Menstrual Disorder Treatment: Surgical Techniques
There are some innovative surgical techniques now being considered for fibroid-related bleeding. While these treatments may be effective, only small numbers of women have undergone these procedures and there have been no long-term follow-up studies. Some procedures include the following:
- Myolysis: this involves delivering electric current via needles to a fibroid at the time of laparoscopy
- Cryomyolysis: involves using a freezing probe in a similar manner to myolysis
- Uterine artery embolization (UAE) is a radiological alternative to surgery that involves placing a catheter into an artery in the leg and guiding the catheter via x-rays to the arteries of the uterus. Once the catheter gets there, it is used to deliver agents that block off the blood vessels that supply the fibroids. With the blood supply blocked, the fibroids should rapidly diminish in size. This procedure is relatively new and long-term data is still lacking in terms of complications, future need for hysterectomy and recurrence of fibroids. The recovery time from UAE can be weeks, and the long-term effect of leaving dead tissue behind is still unknown.
Some women with fibroids opt for medical treatment as the first stage before surgery, or as a way to delay surgery for women who are close to menopause, when fibroids shrink naturally. The most common treatment is called GnRH agonists (gonadotropin-releasing hormone), which is a class of hormones that have been shown to help temporarily shrink fibroids by blocking estrogen production that stimulates their growth. Lupron, Synarel, Supprelin and Zoladex are drugs often recommended to treat endometriosis and may also be suggested as a strategy for pre-treatment of fibroids prior to surgery.
GnRH agonists used to be considered a short-term treatment because side effects include menopausal symptoms triggered by estrogen deprivation, such as hot flashes, vaginal dryness, and significant bone loss. Typically, low doses of estrogen and progestin are prescribed with GnRH agonists to lengthen the therapy in a safe manner and tolerable manner.