Can Major Fibroid Surgery Be Avoided?

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.

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 . This will be the subject of the future installments of this discussion where we will pursue the fascinating world of medical/drug therapies.