Conservative approaches to fibroid treatment for women who wish to have children are a common concern we see in our patients. A question we are asked often is how do women with fibroids have successful pregnancies? Myomas, or uterine fibroids are the most commonly encountered uterine tumors. The word “tumor” insights fear but it really means a mass or growth of cells. Fibroids have many characteristics and fibroids can grow at different rates. Ones that grow rapidly or have altered characteristics on imaging studies need to be attended to in a timely manner. However, what about the slow growing smaller fibroids?
Most active therapies include surgery – can be as an open procedure (laparatomy), laparoscopic (cameras through the bellybutton) or hysteroscopic (cervical entrance to the uterus). The size, location and goals of the patient influence the surgical approach. Hysterectomy is a more radical approach in that the uterus and the fibroids are removed as one. Obviously, for women interested in child-bearing, this path is not an option.
With emphasis on maintaining fertility, a conservative approach is most often rendered. The current standard of care is to remove and partially-remove those fibroids impinging upon the uterine cavity. Data demonstrates that fibroids influencing the cavity reduce chances of pregnancy.
Surgery may not always be the answer. There exists progesterone hormone modulators. These medications (ulipristal acetate) when taken daily can show considerable reduction in large fibroid size. The course of treatment may be 3 months up to 6 months. It is necessary to have 2 menstrual cycles after ending the treatment to restore the endometrial environment back to a receptive state. At this time, a woman can attempt to become pregnant or use ART (assisted reproductive technologies). In the cases where the fibroid size does not regress, then surgical removal is the answer. Such medical therapy can reduce the need for surgery by 40% .
It is imperative to have options for women who have interfering or symptomatic fibroids but who wish more conservative approaches to fibroid treatment, particularly in those who wish to maintain fertility options. If you have questions on how we can help, please contact us!