FIBROID SURGERY

When Should Uterine Fibroids Be Treated?

Uterine fibroids (leiomyomas) are non-cancerous growths that form in the muscular wall of the uterus. Many fibroids remain small and cause no noticeable problems, requiring only routine observation. Treatment may be recommended when fibroid symptoms begin affecting your health, comfort, or daily activities.

Common reasons women seek clinical care for fibroids include:

• Abnormal Menstrual Bleeding: Heavy periods, bleeding that lasts more than a week, or passing blood clots.
• Iron-Deficiency Anemia: Fatigue, lightheadedness, and low energy caused by ongoing menstrual blood loss.
• Pelvic Pressure and Discomfort: Persistent fullness in the lower abdomen, pelvic aching, or pain during intercourse.
• Bladder or Bowel Changes: Increased urinary frequency, urgency, constipation, or difficulty having a complete bowel movement due to mass effect.
• Fertility Concerns: Challenges with conceiving or carrying a pregnancy to term.

When fibroid symptoms become disruptive, it may be time to discuss treatment options with a healthcare provider to explore both surgical and non-surgical paths.

Types of Fibroid Surgery: Myomectomy, Hysterectomy, and Ablation

Surgical management for uterine fibroids varies widely depending on whether you want to preserve your uterus, your overall health, and the anatomical characteristics of your tumors.

1. Myomectomy (Surgical Fibroid Removal)

A myomectomy is the surgical excision of individual fibroids while keeping the uterus intact. Depending on fibroid size and location, a surgeon may use one of several techniques:

• Abdominal Myomectomy (Open): A large incision is made across the lower abdomen. It is generally reserved for very large or numerous fibroids and requires general anesthesia, a hospital stay of several days, and 6 to 8 weeks of recovery.
• Laparoscopic or Robotic Myomectomy: The surgeon uses several smaller abdominal incisions to insert a camera and instruments. This option generally requires general anesthesia and involves 2 to 4 weeks of recovery.
• Hysteroscopic Myomectomy: Performed through the vagina and cervix without external skin incisions. It is used specifically for submucosal fibroids that project into the uterine cavity, but it cannot treat fibroids situated within the muscular wall or on the outer surface of the uterus.

2. Hysterectomy (Complete Uterine Removal)

A hysterectomy is an operation that completely removes the uterus. It can be performed through an open abdominal incision, laparoscopically, robotically, or through the vagina. While it provides permanent relief from fibroids and associated bleeding, it permanently ends the ability to become pregnant. Recovery varies depending on whether hysterectomy is performed abdominally, laparoscopically, robotically, or vaginally.

3. Radiofrequency Ablation

Radiofrequency ablation delivers targeted thermal energy into individual fibroid tumors to destroy their tissue. Techniques can be performed laparoscopically or transcervically under image guidance. While less invasive than an open operation, these procedures treat individual fibroids targeted by the physician and may not be recommended for all fibroid locations or patients planning pregnancy.

What Are the Risks and Complications of Fibroid Surgery?

As with any major operative procedure, fibroid surgery involves surgical recovery, anesthesia management, and potential postoperative complications:

• Intraoperative Blood Loss: Uterine fibroids have a rich vascular network. Cutting through the uterine muscle during a myomectomy can lead to notable bleeding, which occasionally necessitates blood transfusions.
• Pelvic Adhesions: Incisions made into the uterus or abdominal wall can form internal fibrous bands (adhesions). These adhesions may attach to neighboring organs, potentially contributing to chronic pelvic discomfort or future fertility challenges.
• Potential Need for Additional Treatment: Myomectomy removes existing fibroids while preserving the uterus. Because the uterus remains in place, new fibroids can develop over time, and some patients may eventually require additional treatment.
• Anatomical and Pelvic Floor Changes: Removing the uterus during a hysterectomy alters the structural support of the pelvis, which may increase the long-term likelihood of pelvic floor issues such as prolapse or urinary changes.
• Anesthesia and Recovery Risks: Procedures requiring general anesthesia carry common risks such as nausea, throat soreness, respiratory issues, and temporary cognitive fog, along with general surgical risks including infection and deep vein thrombosis.

Comparison: Non-Surgical UFE vs. Fibroid Surgeries

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Why Non-Surgical UFE Is a Proven Alternative

Uterine Fibroid Embolization provides an image-guided solution that addresses fibroids without surgical excision. Performed by an interventional radiologist, UFE manages fibroid tumors by working directly through the arterial system and can treat many fibroids at the same time.

During the procedure:

1. The doctor numbs a tiny access point in the wrist (radial artery) or groin (femoral artery) and administers sedation to help keep you comfortable.
2. Under real-time fluoroscopic guidance (X-ray imaging), a slender catheter is navigated into the uterine arteries feeding the fibroids.
3. Small embolic particles are released to reduce blood flow to the targeted fibroid vessels.
4. Without their primary blood supply, the treated fibroids gradually shrink and soften over time, while surrounding healthy uterine tissue remains supported by collateral circulation.

“Some patients report feeling better already at their two-week post-op visit. But most shrinking and symptom relief occurs 3 to 6 months after UFE. Sometimes big fibroids continue to shrink for 9 to 12 months.”

Is UFE Painful? Recovery and Aftercare Expectations

UFE is commonly performed using local anesthesia and sedation to help keep patients comfortable during the procedure. Cramping and pelvic discomfort can occur afterward as blood flow to the fibroids decreases, particularly during the early recovery period.

The Outpatient Recovery Process

Following the procedure, you are monitored in a recovery suite for a few hours before being discharged home the same day. Because sedation is used, you will need someone to provide transportation.

• First 24 to 48 Hours: Menstrual-like cramping is expected as the fibroids lose their blood supply. This is manageable with prescribed pain medications and rest.
• First Week: Cramping subsides and energy returns. Plan on taking time to rest and avoid strenuous physical effort.
• Return to Routine: Most patients return to work and light daily activities within 7 to 10 days.
• General Guidelines: Normal showering can resume quickly, but tub baths and heavy lifting should be avoided for two weeks or until approved by your care team.

UFE vs. Fibroid Surgery When Future Pregnancy Is a Goal

Pregnancy is possible after UFE, and successful pregnancies and live births have been documented following treatment. However, fertility outcomes vary from person to person based on factors such as age, reproductive health, medical history, and the size, number, and location of the fibroids.

Who May Be a Candidate for UFE vs. Fibroid Surgery?

Determining the most suitable approach depends on your individual symptoms, imaging results, and personal preferences regarding uterine preservation and recovery time. Candidacy is an important part of the efficacy.

UFE is often considered when:

• Fibroids cause heavy periods, pain, pressure, or related anemia.
• You prefer to keep your uterus and avoid major surgical incisions.
• You have multiple fibroids throughout the uterine wall.
• You want a shorter recovery window before returning to regular responsibilities.
• Medical conditions make general anesthesia or open surgery higher risk.

Surgery may be recommended when:

• There is suspicion of pelvic malignancy or cancer.
• A fibroid has a very narrow stalk (pedunculated) that could lead to torsion.
• An active, untreated pelvic infection is present.