radiofrequency ablation, a new minimally invasive surgical treatment for uterine fibroids. This advanced technology uses heat to shrink uterine fibroids.
Radiofrequency ablation is an attractive, outpatient treatment option for women who:
- Want to keep their uterus
- Cannot or would prefer not to take off four weeks from work, exercise, and usual activities to recover from myomectomy or hysterectomy
How radiofrequency ablation works
Radiofrequency ablation is a minimally invasive, laparoscopic-guided procedure. Our surgeons use a specialized tool called a laparoscopic ultrasound to visualize the inside of the uterus and map out the locations of fibroids during the procedure.
Then, through laparoscopic or “keyhole” insertion points (tiny incisions less than 1 cm) in the patient’s abdomen, we individually heat the fibroids with targeted energy, sparing the healthy uterine tissue around each growth.
The fibroids will begin to shrink right away and continue to decrease in size over the next few months. Fibroid tissue breaks down and will be resorbed in the body – patients will not have to deal with passing bulky, bloody tissue. The surrounding tissue is unaffected; only the fibroid is treated. The majority of patients recover fully within a week or two – no hospital stay is required. Most women return to work and regular activities three to five days after their procedure.
“Radiofrequency ablation is a ‘volume-reduction’ procedure. The goal is to reduce the volume of fibroids by 40 to 50 percent. To provide some perspective, a healthy uterus is about the size of a fist. A uterus with many fibroids, or a single large fibroid, can stretch to the size of a full-term pregnancy.”
Symptom relief after the procedure
Radiofrequency ablation is a “volume-reduction” procedure. The goal is to shrink fibroids by 40 to 50 percent. To provide some perspective, a healthy uterus is about the size of a fist. A uterus with large fibroids can stretch to the size of a full-term pregnancy. Reducing the volume of fibroids allows the uterus to return to a more normal size, providing relief from bulk symptoms, as well as reduction in menstrual bleeding.
I have a patient whose fibroids had grown to the size of a seven-month pregnancy. She did not want her uterus removed and did not have the time to take off to recover from a myomectomy.
The patient opted for radiofrequency ablation, which shrunk her fibroids by about 50 percent over three months. While her uterus is still larger than average, her symptoms and quality of life improved. Most importantly to the patient, she got to keep her uterus.
A few considerations
While uterine fibroid radiofrequency ablation can help some women avoid hysterectomy, the treatment is not yet approved for fertility preservation by the U.S. Food and Drug Administration. And not all insurance companies will cover the costs of the procedure.
Healthy, full-term pregnancies after the procedure have been reported, though more data is needed. Researchers are continuing to collect data to provide a more thorough assessment of how the treatment affects fertility. In fact, UT Southwestern researchers are involved in a study to follow these long-term outcomes.
Most women with uterine fibroids can safely have radiofrequency ablation. Women who cannot undergo laparoscopy for other health reasons might be ineligible. These patients can consult with any of the radiofrequency ablation experts on our team to find an effective treatment: Patrick M. Weix, M.D., Ph.D.; or myself.
Fibroids are the driving factor behind many hysterectomies – and too often, women feel as if a hysterectomy is their only option. However, we know that there are various options that may align with the individual goals and values each woman has, and radiofrequency ablation is a treatment option that can help women overcome uterine fibroid symptoms on their own terms.