Uterine Fibroids Treatment: Q&A with Dr. Suzanne LeBlang

July 11, 2017
Ultrasound Women's Health
From the July 2017 issue of HealthCare Business News magazine

MR: How do fibroids affect a woman’s fertility?
SL: We all know that the endometrium is the central cavity where a baby grows. If that is curved at all due to a fibroid pushing on it or growing within it, a woman’s ability to conceive can be impacted. An embryo needs a nice, smooth place to implant and fibroids can affect that. Intramural fibroids, for example, may have a negative impact on implantation and clinical pregnancy rates possibly through altered uterine muscle contractility.

MR: What are the most common treatments for fibroids, and what are the pros/cons of each?
SL: It’s important for women to have a choice, and know all the pros and cons of each treatment, so they can decide together with their gynecologist which one is best suited for them. As a physician, I tend to look at everything through a risk-benefit ratio.

For older women who are mildly symptomatic, one option is to take medications. Medications such as Lupron can reduce the size of the fibroid. However, one side effect of these medications is that they put the patient in a “temporary menopause,” so they stop getting their period. This is a short-term solution, as patients can only take it for six months. While patients are taking the drug, the fibroids will shrink or disappear, but as soon as they come off, the fibroids will come back. Lupron is a good option to reduce a fibroid size prior to surgery or other treatment. It’s the shortest treatment, and the least invasive.

The most commonly performed treatment is also the most invasive: total hysterectomy. With a hysterectomy, the uterus is completely removed and fibroids have no chance of growing back. However, patients should know that it’s a major operation, whether done open or laparoscopically. In most cases, since the uterus has been removed, and in some cases, also the ovaries, this may result in early menopause including symptoms like moodiness, changes in sexual feelings or desire, vaginal dryness, trouble sleeping and so on. With surgery, there are also the risks associated with anesthesia, bleeding, infections and adhesions. In addition, many patients are fearful that removing the uterus will make them lose that sense of what makes them feminine. Not to mention, once the uterus is removed, there is no chance of having children. So, a woman who is not yet family complete would have some apprehension on this course of treatment.

Another procedure called uterine artery embolization is minimally invasive. A catheter is inserted to deliver small particles to block the blood vessels supplying blood to the fibroids. This is a good option for women with multiple fibroids. However, it’s typically quite painful. Cutting off the blood supply to the fibroids causes pain and contractions, and the recuperation period is between two to six weeks. Aside from this, it’s possible that when supply is cut off to fibroids, it can also cut off supply to ovaries, causing permanent menopause. Further, it could decrease blood supply to the uterus, which could affect the ability to carry pregnancy to term.

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