Can Fibroid Surgery Be Avoided?

Surgeons holding surgical equipment at the operating table and working
One of my favorite professors in medical school was fond of saying “There is nothing so constant in medicine as variation.” From my perspective, more than 25 years in clinical medicine, there is nothing so constant in medicine as change. At times the rate at which this change goes on is quite amazing. This can especially be said for the treatment of uterine fibroids over the last 100 years.

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The most dramatic change in fibroid treatment occurred as a consequence of the evolution of surgical techniques. Historically surgery was a very dangerous undertaking from which many did not survive. Now surgery is commonplace and easy at least for the surgeon. In fact, it has become so easy that it has leant itself to excess use.

The term ‘elective surgery’ which did not exist prior to the 20th century is now used to describe the majority of gynecologic surgery. In essence, this term refers to the fact that a procedure is not being performed to save a person’s life. Certainly this is justifiable when the quality of life is being improved or future foreseeable threats can be made avoidable. But when major surgery is performed in the absence of either symptoms or foreseeable future threat to well-being justification is wanting.

Hysterectomy for fibroids has become so common that it has become synonymous with fibroids in the minds of some. No matter how easy and safe major surgery has become, to be cut open has never been a life’s goal any sane individual. Thus, at the same time that surgery was becoming more commonplace, methods to minimalize or avoid it have evolved. Thus we have seen laparoscopy used increasingly to eliminate the need for large incisions in major surgery to reduce complications and shorten recuperation time.


Hysteroscopic procedures have been introduced to replace major surgery in some instances. This is especially true where bleeding associated with fibroid tumors requires treatment. Resection of submucous fibroids from the inside of the uterine cavity and destruction of the lining of the uterus, endometrial ablation, are examples of such hysteroscopic treatments.

Blockage of the uterine arteries has been noted to cause fibroid tumors to die and the heavy bleeding associated with them to cease. This approach has become popularized as uterine artery embolization (UAE) aka uterine fibroid embolization (UFE). It has also become apparent that any method by which these arteries are blocked temporarily or permanently will have the same result. As a consequence, a new method that will be done by gynecologists on an outpatient basis is under investigation.

Thus, the answer is yes that major surgery can be avoided in the treatment of uterine fibroids. Even more exciting is the fact that there are other options available and becoming available in the near future.


Visit the Fibroids center for more articles.

ADHD For Kids: 6 Steps In Managing Their Money

black girl holding 500 hundred euro bills

Little african girl holding 500 hundred euro bills

Many parents report that money is a good motivator for their children with ADHD. It is important, then, to emphasize financial responsibility and to help your child learn money management skills.

How ADHD Undermines Money Management

Most of what we know about the interaction between ADHD and money comes from mistakes that adults with ADHD have made, because no research has been done on the way in which children with ADHD understand money. ADHD interferes with money management in a variety of ways, including:

• Difficulty planning a budget and sticking to it
• Disorganized records Impulsive spending
• Difficulty planning for savings
• Difficulty tracking account balances Losing checks or bills
• Procrastinating on bills or taxes
• Forgetting when bills are due

Sound familiar? For children with ADHD, the same challenges they face with remembering to do and turn in homework can become the challenges they face later with money management.

Children With ADHD Value Money

By the time children are 7 or 8, whether they have ADHD or not, they have a pretty good understanding of what money can do for them, says Gregor Kohls, MA, an ADHD researcher at the Center for Autism Research at the Children’s Hospital of Philadelphia. Kohls and his colleagues have studied the use of money as a way to help children with ADHD learn appropriate behaviors. In his research, he found that parents of children with ADHD frequently rely on money as a reward.

Teaching Money Management

But as with all children, parents must teach money management to children with ADHD. Here are some tips and ideas:

Set a good example. “The concept of money is learned especially through parents,” observes Kohls. Your child is learning about the value of money from how you manage your own money, so try to share with him, in age-appropriate ways, how you make your spending and saving decisions.

Give an allowance. A lot of parents give money when a child asks instead of using an allowance. “What this sets up is a situation where the child learns that whenever I want something then I should have it right now,” explains ADHD specialist David W. Kidder, PhD, a psychologist in private practice in Slidell, La. However, learning to delay immediate gratification is an important part of growing up — so set up a weekly allowance with a clear understanding of what activities or items that money is for. Then hang tough while your child learns to wait until next week before he can get what he wants.

Allow earning money through chores. Children should have chores they are expected to do as household members, but allowing them to earn money through additional chores is fine, says Kidder. “That teaches them that if you work for something then you get a reward for it,” he adds.

Do not pay for grades. Earning money by doing extra yard work is fine, but tying money to grades can actually reduce a child’s pleasure in his achievements. “It’s been shown that children will actually decrease the internal motivation to make good grades and base it solely on the external motivation of money,” says Kidder.

Set up a structure for their money. Children with ADHD benefit from structured environments in all aspects of their lives. This is equally true where money is concerned. In addition to stating what their money is to be spent on, you can also teach them to set aside a portion for savings — or develop any other similar structured plan that suits your values.

Help your child plan ahead. Kohls notes that the problems children with ADHD have with planning also extends to money. “There are theories that propose that children with ADHD seek immediate rewards, and have problems [waiting for] a bigger reward at a later period of time,” he says.

Learning money management is just that — a learning process. Children with ADHD face more challenges along the way than their peers, but with your help they can achieve good results.