Doctors disagree about the best treatments for fibroids.
Surgical options fall into two buckets: surgery to remove fibroids, a myomectomy; or surgery to remove the entire uterus, a hysterectomy. Several years ago, when Phillips was on Medicaid, her’ attempts to get a hysterectomy were denied. She was told that her symptoms would end when she reached menopause.
Traditional fibroid surgery—called an abdominal, or open, myomectomy—requires an incision roughly 8 inches long, a three- to four-day hospital stay and an at-home recovery of six to eight weeks. The fibroids are removed intact, as is the uterus during a traditional hysterectomy.
Laparoscopic myomectomies and hysterectomies feature incisions roughly the size of a quarter, hospital stays of mere hours, and recovery time of a month or less, allowing women to return quickly to their families and jobs and often preserve their fertility. These procedures also lead to fewer complications and deaths than either type of open abdominal surgery.
“I believe treatment needs to be individualized,” Stewart said. Women need to assess where they are in their reproductive lifespan. “Most women get some shrinkage [of their fibroids] at menopause,” she said.
If waiting isn’t an option, treatment choices include medications such as birth control pills, surgery to remove just the fibroids or hysterectomy.
Ablation, a technique that destroys the lining of the uterus, and embolization, which cuts off blood flow to the fibroid to make it shrink, are also options. Focused ultrasound, which uses ultrasound waves to destroy the fibroids, is yet another treatment.
According to Parker, “ultrasound is the least invasive approach, but it has the least amount of data.” It was approved by the U.S. Food and Drug Administration in 2004.
Information on the long-term safety of focused ultrasound, including pregnancy after the ultrasound treatment, is still being collected, Stewart said.